News

The ability to send CT images between hospitals, hiring more nurses, and an Ontario-wide on-call schedule for neurosurgeons are key measures required to help stem the tide of critically ill patients being sent to the United States.

The recommendations are part of an action plan developed by a government-appointed neurosurgery expert panel following a special, 90-minute meeting yesterday.

The meeting was called to address the large numbers of critically ill patients who have been whisked to U.S. hospitals for emergency neurosurgery.

At least 164 patients with broken necks, burst aneurysms and other types of bleeding in or outside of the brain have been sent to Michigan and New York State hospitals since April, 2006, according to Ontario Health Ministry figures.

British Columbia has sent four patients with spinal-cord injuries to Washington State hospitals for care from May to September, 2007, although the recruitment of more staff and the opening of new beds have helped alleviate the problem. Saskatchewan has sent patients to neighbouring provinces - such as Alberta, which is working at maximum capacity - for specialized neurosurgical services.

But nowhere is the problem as severe as it is in Ontario. In an 84-page report released last month, James Rutka, head of the province's neurosurgery expert panel, labelled the out-of-country transfers an "alarming trend."

Yesterday, Dr. Rutka, who is also chairman of the division of neurosurgery at the University of Toronto, sounded optimistic that a solution was in sight.

"I think we've got some traction now," Dr. Rutka said following the meeting. "Everyone feels that this is such a critical issue, which is the care of neurosurgical patients."

Critically ill patients have encountered barriers to accessing neurosurgery in Ontario at every turn. The problems include: limited access to teleradiology; limited operating-room time; too few intensive-care beds; a short supply of neurosurgically trained intensive-care nurses to staff them; and too few neurosurgeons.

More than two dozen people, many of them members of the neurosurgery expert panel, were in attendance at yesterday's meeting. Alan Hudson, head of Ontario's waiting-time strategy and the person who struck the panel, was also there.

Four suggestions made at the meeting, to be sent to government for its consideration, are:

A province-wide system where CT scans, MRIs, and other diagnostic images can be transferred electronically between hospitals. That way, neurosurgeons can assess these patients from afar. As Dr. Rutka, himself a pediatric neurosurgeon, noted yesterday: "Many patients who have left the province to go to the United States probably wouldn't have gone if that information were available up front."

Developing a province-wide neurosurgical on-call schedule so it is clear what neurosurgeons at the 13 Ontario hospitals that offer the service are on call for urgent patient referrals.

Determine how many more neurosurgical nurses are required. Without enough neurosurgical intensive-care unit nurses, patients can't be cared for in the numbers required.

Observe, over the next three months, how effective the additional $4.1-million in funding provided to Toronto's University Health Network has been in reducing the number of patients sent out of country. If proven effective, then funding to other centres - particularly the neurosurgical shortage hot spots of Windsor, London and Hamilton - would be critical.

So far, the funding "has worked to a degree but it hasn't solved the problem completely," Dr. Rutka said.

Before that extra infusion of government money, 12 to 15 emergency neurosurgery patients from Ontario were sent out of country each month. Since December, shortly after the money was provided, the numbers have dropped: three to eight Ontario patients have been sent to the United States monthly, he said.