Strips of green painter's tape are stuck to the hospital's walls, ceilings and windows – the labourer's equivalent of Post-it notes. Messages written in marker remind the various trades of the work that remains: Check for door replacement. Needs soap dish. Paint around access panel. Patch ceiling/crack. Adjust motion sensor. Demo.
As in, demolish.
Wires dangle from the ceilings, and dust settles on the new vinyl floors. Fans whirr to diffuse paint fumes while IT crews in hard-hats set up computers in nursing stations. Hospital beds are crammed into a dining area for temporary storage.
This was the scene two weeks ago at Humber River Hospital's Finch site – a mothballed northwestern Toronto facility getting a multimillion dollar makeover after sitting mostly vacant for more than two years. On Sunday, the hospital is slated to reopen with a new name and a new mandate. The Reactivation Care Centre (RCC) will host patients who no longer need the acute services of a traditional hospital, but are unable to live independently; they might be waiting for home care or a spot in a long-term facility, for instance.
On opening day, Mackenzie Health, Southlake Regional Health Centre, North York General Hospital and Humber's Wilson site will each move 30 patients into the centre. Ambulances are scheduled to pull up to the main entrance every 10 minutes, beginning at 8 a.m. When the second and final phase of renovations is complete in the early months of 2018, Markham Stouffville Hospital will transfer 24 patients to the centre, and Mackenzie will send over another 90.
The five hospitals will staff their own wings with nurses, physiotherapists, social workers, occupational therapists, dietitians and speech-language pathologists, among others. Physicians will be available in person or remotely through the Ontario Telemedicine Network. In most cases, two hospitals will share a given floor, with common space in the middle. Humber, which owns the property, is the landlord, and the other hospitals are commercial tenants.
This is the first time in Ontario that so many hospitals will house patients under one roof, said Scott Jarrett, executive vice-president and chief of clinical programs at Humber.
"Here you have infrastructure currently built, so we didn't have to invest hundreds of millions of dollars to build a new institution," said Mr. Jarrett, who is overseeing the project. "We had an institution that needed a refurbishment and a refresh … so we can provide a service relatively quickly."
The reopening, which provincial Health Minister Eric Hoskins announced on Oct. 23, ahead of the flu season, is part of the government's latest effort to free up acute-care beds, reduce emergency department wait times and keep admitted patients out of unconventional spaces such as gyms, hallways, auditoriums, lounges and offices. The October announcement touted the creation of 2,000 hospital beds and community spaces, and an investment of $40-million in new funding for home care.
"We're seeing higher [flu] rates earlier than last year, with greater degrees of illness," said North York emergency physician Dr. Joshua Tepper, who is the president and CEO of Health Quality Ontario, which advises the province on improving the health-care system. "So I think it is a very prudent decision to be moving quickly toward building capacity."
According to the Public Health Agency of Canada's weekly flu report, covering Nov. 19-25, there have been 2,080 laboratory-confirmed influenza detections across the country so far this flu season. During the same period, 371 flu-associated hospitalizations were reported – a "considerably elevated" number of cases when compared to the same time-frame over the previous two flu seasons, the report said.
Like many hospitals in Ontario – and across the country, to varying degrees – the five facilities feeding into the RCC are grappling with overcrowding. According to figures provided by the hospitals, the average acute-care occupancy rate for the first 10 months of this year ranged from 96 per cent to 118 per cent. Across the board, the rates were higher than the 85-per-cent threshold that many experts describe as the ideal for preventing the spread of infection and accommodating unexpected surges of patients.
All five of the hospitals reported using beds in unconventional spaces, but Southlake's reliance was by far the most pronounced. In October, an average of 62 acute-medicine patients were treated in unconventional spaces, including in an auditorium that holds 10 beds. The acute-care occupancy rate for October was 124 per cent.
"We have been in a surge for the last year to 18 months," said Dr. Steven Beatty, chief of staff at Southlake, which has the third-busiest emergency department in the province. "[The relief] couldn't come at a better time, in the sense that the water has been running overtop the barrel for quite a while now. This came as a very welcome announcement from the ministry, and is, I think, a very important recognition that hospitals like us are struggling."
Southlake plans to soon do away with the beds in the auditorium and other unconventional spaces, thanks in large part to the opening of the RCC.
Humber's Finch property was an acute-care hospital from its opening in 1970 until the fall of 2015, when it became an urgent-care site and medical imaging clinic. By providing urgent care until the summer of 2016, the hospital effectively served as an emergency department, offering immediate treatment and then sending people home. The imaging clinic was in use until the end of last year.
For two years, then, much of the building sat vacant. The plan was to sell the site, so the hydro and heat were left on to guard against decay. Outside, several signs advised that the hospital was closed and that Humber had a new facility, on Wilson Avenue. Although the reopening was not publicly announced until October, Humber started the planning process in early 2017 and got the ministry's green light to go ahead with design development in September.
Reopening the hospital has been no small feat. The project involves upward of 300 people, including officials from the five hospitals, the provincial health ministry, consultants, various trades, designers and inspectors.
To support the first phase of the transformation, the province has committed to providing the Central Local Health Integration Network, which includes the five hospitals, with up to $14.49-million in additional base funding for the 2017-2018 fiscal year. The construction contract for the second phase has not been awarded, so the total project cost, the ministry's capital grant and the hospital's share of the costs have not yet been determined.
Much like a home renovation, the project has had its unforeseen impediments. Ripping out and replacing the flooring meant temporarily removing dozens of toilets. But when workers went to pick up the toilets, they fell apart.
There was also the matter of modernization.
UV lights were installed in patient bathrooms – the first time that the technology will be used in an Ontario hospital for infection prevention and control, Mr. Jarrett said. The elevators had to be serviced so they would go where they were told. LED lights replaced fluorescent bulbs, brightening the hallways and increasing energy efficiency.
Vital-sign monitors were mounted in patient rooms, and state-of-the-art smart beds were rolled in by the dozens. Their blue mattresses oscillate to prevent bed sores, inflate on either side to help staff reposition patients, and sound an alarm if significant motion is detected.
On Monday, with less than one week to go before the reopening, the hospital was brimming with activity. Staff from the participating hospitals were on site for a tour of the still-unfinished space, with some receiving training on the new equipment.
A contractor tested the medical gases in patient rooms, making sure the oxygen and nitrous oxide lines, for example, had proper flow rates. Humber staff, their fingers stained purple, spray-painted the legs of dozens of walkers, assigning each hospital a colour. A worker used a machine to chip out the old flooring at the west entrance.
The labour will go down to the wire. The final few days will see sinks and soap dispensers installed, holes in the walls patched, door frames coated with paint, and plastic wrap removed from medical equipment.
The call-bell system, which allows patients to communicate with the nursing station, will be tested room-by-room through Friday. Saturday will be spent stocking supplies, making the beds and ensuring all the rooms and equipment have been disinfected.
"We're all trying to run acute-care hospitals, and at the same time we're really trying to get this up and running," Mr. Jarrett said of the leadership at the five hospitals. "We see the benefit and the need for it."
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