Delay is not your friend

In an emergency, delay is not your friend Replacing both of Windsor Regional Hospital's acute care Metropolitan and Ouellette Campuses  with an urban Urgent Care Centre will put lives at risk It is misleading -- and potentially life-threatening -- to suggest an urban Urgent Care Centre (UCC) is an acceptable replacement for the existing emergency department (ED) in downtown Windsor. Yet, the elimination of both of Windsor's current acute care hospital campuses is what Windsor Regional Hospital (WRH) planners want us to accept as a "done deal," no questions asked.  How is it possible that the location of a new single site acute care hospital -- far from the region's most densely populated neighbourhoods -- is irrelevant from a medical point of view? According to WRH's official Twitter account, apparently the site of a hospital has no impact at all!

Thankfully, the Ministry of Health has been asking the truly relevant questions. Below is an extract from the Stage 1a and b planning documents. Windsor Regional Hospital's responses, in blue, were redacted for reasons that we'll probably never know.

It's critical to inform patients with potentially life-threatening conditions The distinction between an ED and a UCC is so important that the 2009 HayGroup report we wrote about last week recommends conducting a public information campaign to educate patients about where to go for appropriate treatment. Inadvertently going to the wrong place will cost lives.

Excerpt from HayGroup report to Erie St. Clair LHIN, 2009

Yet in Windsor-Essex, the single site hospital proponents use misleading language (like calling the UCC - - a satellite ED) to blur the critical distinctions between these two types of facilities! Knowing when Urgent Care is the right treatment A UCC is not intended for emergencies. This is what patients are advised to do, on the Hamilton Health Sciences website:

When lives are at risk, delay is definitely not a friend For patients with potentially serious conditions, minutes matter. It's critical to know where to go for the right treatment. But how do you know? Do I have indigestion or am I having a heart attack? Is it a simple broken bone or a more serious compound fracture? If you don't have a car, or you don't have money for a taxi or an ambulance, an inaccessible hospital poses a life and limb threatening risk. A UCC has no ICU or overnight beds This week Windsor Regional Hospital's CEO tweeted:

UCCs are typically staffed with ER physicians and nurses. But that's not the issue. Without an attached ICU or overnight beds, patients with life-threatening conditions will have to travel to the proposed acute care hospital location on County Road 42 for the treatment they need.

We also don't challenge the assertion that the vast majority of ED patients go home without being admitted as inpatients. Again, that's not the issue. How many patients are sent home with follow-up referrals?  The HayGroup report was concerned about where referrals might be located. They described "referral centres" that are "in the city, but not on the outskirts": Typically referral centres are located at or near acute care hospitals. Moving all hospital healthcare to Windsor's outskirts means the referral centres will no longer be located "in the city." How many additional trips will patients have to make in order to complete their treatment? What about those who DO need to be admitted to hospital?  There are inpatient transfers between Ouellette and Met Campuses today -- a distance that's just under 4 km. The distance  between the proposed UCC and the new hospital site is 15 km. The new hospital's proponents haven't provided the public with any data comparison of: How much of the transfer cost (time and money) will be offloaded to patients? What if you don't have a car or somebody to drive you? What is the financial impact to taxpayers for ambulance transfers? The planning documents submitted to the Ministry of Health contain some insights into these unanswered questions. 1.  Nearly one in three patients needs treatment at an acute care hospital The second largest group of total ED users have what is known as emergent conditions. Their triage level is classified as CTAS 2 on the 5-level scale used to prioritize the seriousness of patients' conditions. This patient group needs treatment in an acute care hospital.

2. More than one in three ED patients live in the densely populated and centrally-located neighbourhoods near Windsor's existing hospitals.  The table below shows where Windsor Regional Hospital's ED patients live: 71% are in the City of Windsor. (It appears many of Essex County's 181k residents seek emergency treatment at Erie Shores Healthcare in Leamington or Chatham-Kent Health Alliance in Chatham rather than travelling to Windsor.)

On average, 37% of total ED visits are by people living between East Walkerville and Olde Sandwich Towne (Windsor Wards 2, 3, 4 and 5) -- which includes the region's most densely populated neighbourhoods. All have excellent access to one (or both) of Windsor's two acute care hospital campuses today. The distance to the proposed acute care hospital site from each of these neighbourhoods ranges from 11 km to 18 km. Do the math: More than 13,000 patients a year who live in Windsor's central neighbourhoods need treatment at an ED (37% of 35,856 CTAS 2 patients). For them (and their families), the travel distance will exponentially increase.

Source: Stats Canada 2016 Census data

3. One in 6 patients visits the ED overnight We saw from the response to the Ministry's questions that the proposed UCC will close its doors to patients at 10 p.m.

Do the math: With 16.6% of ED visits being made overnight, 8,000 patients (37% of 21,733 annual visits) who live in Windsor's central neighbourhoods will be most negatively affected. They will be forced to travel to the proposed exurb hospital if they need treatment after the UCC closes its doors. Shifting the blame for an inadequate plan Instead of addressing the many flaws that seem to be preventing the hospital planning process from progressing more rapidly, Windsor Regional Hospital's CEO David Musyj prefers to insinuate that CAMPP's appeal has caused a delay. On July 30, 2019, he even suggested we drop our LPAT challenge. Why would he not want this important and transparent provincial oversight process to run its course?

On April 16, 2019, the LPAT Tribunal granted CAMPP an appeal "based on the breadth and nature of the likely issues." Since 2015, Mr. Musyj has insisted that Windsor-Essex residents accept the County Road 42 acute care hospital site as a "done deal." Yet, if implemented as proposed, the location will create unacceptable life-threatening delays for many thousands of people.

The ultimate delay: If we don't get the plan right, the region will be stuck with an inadequate single site acute care hospital location for generations to come. Locating our new regional hospital in a neighbourhood where exponentially more people already live will save lives. Why not build a UCC in a county municipality (or on Windsor's outskirts) where both population and population density are signficantly lower than in the heart of the city?

Stay Tuned Later this month: How are similar issues affecting another Canadian community grappling with the same problems?

In their own words: Weekly round-up of comments from our friends and neighbours

"I can’t speak for everyone but i still truly believe that dialogue and discussion is the only way to resolve our differences. If we could come to the table and find common ground we could probably develop a plan that satisfies all interests."

"Really concerned about lack of support from elected people that should be stepping  up."

"The  money spent on lawyers shows a lack of respect for taxpayers suffering from long term lack of  funding in this area. The  money is intended for health services, not to help a small group of people assert their will. "

"The evidence is so overwhelming it is baffling."

"There are many more concerns that I have in addition to the location. These concerns have been expressed a number of times, but David Musyj just wants to completely ignore them without so much as an understandable explanation on why he's ignoring them."

"Reading between the lines I'm wondering if the province is suggesting the current plan does not meet "the service needs of the region" or is not guided by "sound fiscal planning""

"We live in a democratic society where people, groups, and organizations are allowed to express their opinions and positions freely. No one should be afraid to advocate for their members best interest. There should be zero tolerance for bullying."

"Thank you Tim for saying it exactly as most of us feel. We have to remember that people usually act this way (bullying) when they feel they are being 'found out' (for lack of a better word), feel they have no other way to go, or their ego needs a boost and can get it no other way because we are not playing into their whims."     -- in reference to Tim Stewart's letter published in the Windsor Star on July 27, 2019: https://windsorstar.com/opinion/letters/reader-letter-mayor-should-not-bully-organizations-about-mega-hospital-site