Originally published in The Ottawa Citizen August 21, 2002
Original Title: Who Wants to Save a Million Dollars?

Despite the problems in our health-care system, there are some roses worth our attention. One such rose is the Riverside Acute Care Medical Centre. Unfortunately, if the Ottawa Hospital administration has its way, the rose will whither at the end of September this year.

The Health Restructuring Commission, in its final report, stated that the Ottawa Hospital provide both community-based and teaching-based hospital services. To that end the Riverside has done an admirable job as a community-based facility. In fact, the Riverside Hospital was rated outstanding during its accreditation process four years ago. It was the second most cost effective hospital in the province.

Servicing an older population as well as families from all over Ottawa, the Riverside Acute Care Medical Center (RACMC) not only provides acute care but virtually all of the emergency services that are found at Ottawa Civic (OCH) and General (OGH) and Queensway-Carleton (QCH) hospitals. The primary difference between the ACMC and an emergency room is that the Riverside does not accept ambulances; you have to be able to walk in. A tour of the Centre revealed a spacious, bright and well-organized emergency room.

There are four electronically monitored cardiac beds. The staff is prepared to treat heart attacks, irregular heart beats, respiratory distress and other life threatening conditions if they walk in. They will administer clot-busting drugs to treat heart attacks. For patients that do not require in-hospital cardiac admission, a cardiology clinic nearby will receive patients from the ER after the assessment.

The centre has nine decently-sized cubicles, a Gynecology room, Ear, Nose and Throat (ENT) assessment room, and an eye station for ocular emergencies. Two orthopedic surgeons provide follow-up for fractures seen at the ACMC. A large casting room houses all the equipment. Complex fractures or open fractures (bone protruding through the skin) that require immediate treatment are referred to the tertiary centres like the General or Civic.

There are two well-stocked and equipped suture rooms to handle most skin trauma.

The Centre has an Intravenous Room for patients requiring antibiotic treatment. Patients no longer remain in hospital for this simple procedure. They come in at designated times for about 30 to 60 minutes and then go about their daily business. Everyone supports this cost-effective alternative. Ten ER physicians provide medical services from 11 AM to 10 PM every day. The Centre used to open at 7 AM but the Ottawa Hospital administration cut the hours back last October because they felt it competed with the local family doctors; a non-issue since many of the doctors refer their patients to the Centre when on vacation or for further medical assessment and treatment.

Approximately 80 to 120 patients are seen daily or about 40,000 per year. Three physicians staff the ER every day. If patients come to the ACMC simply because they are unable to find a family doctor they are treated and are given a list of family doctors accepting new patients when they leave.

Patients come from all parts of Ottawa including Barrhaven, Kanata and Stittsville for simple reasons. They get first-class medical treatment within a reasonable time frame. Waiting times at the QCH are about four to five hours, the OCH, five hours and the OGH six to seven hours. The Riverside average wait is one to two hours. There is also ample parking in front of the Centre.

This is a win-win Centre for the ER system, staff and patients. Patients love the service, family doctors have a means to provide quick ER assessment for their patients and ER physicians and nurses have first-rate facilities. It also saves the system money because it is more expensive to evaluate patients in a tertiary centre.

The tertiary centres can focus on their mandate to handle the complex injuries and intensive care services. Indeed, the Riverside relieves the tertiary centres of the less complicated patient emergencies thereby relieving the pressure off these centres. They also stabilize the more critically ill patients prior to transferring them to the tertiary hospital.

The Ottawa Hospital administration plans to close the Riverside Acute Care Centre this September 28th. The administration wishes to cut costs to the global hospital budget. The projected saving is one million dollars per year. The provincial government has not been involved in this decision. Indeed this decision seems to contravene the Health Restructuring Commission’s recommendation to maintain community-based services.

The staff and patients are baffled by this decision. It is difficult to understand how money will be saved. All the nursing staff will be transferred to other departments within the Ottawa Hospital System. Their salaries will not change. The bricks and mortar of the ER will remain and will have to be maintained. The physicians will move on and see patients elsewhere for the same OHIP payments. Forty thousand patients per year will flood the remaining ERs increasing waiting times and straining service provision. It will cost more to treat them.

Patients stand to lose money from lost wages because of longer waiting times. Imagine waiting six to eight hours to have a simple wound sewn up.

The General plans to provide a fast-track triage and treatment centre for many of these patients. If this is the case, how much of that million dollar saving will be spent to re-invent the wheel? The Riverside already fulfills this fast-track concept.

This seems to be a monetary shell game by an administration under pressure to show it is cutting services to save money. The Riverside physicians looked into privatizing the Centre to keep it afloat but the OHIP remuneration for patient services, when overhead was deducted, was insufficient to attract enough physicians to maintain the service.

This is a situation where the funding of community emergency health-care services should be borne by the public system. I urge everyone to let the Ottawa Hospital administration know what they think about this decision. Everyone loses if it closes.

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© Dr. Barry Dworkin 2002