As health care changes, Canadian hospitals under pressure

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This is part of The Globe's three-month series on the challenges facing Canadian hospitals. Follow @Globe_Health on Twitter and share your hospital experiences with #thehospital

Friday, Oct. 25 was an ordinary morning for Robert (Bob) Mutrie, 80, a retired architect – until he noticed that his wife, Jean, was sleeping later than usual. When he went to wake her up, he realized something was drastically wrong. She had opened her eyes, but she couldn't speak or move. Like many Canadians in a desperate situation, Mr. Mutrie called 911.

Not long after the ambulance delivered Mrs. Mutrie to the emergency department of Toronto's Sunnybrook Health Sciences Centre, doctors gave her husband the bad news: His wife was dying from a massive bleed in the brain. Within less time than it takes some people to commute to work every day, she had gone from an acute to a palliative care patient.

Mrs. Mutrie no longer had the option of dying at home in her own bed; still, the hospital wanted to make her death as peaceful as possible. They put her in a quiet corner of the hectic unit while the nurses who run Sunnybrook's patient-flow unit – the air-traffic control centre of the hospital – scrambled to find her a room so she could spend her final hours in privacy, comforted by her family, in a hospital that regularly runs at more than 100-per-cent occupancy.

Even in the midst of his grief, Bob Mutrie was able to reflect on that larger picture, "This goes on day after day after day," he observed quietly.

Close to 60,000 patients arrive every year in the emergency department, the entry point for the myriad services offered by Sunnybrook. They are stroke or accident victims, cancer patients, expectant mothers in premature labour, elderly patients coping with a complex series of illnesses, and otherwise healthy people contorted in agony from kidney stones, earaches, slipped discs and appendicitis.

Sunnybrook's size, location, intensity and diversity make it a fascinating petri dish for an investigation into hospital efficiencies and innovative techniques. But for ordinary people like the Mutries, Sunnybrook is also an encounter with the pulsing heart of the health-care system. Many of them arrive scared, confused and in pain. Every obstacle they encounter – parking, food, hospital-based infections, wait times, overcrowding, post-operative treatments, cancelled appointments, road blocks in navigating the system and frustrations in finding affordable home care – plague other hospitals across the country.

That's why The Globe is collaborating with Sunnybrook in an intensive three-month investigation to identify and find solutions to the gnarly problems affecting all of us. We are shadowing doctors, observing nurses and talking with patients and their families to come up with answers to critical questions.

"Most Canadians know how frustrating a hospital experience can be – from lineups at the ER to bafflegab from staff. We want to explore ways to change that," says John Stackhouse, editor-in-chief of The Globe and Mail.

In the words of Dr. Barry McLellan, CEO of Sunnybrook, "We thought this project would be a great way to share ideas about what the system is doing well and an opportunity to stimulate dialogue from those who work in the field and those who rely on it for care, to find out how we can make it better."

Founded as the country's largest veterans' centre after the Second World War, Sunnybrook now sees more than a million patients a year, of which about 30,000 are admitted. Its occupancy numbers are higher than comparable hospitals in Toronto because of the volume of trauma, stroke and burn patients who are sent there. But it's similar to many large urban hospitals across the country in our $200-billion-a-year health-care system.

And so are its challenges. Hospitals were designed as acute treatment centres, but as the population ages, many are turning into ultra-expensive chronic-care facilities. Not only are more Canadians older, life expectancy is soaring. Far too often they are being admitted over and over to hospital in what is called "bounce back" because they don't have adequate home care or support to juggle their myriad medications and chronic health issues.

These are only some of the issues hospitals face – and the demands will only multiply if they try to continue to treat chronic illnesses in complex-care facilities while struggling to be efficient and cost-effective. They can't do it all and they can't do it in isolation. We must identify the problems and find solutions now.

Your input

We aren't embarking on this ambitious project alone. We want your help – and to hear about health care in your community: What works, what doesn't, and what you think we should do about it. Share your experiences – and ideas for change. Follow @Globe_Health and tweet with #thehospital to join the conversation.

As a start, tell us what you see as the biggest problems in hospital care.