There seems to be something different this year, compared to last January.

“Don’t get me wrong, it’s busy, just like our predictive model said it would be. The model validated what we have always intuitively known,” says Graham Blue, Director for Emergency Services “And it hasn’t been easy. But, at the same time, the surge in demand we’re seeing at our Saskatoon hospitals this January doesn’t feel the same as other years.”

Actual versus predicted data on surge

This chart shows our actual census as compared to what was forecasted using Saskatoon Health Region’s predictive model for the post-Christmas and January surges in demand.

It’s a sentiment echoed by others working through Saskatoon Health Region’s latest surge, as well as those involved in surge planning over November and December.

Saskatoon Health Region’s predictive model, developed over the past year, indicated there would be a bump in demand in the days immediately following Christmas. Based on what happened in the past, this bump was expected to start a domino effect for demand in hospital beds. A spike in patients needing hospital care was expected to hit its highest point in early January, causing intense pressure for the coming weeks.

“We saw the demand increase as predicted right after Christmas, and our large spike began around January 3,  with peak days both Tuesday and Wednesday of the following two weeks,” explains Jackie Mann, Vice-President for Integrated Health Services. “The model had told us that is about when we would feel the first pressure points and it told us how much that demand would be. It was pretty close on both points.”

A team of physician and operational leaders put plans in place to first clear the post-Christmas hurdle and then deal with the January peaks. This included adding more pre-scheduled staff and process changes, opening and pre-planning for additional spaces and physical beds for flex areas, along with clear criteria on which patients could safely be cared for in these surge spaces. There was also a pre-planned reduction in a few elective inpatient surgeries in targeted areas (not cancer-related or emergent) that would have required a hospital stay.

“It’s still been tight and everyone is feeling the strain of the increased demand,” says Mann. “But thanks to both physician and administrative leaders coming together and making some key changes from slightly adjusting surgical schedules, to staffing of medicine units, to other units accepting and safely caring for patients they don’t typically have in their areas, and creating some physical flex areas at all three sites, we aren’t seeing what we did last January, when units were overwhelmed for weeks at a time.”

Mann does point out that influenza season hasn’t hit as hard at this point, which likely has helped bring the predicted numbers down slightly.  It appears this is a bit of anomaly this year compared to others. Leaders point out it’s tough to prove any single action was the key to this different feeling on the units from last year to this.

“What we do know is we are not running units on overtime and scrambling day to day to find a large number of beds,” says Mann. “That’s not to say we aren’t feeling days of extreme pressure and our hospitals are very full. However, we have staff and physicians who have been pre-scheduled for this spike, which helps to avoid exhausted staff that can create unsafe situations for everyone. And even when a flex area might not be needed from one particular day, we have been able to move those scheduled staff into areas where they are unexpectedly short staffed and have the right skills to provide care for patients.”

It took the cooperation of the entire Region to ensure that the plans for the surge were put into action, and that they worked. “Region staff worked incredibly hard to prepare for the demand we knew was coming and they continue to do so today, especially as we hit the next number of peaks. To our staff and physicians who are on the front lines of these intense days in demand, we are incredibly thankful for your efforts to ensure those coming in seeking treatment are cared for.”

This first large peak is expected to ease towards the end of next week to more manageable levels, but already plans are being developed for the next forecasted peaks in early February, along with predicted spikes again in late February and early March.

“We have a better idea now when these spikes in demand will hit so we can flex up where we need to,” says Mann. “Using this data, we are looking ahead quarterly to what is on the horizon. A small team is working on those plans and will bring them to physician and administrative leaders for review and then implementation. This is exactly how we had hoped this tool would be used when it was initially developed initially last February during our 14 Day Challenge.”

“By creating the awareness of surges for the system that using data and the predictive model, the system responded. We were able to get in front of this with real actions and plans,” says Blue. “We felt the results of that in ED. We were able to do our business of ‘incoming patients’ in ED. When the system is in poor shape with patient flow and unprepared for a higher rate of demand, we feel that backlog in ED. This is frustrating and tough for both staff and physicians, as well patients and families. This year, it was still extremely busy, but we definitely felt more prepared than in previous years.”