Those who work in health care know that traditionally in January, our hospitals and emergency rooms get beyond busy.

In January 2015, the three hospitals in Saskatoon were at overcapacity for most of the month, coming off of a difficult fall where the system was stretched. January 2016 is predicted to be similar.

But this year we are in a much better position to prepare for that surge, and a significant peak in the immediate days following Christmas.

Saskatoon Health Region's predictive model is calling for a surge in demand after Christmas.

Saskatoon Health Region’s predictive model is calling for a surge in demand after Christmas.

One of the things that came from the Better Every Day 14 Day Challenge in 2015, and was improved during 90 Days of Innovation: Ready Every Day, was the predictive model. This model predicts admissions and discharges at the three Saskatoon hospitals, allowing managers to staff up or down, depending on what the model shows is ahead. This predictive model is now accurate to within 94 per cent, which is why when it started forecasting a high peak in January, the Region took notice.

In early November, while managing with our day to day capacity challenges and smaller predicted surges, operational and physician leaders started making plans to deal with the upcoming peak. In January, it’s forecast we will have up to 100 more patients needing admission than we have hospital beds, if we don’t take any actions.

“The predictive model is giving us an opportunity to proactively be prepared for the forecast peak,” said Jackie Mann, Vice-President of Integrated Health Services for Saskatoon Health Region. “We know we need to prepare our staff and facilities for this influx, so we can maintain safety, and better support our patients and our staff and physicians through this very busy time. We know that the great work that occurred this year to support increased community resources, such as the implementation of the paramedicine program, is helping to maintain people in their homes, rather than coming to emergency, however we are still anticipating the need for additional capacity.”

First, emergency departments are preparing for a post-Christmas rush, coming up with ways to flex their capacity up and down. This includes bringing in additional staff at regular time instead of overtime for those immediate days following Christmas and identifying physical spaces to care for the expected demand. Additional physician coverage is also in place.

Data also shows that length of stay in hospital increases with medicine patients over the Christmas season, not only in Saskatoon but in other healthcare centres. This means patients are not progressing toward going home as fast as they normally would at other times of the year. The Region is working on removing barriers that could slow the progress to home. Physicians will be minimizing handovers this year to keep care continuous during this time. They are also identifying barriers that prevent patient progress to discharge from moving forward during the Christmas season. These barriers are being looked at to see if the Region can minimize or remove them.

This work will not only support staff and physicians in delivering exceptional care to patients who have to be in hospital over Christmas, but it will support patients in returning home as soon as possible.   This will allow clinical units to bring in patients who are waiting in emergency for a hospital bed and that area’s specialized care, freeing up emergency rooms to receive the next patient who needs their services.

“By better preparing for the post-Christmas surge, this will help us better position ourselves to handle for our largest peak in demand for the year which hits that first week of January,” explains Mann.

Already, overcapacity beds at St. Paul’s Hospital and Royal University Hospital are being staffed into January, proactively, at regular time, as compared to past approach of relying on calling in staff on short notice or overtime. Overcapacity “pods” will be treated as regular care areas, and standards are being developed to guide which patients are placed there depending on the physical space, skill set of staff and physician coverage.

“There is a lot of work underway in many areas,” says Mann. “We are also looking at the demand we are able to control for our hospital beds. This includes booked procedures that aren’t urgent or emergent, but do require a hospital stay. By adjusting this controllable demand for our hospital beds, we can better handle the predicted uncontrollable demand. This would be for services such as emergencies surgeries due to falls, influenza complications and other illnesses that need immediate medical care and hospitalization.”

The Region is finalizing the Christmas plans and is working to implement a number of other actions in advance of January. This will include some alterations in surgical volumes which are expected to free up some bed capacity to help to handle the expected surge overall in emergency orthopedic patients and medicine patients.

“For the first time, we have a proven tool that accurately tells us what is coming and when so we can make solid operational plans,” says Mann. “We are taking an aggressive and proactive approach in our decisions. We are asking everyone to work together to get through these next number of weeks and ensure we can safely care for our patients, and support our staff and physicians.”

Watch for more details in the coming days and weeks as we finalize and operationalize these surge plans.