LAKELAND - Hospital acute care bed closures are not uncommon, in fact, they happen every year.
“The current bed closures that we have are primarily in the North Zone. These are our most challenging sites to staff. Historically, they’re the sites most subject to disruption. It happens every year, especially in the summer, to a greater or lesser extent,” explained Alberta Health Services (AHS) Vice-President and Chief Operating Officer Deb Gordon.
She explained during a meeting with the media on July 23 that bed closures happen all of the time, even in other parts of the country.
“Temporary bed closures are not uncommon for AHS, or for any other health system across Canada. The system is very dynamic and we manage beds on an hourly basis based on patient need, based on staffing levels, based on acuity of patients, and many other factors,” detailed Gordon. “Temporary bed closures and openings are happening every year to adjust to staffing and patient need, and we have seen it happen many times over the past 16 months of the pandemic as AHS opened additional acute care and intensive care unit (ICU) spaces to ensure we had the ability to care for patients with COVID-19 and other illnesses.”
Currently, 98.5 per cent of all AHS provincial acute care beds are open. Eighty-nine of the 125 currently closed are within the AHS North Zone. The remaining 36 are in the central area.
In June, both St. Paul and Elk Point were forced to reduce the number of acute care beds in their facilities. At the St. Therese-St. Paul Healthcare Centre, 10 of their 30 beds closed while five of the Elk Point Healthcare Centre's 12 beds were unavailable.
Originally, AHS was predicting the closure in Elk Point to last until Aug. 1, but announced in early July they were ready ahead of schedule.
Even though Elk Point opened up all of their beds earlier this month, Gordon said the community's emergency services department is continuing to face shortages.
“As of July 22, there are just two sites where patients are being diverted from emergency departments and those are on certain days and on certain times,” Gordon explained. “Those sites are Elk Point and Fort Vermilion. We really don’t like to see this happen, but to reiterate, it happens every year, especially in the summer, when staffing physicians need to take time off.”
Gordon noted that even when AHS does decide to close beds, it "has a limited impact on a patient or a community, because even with the closure, supply exceeds demand."
She explained how in most cases, there are still beds available to accept patients, and while there may be less of them, it's in order to provide healthcare staff the certainty about the number of patients that will be under their care at any given period of time. This, Gordon said, allows AHS to reduce the pressure on their staff.
According to Gordon, when there is a bed closure at one of their facilities, they keep their sites operating as normal "to ensure all patients continue to receive safe and high-quality care when they need it, even if that requires getting their care in a neighbouring community."
“Changes to services are not new. It’s common, especially in the summer when staffing levels are historically a little bit lower as our healthcare workers take well deserved personal time or vacation,” she stressed.
This year, however, is not a typical one. Hot off the heels of a pandemic, AHS is facing a new challenge.
The impact the COVID-19 pandemic had on physicians and staff is something the provincial healthcare system has never seen before, Gordon said.
"We had more individuals employed to-date than ever before, but people are tired. Many of them have been doing far more than their usual hours over the past 16 months. They need and deserve a break," Gordon added. “They’re less able to work extra shifts than they would have been a year ago."
She continued, "This is not an AHS or even an Alberta problem. It’s across the country. We’re all struggling with similar issues – our workforce has been through a very tough 16 months of pandemic response."
Although acute bed closures have been described by Gordon as common, shutting down beds in emergency departments is not.
“Bed closures in emergency departments are infrequent, but they do happen from time-to-time," detailed Gordon.
If it happens every year, why weren't they prepared
Dr. Verna Yiu, AHS President and CEO explained how even though bed closures are common, this is the first time they have been faced with a pandemic.
“I think one of the things is that, obviously none of us have been through a pandemic, so this is a new experience for everyone. I would say it has been a really rough 16-plus months. Everyone is very tired, nobody has had much vacation," she said.
“One of the things that is really different this year is the pandemic. We’re coming out of a significant pandemic response... and so, we have done a lot of things to try and put ourselves in a position of having available staff. We are moving 760 or so registered nurses back from positions they’ve been working in during the pandemic to the jobs they normally do in the health system. That will help us balance out the staffing," she noted. “We’re also very fortunate to have hired 1,000 registered nurses during the pandemic response, and as some of those nurses are no longer going to have their pandemic assignment, we are having our human resources team work closely with each one of them to see if there is another place in the system where they would like to take up work."
Gordon stressed that any closures are temporary.
Vacancies are also nothing new, Gordon said, and AHS continues to focus on filling open positions throughout their system.
“The COVID-19 pandemic has had an impact on staffing because of the need for redeployment," she noted, adding what that means is staff are having to do work they wouldn't normally do.
“COVID has also increased the workload for frontline healthcare providers, with most frontline staff working many long and very hard hours throughout the pandemic. Our staff are currently a little less available to take extra shifts voluntarily. This can also lead to a temporary reduction in staffing levels,” Gordon continued.
With that in mind, AHS increased the number of regular, temporary, and casual nursing positions they have from 30,000 to 36,000.
"We are seeing a higher number of temporary vacancies. But that’s expected and is actually positive. As we move to demobilize our COVID-19 workforce, it’s these temporary work positions that are being vacated and left vacant, and that’s so people can return to their original positions or conclude their time with AHS,” explained Gordon. “Around 760 registered nurses who were in temporary COVID positions will be returning to their regular positions. This will help balance out staffing levels once that process is complete."
According to Gordon, over the last year, AHS has filled over 1,000 vacancies for registered nurses.
“There are approximately 1,700 more RNs working in AHS today than there were in 2019,” she expressed. “Some of these nurses joined AHS on a temporary basis only, and we’re directly working with these nurses to see if they would be interested in opportunities at AHS in other areas as their pandemic assignment concludes."
Some healthcare staff have been expressing how the shortages are impacting patients' overall care, to which Yiu said, “At the end of the day, if you need the care, you will get the care."
Gordon noted, “These are extraordinary times coming out of a pandemic... No one should feel nervous or hesitant about seeking care in the system. The system is safe and open for patients."