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Where Accessibility Meets Accountability

Carolyn Leckie

April 10, 2014

It was late at night when I finally exited through the automatic doors of the emergency department. I was alone, disoriented, nauseous, and barely able to walk straight- thankfully the bus stop was close enough to stumble to. It had been 10 hours since I first came in, bewildered, alone and in excruciating pain. I patiently waited, understanding I was not in life threatening danger. When I was finally seen by two nurses and a doctor, they were kind but barely took the time to answer my questions regarding what drugs they were pumping into me. Once I finally confirmed my pain level had fallen below the threshold, they politely wished me well and vanished. When I was finally able to stand, collect my things and walk past the curtain there was no one around I could question regarding the medication side effects or even directions out of the hospital. The IV had been out of my arm for about 5 minutes and I already felt overwhelmingly unprepared but accountable for my safety.

Now, I do not mean to degrade those doctors, paramedics and nurses whom I am sure work very hard while coping with under-funding and under-staffing issues in emergency departments across the country. After all, I did have full access to my primary health care needs: I received fluids, pain medication, a quiet bed and even TV access- all at no cost to me! It was humbling to see how quickly these care workers could cooperate to put me back on the mend. Despite this triumph in accessibility, I still felt in the dark about how to proceed from here. I had to repeatedly call a doctor to receive answers to my simple health concerns, like the next steps in treating my ailment. Luckily he was a kind soul who stepped back, took a breath, and prescribed me a solution. Perhaps he took pity on me in my vulnerable state and my first hospital visit, or maybe whining enough is exactly what it takes to access the health care information necessary to prevent future visits to the emergency department.

Though I personally did not receive assistance in the discharge process, it is known that volunteer porter systems are a staple of hospital exits. But does the hospital’s accountability for your health end at the door? The political and ethical issues surrounding this question can be dizzying, but rest assured I am not the first to look for answers. Following Ontario’s Excellent Care for All Act (2010), the Health Quality Ontario (HQO) board has been mandated to report annually on four main areas: access to publicly funded health services; human resources in publicly funded health services; consumer and population health status; and health system outcomes[1]. Community Care Access Centres in conjunction with their Local Health Integration Network partners and the Canadian Nurses Association work together to facilitate this data collection and align service providers with recommendations. These recommendations arise primarily from HQO’s Knowledge Translation Network and Quality Compass- repositories of tools and resources for care quality improvement. This means steps are continually being taken to improve the patient’s experience both in and outside of your hospital’s doors.

There has been substantial progress made in recent years in the Canadian Health Care system in terms of increasing the accessibility of primary health care. This is particularly true for those with ‘high care needs’ including elderly populations, children who are medically fragile and those with exceptional needs. Access to community-based services and educational material is at their fingertips through the CCAC, with information aggregated on sites like thehealthline.ca and healthcareathome.ca. These resources have reduced emergency department readmission rates and save roughly $380 per patient per day[2] in supporting high care needs patients in their transitions home. It is my hope that these programs can evolve to build more bridges for patients with acute health care needs, improving their navigation of the primary health care system. This includes better mandated safe discharge processes, future treatment information accessibility, and transition home assistance for all persons- not solely those with high care needs. With these changes, acute emergency department visits by patients like me will become more efficient, reduce readmission rates, and by less taxing on both patients and clinicians.

[1] Health Quality Ontario. 2013 Yearly Report on Ontario’s Health System, 10 February 2014, 
[2] Ontario Hospital Association, OACCAC Utilization Reports Q1-Q3, FY11/12, Ministry of Health and Long-Term Care, March 2012.