Hospital details bed management after shortfall crisis
An organisation that speaks up for patients has slammed hospital chiefs, claiming that they failed to foresee staff and bed shortages at the island’s only hospital.
The Bermuda Healthcare Advocacy Group also condemned senior managers of the Bermuda Hospitals Board for earning “oversized” salaries while overseeing a decline in healthcare.
Scott Pearman, the chief executive of the BHB, responded with details on the hospital’s efforts to redress shortages — and details on how the hospital assesses when a patient is ready to be sent home.
The BHAG spoke out in response to reports last week that patients were being treated in the corridors of King Edward VII Memorial Hospital because of a lack of beds on wards.
A second report revealed that cancer patients could not be given chemotherapy treatments at KEMH because of a lack of staff — and were asked instead to get treatment overseas.
In a statement, the BHAG said: “The problem of bed shortages has been an ongoing issue for many years and gets worse as time goes on.
“Who is actually in charge of beds?”
The group queried whether the assessment procedure for discharges was being “mismanaged”.
Addressing the issue of salaries for senior BHB staff, the statement said: “The upper management salaries need a serious review to determine if they are actually qualified for their positions.
“Are they working for these oversized salaries or just heavily reliant on overseas consultants to advise them of their job functions — a duplication of services to the public purse?”
Hospitals around the world are dealing with the same issues and the same problems of overcrowded emergency departments and long waits for inpatient beds, the Bermuda Hospitals Board chief executive acknowledged.
Scott Pearman responded to queries from patient advocates, telling The Royal Gazette: “The problem is also getting worse every year with an increasingly old and unwell population.
“We have two daily multidisciplinary team meetings focusing on bed flow that include nurses, doctors, support areas such as imaging services and lab, as well as environmental services and others. We approach the issue as a team every day.”
Physicians who consult with a patient, their family and their care team make the call for when a person is ready to leave.
Mr Pearman added: “Our social workers try to bridge the gap between transitioning a patient from acute care to either home or to a nursing home and, yes, there are home assessments that may take place for some patients.”
He said patients with delayed discharges “frequently still have complex and highly individual issues to address”.
A “bed flow task force” also meets to examine “what needs to change at BHB to address the issues we are seeing”.
Mr Pearman said the decision to double up patients per room in acute care had come from the task force in response to “the recent crisis”.
He added that there had been “incredible focus” on strengthening communication between GPs and the hospital, including improving the use of the BHB’s electronic medical records system.
The Royal Gazette has requested up-to-date details of salaries of senior BHB officials. Although that information has yet to be provided by the BHB, a 2020 report by the Gazette showed that the top five executives earned a combined $2 million.
BHB said its 2021 annual report where salaries are listed was complete and “now with the ministry”, awaiting release.
The BHB has completed clean audits for fiscal years 2022 and 2023, with the reports to be completed in “the next couple of months”.
The board also said it had benefited since 2018 from a clinical affiliation with Johns Hopkins Medicine International, notably in stroke care — adding that Johns Hopkins was working with the hospital to improve its “trauma and burns care pathways”.
The BHAG statement claimed that basics in healthcare were being “overlooked”, and that there were obvious solutions to pressing problems.
It said: “The old nurses’ quarters, now demolished, used now for staff parking area would be a fantastic area to build a simple purpose-built facility that would provide a step-down care facility and not kicking everyone out if they are felt to be there too long.
“So many Bermudians are having to leave home for overseas shores to find the medical care they need.
“Over the years our group has had many people contact us with their staggering stories. Insurance companies dictate as to whether one is sent overseas or left here to die.
“Our thoughts have always been that if a medical procedure is not available on island for whatever reason, the insurers should pick up the overseas costs as though the patient had treatment here, in full.
“There have always been many viable options to BHB where we find our only hospital is on the brink. We need to hold those accountable whose responsibility it lies with.”
Mr Pearman said the BHB was “just starting out on a strategic planning process, something we do every five years”, and would welcome meeting with the group.
However, he said, “basic numbers” showed that the hospital had adequate numbers of acute care beds.
Mr Pearman added: “We have about 40 medically fit-for-discharge patients, but even at our peak last week we had 34 people waiting for beds.”
He said acute care represented the most expensive level of care, and could not give patients unable to leave the appropriate quality of life.
“They are more likely to become deconditioned as they don’t get up and move around as much, are more likely to pick up an infection, and there is also a mental deterioration without hobbies, activities, events and trips,” he said.
“This is not the best life for our seniors and vulnerable patients.”
Mr Pearman said BHB officials were encouraged by Throne Speech references to the Government looking into offering “more nursing home placements and support for people who need adjustments at home or care in the community”.
“Part of the issue that caused the escalation to an Alert Level 3 last week is that throughout March there were only three days we discharged more people than we admitted.
“Discharge is where the critical point is and so strengthened community support systems brings new hope for these patients.”
Mr Pearman said the BHB’s options for transitional patient placements had been reduced by the October 2014 impact of Hurricane Gonzalo, which left the old continuing care unit “so badly damaged that it had to be demolished”.
“Up until then, the plan was that we could develop the evacuated units in the General Wing into rehab and step-down units, enabling us to focus acute care beds on acute care patients.
“Losing CCU essentially meant the General Wing units had to house our long-term care patients instead and doesn't give us the space to do much more.”
Mr Pearman acknowledged the need for purpose-built facilities and said there was space on the KEMH site.
“Back in 2008, we worked with Johns Hopkins Medicine International to come up with a site plan that identified how the site could be developed,” he said.
“The long-term plan was to build the ACW, then use the rest of the site to build additional wings.”
However, he said, the “critical issue” was not one of building new space or renovating existing facilities.
Mr Pearman said that outside the acute care wing, buildings at KEMH and the Mid-Atlantic Wellness Institute were ageing and in need of replacement or redevelopment.
He added: “The issue now is how it could be financed or provided by the private sector.”
Last Thursday, Kim Wilson, the Minister of Health, said that she was confident that the BHB board would reckon with its staffing and space issues.
She said: “The recent challenges at our hospital have highlighted the pressing issue of bed shortages and the impact this has on our acute care wards.
“The Government is committed to ensuring that our hospital resources are readily available for those in need of acute care, which includes transitioning patients who no longer require acute care to suitable alternative care settings.
“Streamlining the transition of medically fit patients to alternative care settings is essential to relieve pressure on hospital resources and enhance access to care.”
• To read the Bermuda Hospitals Board response in full, see Related Media
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