Exploring reasons for bed pressures in Winnipeg acute care hospitals

Use of Hospitals by Older versus Younger Canadians: Myths and Misconceptions

ABSTRACTThis study investigated concerns regarding the extensive use of hospitals by older people and subsequent long wait lists. We analysed complete individual-anonymous, 2014-2015 inpatient hospital data for all Canadian provinces and territories (except Quebec). People aged 65 and older accounted for 37.0 per cent of all hospital episodes and 41.5 per cent of all admissions to intensive or coronary care units. Similarly, of all admitted individuals, 32.8 per cent were older. The data also revealed only 14.3 per cent of older Canadians living outside of Quebec were admitted to hospital one or more times that year. This study indicates that issues other than hospital use by older people should be addressed in Canada for improved hospital accessibility. Improved care of older persons is also indicated, as their higher risk of hospital admission, longer hospital stays, and dying in hospital could be from a lack of age-informed hospital and community services.

A Comparison of Methods for Forecasting Emergency Department Visits for Respiratory Illness Using Telehealth Ontario Calls

Objectives: Anticipating increases in hospital emergency department (ED) visits for respiratory illness could help time interventions such as opening flu clinics to reduce surges in ED visits. Five different methods for estimating ED visits for respiratory illness from Telehealth Ontario calls are compared, including two non-linear modeling methods. Daily visit estimates up to 14 days in advance were made at the health unit level for all 36 Ontario health units.

Methods: Telehealth calls from June 1, 2004 to March 14, 2006 were included. Estimates generated by regression, Exponentially Weighted Moving Average (EWMA), Numerical Methods for Subspace State Space Identification (N4SID), Fast Orthogonal Search (FOS), and Parallel Cascade Identification (PCI) were compared to the actual number of ED visits for respiratory illness identified from the National Ambulatory Care Reporting System (NACRS) database. Model predictor variables included Telehealth Ontario calls and upcoming holidays/weekends. Models were fit using the first 304 days of data and prediction accuracy was measured over the remaining 348 days.

Results: Forecast accuracy was significantly better (p<0.0001) for the 12 Ontario health units with a population over 400,000 (75% of the Ontario population) than for smaller health units. Compared to regression, FOS produced better estimates (p=0.03) while there was no significant improvement for PCI-based estimates. FOS, PCI, EWMA and N4SID performed worse than regression over the remaining smaller health units.

Conclusion: Telehealth can be used to estimate ED visits for respiratory illness at the health unit level. Non-linear modeling methods produced better estimates than regression in larger health units.

Anticipating Change: How Many Acute Care Hospital Beds Will Manitoba Regions Need in 2020?

Being able to anticipate future needs for health services presents a challenge for health planners. Using existing population projections, two models are presented to estimate the demand for hospital beds in regions of Manitoba in 2020. The first, a current-use projection model, simply projects the average use for a recent three-year period into the future. The second, a 10-year trend analysis, uses Poisson regression to project future demand. The current-use projection suggests a substantial increase in the demand for hospital beds, while the trend analysis projects a decline. The last projections are consistent with ongoing increases in rates of day surgeries and declines in lengths of stay. The current-use projections need to be considered in the context of relatively low occupancy rates in rural hospitals and previous research on appropriateness of stays in acute care hospitals. If measures are taken to ensure more appropriate use of acute care hospital beds in the future, then the current-use projections of bed shortages are not a cause for concern.