My View - Protecting hospital capacity with an ageing population

VIEW - Christopher Dawson, Spritely CEO

As our population ages the health system is coming under increasing pressure from a rise in people with chronic and complex conditions. We’re also seeing an increased number of surgeries for older people due to falls, and long-term joint deterioration. Demand for hospital beds (and even chairs) keeps increasing. This is impacting emergency departments very publicly.

We’ve heard about rising tensions in ED, we know that many ED departments are operating at (or over) capacity. ED staff are burnt out and patients are frustrated at wait times. Phrases like “ambulance ramping”, “bed block” and “patient flow” have entered common parlance.

Winter surge
We’re likely to see more articles related to hospital capacity (like this one) when the next winter surge arrives. This surge happens each year, as surely as the tide goes in and out each day, but the high watermark is relatively low when you consider our ageing demographic. By that I mean, winter surges will be much bigger in the future than they are now, because older people are (statistically) more likely to be hospitalised due to winter illness.

Pressure on Emergency Departments will increase
This research from Finland showed “there was a three-fold increase in ED visits made by patients 80 years or more compared to those under 80, and aging of the population will lead to a rapid increase in the number of ED visits.” The same study concluded it “unlikely that increasing ED resources is feasible.”

Managing the health of older people at home
Over the next 15 years, Statistics NZ predicts that the number of people aged 85+ will increase by around 100,000. If we accept that hospital and resthome beds will not keep pace, the only logical strategy is to get better at managing the health of older people at home.

Reducing average length of stay and readmission rates for older people
Some NZ hospitals have set up specialised supported discharge teams (SDTs) to help older people recover at home following discharge from hospital after surgery or an adverse event.

According to Parsons et al (2019), SDTs have an important role to play reducing length of stay and readmission rates. Parsons’ randomised controlled trial found that participants referred to the SDT had a shorter length of stay immediately prior to discharge when compared to usual care (mean 20.9 days vs 26.6 days), and in a 12-month period spent less time in hospital and had lower healthcare costs.

SDT services will inevitably come under pressure as aging demographic trends make their impact felt. Remember, even the oldest baby boomers are only approaching 80, so we’re just at the cusp of this large demographic bubble entering old age.

If SDTs can’t keep up with demand, it could negatively impact patient flow at a time when winter surges become much more intense.

SDTs can improve hospital capacity
This simple diagram attempts to illustrate some of the key actions that can impact hospital capacity and where SDTs can help.

Our population is growing and ageing at such a rate that it isn’t feasible to solve the capacity issue by adding more beds/staff. Reducing presentations/ admissions is also unlikely given these demographic pressures.

As more older people come to hospital and there are proportionately less beds to accommodate them, we need SDTs to alleviate pressure on hospital capacity by minimising length of stay and reducing readmission rates.

In my view, it’s important that hospitals find ways to improve the efficiency of SDTs so they can manage more patients in the future and still maintain service levels. This will help to protect hospital capacity and reduce health care costs in the face growing pressure from our ageing population.

How do you increase patient capacity for supported discharge teams?
Remote patient monitoring is one way to do it. This is being actively trialled at Hawkes Bay hospital where the supported discharge team has saved considerable time by using RPM technology to minimise travel time and enhance clinical oversight. They can now provide out-of-hospital rehabilitation for more patients, and the more patients they provide for, the more bed days they free up at the hospital.

In Australia, the cost of not providing out-of-hospital rehabilitation services for patients needing total knee replacement was estimated by the Australian Medical Association to be around $30 – $60 million and 47,000 to 94,000 bed days per year.

In New Zealand, hospital capacity remains a pressing issue. It can’t be solved by a single initiative, but it can be helped by “powering-up” supported discharge teams with RPM technology so they can increase patient flow.

Preferably before our next winter surge rolls in and we set a new high-water mark.

If you want to contact eHealthNews.nz regarding this View, please contact the editor Rebecca McBeth.

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