Community Access Hospitals
The Problem
There are communities in Saskatchewan facing a health care crisis. They are being forced to close down emergency rooms and severely restrict admission to the local hospital. There are simply not enough doctors. The current government has not adequately addressed this issue. Nor has it offered any options to these communities.
As a result, residents have no place to go in an emergency. There is a need for new approaches – innovations that offer consistent health care to those who need it when they need it.
A Real Option – Community Access Hospitals
Under the Community Access Hospital model, communities would be able to retain their hospital with a Nurse Practitioner. Nurse Practitioners would work in collaboration with doctors in one of two ways:
- Through an agreement with doctors in nearby communities
- A team of doctors hired at the provincial level
All other staff normally employed to run a hospital will also maintain their jobs like, RNs, LPNs, or Special Care Aids, dietary, housekeeping, lab/xray and maintenance.
The hospital would continue to remain open, to admit acute care patients and deliver emergency services. To supplement emergency services, emergency medical technicians would be on site.
This model builds on the concept of primary health care clinics in which a range of health professionals, such as pharmacists, dieticians, physiotherapists and social workers work as a team to deliver health care. It paves the way for alternative models in which various health professionals can broaden their range of practice to use the full benefit of their education and training.
To start, this model can be tested in a few communities that currently have hospital closures. Over time, changes in the system will be required including allowing for Community Access Hospitals under the Regional Health Authorities Act; more accessible training for nurse practitioners interested in taking on this role; the hiring of a core of physicians at the provincial level to provide consultation and collaboration, and agreements to be developed with local doctors who are interested in working with this new model.
The Community Access Hospital approach is not a replacement for physicians. It is a supplementary approach to address the practical issue of the doctor shortage that communities face.
The Facts
Recent media reports identify 22 Saskatchewan communities that do not have the doctors they need to operate the local hospital. Other jurisdictions are meeting this challenge by expanding the role of other health professionals, most often with Nurse Practitioners.
Nurse Practitioners are already practicing in rural Saskatchewan. They are senior nurses with with advanced education beyond a registered nursing degree, often with a Masters degree in Nursing. The Community Access Hospital model offers another step in this approach as a doctor would not be required to be on site in order for a hospital to remain open. A physician is available for consultation and collaboration either in a nearby community or in a central pool of physicians.
Hospital and health clinic models that are not solely physician-led are working successfully in other parts of Canada and the world. In Ontario, 25 nurse practitioner-led clinics are either in place or under development. Nurse practitioners are able to diagnose conditions, order diagnostic tests, provide prescriptions, and make referrals to specialists and other health professionals such as physiotherapists.
In the United States there are more than 1300 hospitals operating in rural areas that do not require a doctor to be on site (although a doctor must be affiliated with the hospital), relying instead on advanced clinical nurses, physicians’ assistants and nurse practitioners to provide 24-hour service. Australia is also finding success with nurse practitioner-led clinics.
Read the News Release. Read Dwain Lingenfelter's speech. Read Judy Junor's speech.
