End hallway medicine: ban hallways
There’s been a lot of talk about “hallway medicine” (i.e. patients receiving treatment in hospital hallways due to hospital overcrowding) in Ontario over the past couple of years. A recent report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine provided recommendations to the government on how to improve the current situation. The key findings from the report were as follows:
- Patients and families are having difficulty navigating the health care system and are waiting too long for care. This has a negative impact on their own health and on provider and caregiver well-being.
- The system is facing capacity pressures today, and it does not have the appropriate mix of services, beds, or digital tools to be ready for the projected increase in complex care needs and capacity pressures in the short and long-term.
Following the release of the report I saw a number of articles and heard several radio interviews, all of which featured emergency room doctors and occasionally nurses. Undoubtedly they have experience which can contribute the the discussion. However, I was frustrated by what I saw as the glaring absence of input from public health. I think that perhaps everyone thinks that the problem lies within the hospitals and therefore the solution can be found there too, even if it’s the suggestion from ER doctors that more home care supports are needed. However, while not an immediate solution to the problem, I think that we need to look further upstream for real long-term solutions. Adding more beds, increasing home care, and improving system navigation for patients are all important but they don’t address the reasons why so many people are ending up in the hospitals in the first place. If we can prevent the need for emergency care then we can reduce the number of people in need of hospital beds.
I was pleased to see that alPHa (Association of Local Public Health Agencies) submitted a response to the report to the government highlighting the important role of public health in improving healthcare and ending hallway medicine. I was also pleased to see OPHA (Ontario Public Health Association) submit a letter to the Minister of Finance advocating for health promotion and chronic disease prevention measures that would help to end hallway medicine. Has anyone seen anything about this in the news though? I haven’t heard any public health officials or representatives publicly advocating for the important role of public health in ending hallway medicine. Public health needs to do better at getting their messages to the public. If people don’t know about what public health does to prevent injuries and chronic disease, reduce infectious disease, and advocate for the social determinants of health then how can we expect them to support these initiatives or even to recognize how these things contribute to the demand for healthcare services?
In addition to the importance of public health in ending hallway medicine I’d like to see more effort to connect with those who are likely most in-the-know about patient concerns: reception staff. Yes, doctors, nurses, other allied health professionals, and patients can all contribute important insights but who speaks to everyone seeking care? Who hears the complaints and concerns that people may not feel comfortable voicing to doctors? Who is at the first point of interaction with the public? Reception staff. I’m sure that they could contribute a great deal of valuable information to the consultation on ending hallway medicine.
If the government truly wants to end hallway medicine they need to consider the reasons that people need healthcare and the impact that their cuts (and decisions) in other areas is going to have on the demand for hospital services. Hallway medicine is not happening in a vacuum. Cuts to social assistance, ending the basic income pilot, cutting support for cycling infrastructure, reducing funding to the Trillium fund, reducing oversight for meat processing facilities, cuts to mental health funding, ending minimum sick days and reducing employee protections, cancelling the planned raise for the minimum wage, increasing accessibility and affordability of alcohol, and on and on, are all going to result in an increased burden on the healthcare system and our hospital hallways are only going to become more crowded.
