Province's 'hotspotting' program to cut number of ER superusers

Saskatchewan's provincial budget includes $4million this year, to triage emergency room wait lists andcoolso-called "hot spots".

Officials with the Ministry of Health estimate one per cent of hospital patients use at least 20 per cent of health services. One hospital has identified aSaskatchewan man who visits theemergency room at least every second day.

Tracking those patients and identifying the root cause of their problems has ledto significant savings in health care spending in other provinces and states.

"If you don't have a house, you might end up going to emergency rooms to deal with mental health problems, or to warm up," said Dr. Cory Neudorf, of the Saskatoon Health Region."Some of these patients cost the system $100,000 a year."

Who are the superusers?

Neudorfsaid repeat visitors to emergency rooms tend to fall into one of three groups:

• Frail elderly patients who suffer from multiple chronic diseases. Often admitted fromlong term care homes or the community, they tend to require long hospital stays until doctors can sort out their medical needs.
• Patients suffering from severe mental health issues, including addictions. Often their housing is unstable, precarious, or non-existent.
• Patients needing end-of-life hospice or palliative care, who present themselves at emergency room.

Solving the problem

To clear the backlog in Regina and Saskatoon, budget documents call for $800,000 to provide house calls to seniors with complex needs. There's $1.5 million to find and help patients who are repeatedly hospitalized. Another $1.7 million is allocated for cutting emergency wait times.

ERsare overcrowded because these patients are unable to move up into the admitted beds that they need,- Gerry Schreimer, MD Ambulance

"These patients are often spending multiple hospital visits and long stays in hospital just because there are no other services in the community," Neudorf said.

At MD Ambulance, chief operating officerGerry Schreimer said from the time a call comes in, his paramedic crews spend an average of 70 to 80 minutes with eachpatient. But it can take much longer.

"We've had times where we're with a patient in the hallway for seven and a half hours, because the ERs are overcrowded because these patients are unable to move up into the admitted beds that they need," said Schreimer.

'Almost an epidemic'

Schreimercalledthe move to stop chronic emergency room visitorsa step in the right direction.

"It's almost an epidemic issue," he said. "If a patient or family calls for EMS, we're obliged to take them to the hospital whether we think it's an issue that requires hospital care or not."

Neudorfsaid emergency rooms are expensive, and designed for acute health problems, not patients with chronic complaints.

"You can often deal with the underlying problems more cheaply than not dealing with the emergency room visits," he said. "The issue is you need some money to get things kickstarted."

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