Dear Sir,

Thank you for Jonathan Bell’s article in Tuesday’s newspaper. While the story was excellent in many respects, I hope you will allow me the space to introduce or expand on some issues related to emergency department boarding at King Edward VII Memorial Hospital.

Emergency department boarding has already been reduced by more than 50 per cent within weeks — just by implementing a few of the simple measures as recommended in my letter of concern submitted to the Government and the BHB in January. This is hard evidence that the problem could be eliminated in its entirety if all of my initial recommendations had been followed.

I was unaware until quite recently that the resources exist in Bermuda for the introduction of case management for emergency patients — particularly high-risk “super users” after their admission to hospital. This is a well-proven solution to ED boarding and hospital overcrowding in many overseas jurisdictions.

Furthermore, case management has been employed at the Mid-Atlantic Wellness Institute for its psychiatric patients for many years with tremendous success. It simply adds another important option to the “toolbox” of measures that could be adopted to completely resolve ED boarding — and its attendant risks for patients “once and for all”.

While I am pleased that an organisation has finally been chosen to conduct an independent external review of ED boarding at KEMH, I am somewhat disappointed that the selection process took more than two months to complete.

This organisation (Acumentice) will need to review bed flow/bed management practices at KEMH in great detail, because it is well recognised that ED boarding is virtually never a problem that originates in the Emergency Department itself. Rather, it is because of bed-flow processes throughout the hospital that create “exit block” once emergency patients have been fully assessed and are awaiting transfer to one of the wards.

I would submit that in KEMH’s case this occurs primarily because of a combination of sub-optimal management of their own (inadequate) inpatient beds and a dearth of step-down, “skilled“ nursing home, and “unskilled” nursing home beds in our community. The latter is a problem that the Government recognises and is already beginning to address — so I think Acumentice will focus primarily on internal problems with bed-flow management at the hospital.

While we can’t easily rectify the incredibly poor design of the acute care wing, there really is no excuse for not having introduced “workaround” solutions that could have prevented immeasurable suffering and avoidable deaths over the past ten years.

The people of Bermuda must no longer accept “the unacceptable” and should demand the complete resolution of the Emergency Department boarding crisis at KEMH as a major health and safety initiative for our community.

EDWARD A. SCHULTZ

Smith’s