Emergency room physicians sound the alarm

Pam
Pam Frampton
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Address crisis or more people will die needlessly, they warn

Brian Sinclair died waiting in a Winnipeg hospital’s emergency room in 2008 after spending 34 hours without seeing a doctor.

A double amputee, he had a bladder infection caused by a blocked catheter that could have been cured by antibiotics.

Instead, he died unnoticed in a busy hospital, surrounded by medical staff.

The 45-year-old’s death is the subject of an inquiry that is adjourned, but will resume in January.

“That inquest,” says Dr. Howard Ovens, “is a very tragic example of what can go wrong in an overcrowded emergency department.”

Ovens should know. He’s the emergency department head at Mount Sinai Hospital in Toronto and a member of the public affairs committee of the Canadian Association for Emergency Physicians (CAEP).

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CAEP came out swinging this week, decrying overcrowded emergency rooms in Canadian hospitals as a public-health emergency.

In a conference call that The Telegram participated in on Monday, emergency room physicians warned more people could die if the situation is not addressed — stat.

“The risk for adverse outcomes is much higher if a visit is made to an overcrowded emergency department,” Ovens said.

Anyone who has ever accompanied a family member to emergency knows space there is at a premium.

What they might not realize is that the health-care system is like a garden hose — a kink anywhere along the way snarls the whole system and slows everything down to a trickle.

When my father ended up in emergency this summer and spent hours on a gurney in the hall waiting to be admitted, I noticed a paramedic standing at the gurney next to his, which was occupied by a frail-looking woman, with a relative sitting nearby in a chair. It was close quarters, with hospital staff rushing to and fro. I felt bad for my dad and the elderly woman, knowing both probably felt stripped of privacy and dignity in the busy hallway.

I also felt bad for staff trying to cope in cramped conditions.

What I didn’t think about was that the paramedic was obligated to stay with his charge until she was seen by someone in emergency, and that every hour he spent waiting meant another hour with one fewer ambulance on the road.

And, for every person occupying a stretcher in the hall, there was one fewer for new arrivals at emergency needing to be examined.

Every person languishing in a hospital bed waiting to get a placement at a long-term care home means one less bed available for people needing acute care.

It’s a vicious cycle — one that starts in the emergency department and, in worst-case scenarios like the case of Brian Sinclair, can end there, too.

“(Emergency department) crowding is not just an issue of patient convenience, or even of simple comfort,” the Canadian Association of Emergency Physicians (CAEP) said in a news release, “it constitutes a public health crisis.”

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CAEP wants national benchmarks established for emergency department wait times, and it wants provincial governments to sign on and to publicly report that data.

Some provinces already do just that, including Ontario, where you can go online and find out how long people typically wait in emergency at any hospital in that province.

“I think it’s very important to adopt public reporting for many reasons,” said CAEP’s Dr. Howard Ovens. “Once your report card is being shown, it affects your behaviour. It’s not just that the public has a right to know — which I think they do — but the quality improvement process is much more likely to succeed if the information is reportedly publicly.”

                       •••

A June 2013 report by the Wait Time Alliance concluded that Canadians are waiting too long for health care and that not all provinces are doing a good job of informing the public about wait times.

When the alliance reviewed provincial wait-time websites, Newfoundland and Labrador scored 3.2 out of five, netting us a grade of C, placing us below the national average and third from the bottom when compared to other provinces.

This province does a great job of meeting wait-time targets for procedures such as joint replacement and radiation, and a great job of communicating that wait-time data to the public, but when it comes to emergency department information, it is currently not available.

“I think the citizens of Newfoundland and Labrador deserve to know how their emergency departments are performing,” Ovens said. “The fact that the information is not immediately available is scandalous.”

Dr. Andrew Affleck, the lead physician for trauma at the Thunder Bay Regional Health Sciences Centre, also contributed to the position paper that CAEP released this week calling for a national strategy.

He agrees that hospitals are unlikely to improve their systems if they don’t first collect and share data about wait times and adopt a national benchmark system.

“I think there’s a danger down the road if provinces don’t take a look at this,” he said.

In this province, the government has committed to reporting wait times, but isn’t ready to post ER data online yet. First, it has to complete reviews of the 13 Category A emergency departments in the province; five have been done so far.

“The provincial government has made a commitment to publicly post wait times information for emergency departments and is working towards that goal,” a Department of Health spokesman said in an emailed statement.  

The province is also going to implement an Emergency Department Wait Time System at the Health Sciences Centre and St. Clare’s in St. John’s.

“This system will capture real-time emergency department information to help recognize bottlenecks in patient flow so that quick actions can be taken to resolve the problem,” the spokesman said.

There was no estimated time given for when the reviews might be complete and the information made available.

Let’s hope it’s soon.

Given our aging population, people’s propensity to live longer and the number of elderly people who end up in emergency rooms with chronic conditions, we need to do everything we can to prepare for what Affleck calls “the baby boomer tsunami.”

As CAEP points out, with every passing year, more and more beds intended for patients needing acute care are taken up by people needing an alternate level of care — say, a nursing home or rehabilitation.

Ignore the tsunami and we just might get swept into the undertow.

 

Pam Frampton is a columnist and The Telegram’s associate managing editor. Email pframpton@thetelegram.com.

Twitter: pam_frampton

Organizations: Canadian Association, Emergency Physicians, Mount Sinai Hospital Wait Time Alliance Thunder Bay Regional Health Sciences Centre Department of Health Emergency Department Wait Time System

Geographic location: Toronto, Newfoundland and Labrador, Ontario

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