Calgary ER doctors say don't blame them, long wait times a result of a systemic crisis
ER beds taken up by patients who’ve been admitted but have nowhere to go
Some Calgary ER doctors say there are days when they feel as though their hands are tied, knowing they don't have the staff or the space to treat their patients in a timely manner.
That's because emergency beds and resources are increasingly being taken up by in-patients — people who've already been admitted to the hospital but have nowhere to go because the units are full, sometimes beyond capacity.
"It's incredibly frustrating and patients are very frustrated," said Dr. James Andruchow, ER physician at Foothills Medical Centre.
"But it's analogous to being angry at the car in front of you when there's a multi-car pileup one kilometre down the road … this is not just an emergency problem, this is a system-wide capacity issue," said Andruchow.
Andruchow says there are many reasons why the issue is coming to a head right now.
There's a nursing shortage. There's still a lot of patients being admitted with COVID. There's a provincewide surgical initiative that's trying to ease the pandemic-related backlog of non-elective surgeries. And there's a mental health and addiction crisis.
Dr. Rick Morris, who works in the emergency room at the Peter Lougheed Centre, says critical patients are still being seen and treated efficiently, whether that be in a hallway or other non-traditional setting. But he says it's the people with a bellyache or other non-critical illness who are left to wait.
He says there are times when all of the PLC's roughly 30 ER beds are filled with admitted patients, pushing wait times to 12, 14, 16 hours.
"You feel at a loss and you just think … if you're not that sick, you should go home, go see your family doctor the next day (because) you're gonna be waiting for hours, unfortunately. We don't want you to, but that's the reality," said Morris.
Ease the burden
Andruchow says the ER carries the brunt of the overcapacity load. He says that while in-patient units can run 10 to 20 per cent over capacity, ERs can run 80 to 100 per cent over capacity.
"Our system right now is unsustainable, and these issues are only getting worse. And so yeah, I would strongly advocate that all of our various political parties put together real strategies to deal with this," said Andruchow.
Andruchow says there is a policy in place that is supposed to trigger the movement of emergency in-patients up to the units when they reach a certain threshold.
WATCH | At times all 30 ER beds at Peter Lougheed Centre are full, doctors say:
But he says it's not being done consistently because in-patient resources are stretched, too.
"Having predictable, proportional surge strategies that allow the patient care workload — and, quite honestly, the risk — to be distributed among the system is something that could be done as of tomorrow and would make a significant improvement in the care of emergency department patients."
Morris says another way to ease the burden on ER departments would be to limit the number of elective surgeries being done — again, when the number of in-patients in emergency reaches a certain threshold.
"So one or two beds a day get freed up to admitted patients who need in-patient care."
Need more nimble system
The department head of emergency medicine in the Calgary zone says this is not just a Calgary problem or an Alberta issue. It's a global phenomenon.
Dr. Eddy Lang says AHS is aware of this backlog in emergency departments and is working to address it — for example, by adding more long-term care beds and mental health and addiction beds. But he says it's not happening quick enough nor will it necessarily resolve the issue.
Rather, he believes, Alberta needs a more nimble and responsive health-care system.
"Other hospitals around North America will cancel scheduled surgeries when the emergency departments are unsafe. There is some trigger somewhere that will do that in AHS, but we are not seeing that happen, on any regular basis, at least," said Lang.
AHS responds
In response to the surgical postponements, a spokesperson for AHS issued a statement.
"AHS is balancing these surgical efforts with ensuring we have capacity to provide care for Albertans, including emergency department services," it says in part.
"Hospitals sometimes postpone surgeries on a case-by-case basis to help manage bed and staff capacity on any given day. However, we are working hard to avoid significant surgical postponements that will only add to the burden on patients and our health-care facilities. The pandemic saw many people have their scheduled surgeries delayed, and this has resulted in some people seeking care in our emergency departments."
As for the increased wait times, AHS attributes it to an increase in more seriously ill patients visiting emergency departments, as well as increased staff vacancies and absences caused by illness and fatigue.
It attributes the spike in seriously ill patients to the deferral of care that happened during the pandemic.
It also says it's working closely with the provincial government to add capacity across the whole health-care system, including emergency, medicine, EMS and surgery, in both hospitals and contracted surgical facilities, where it can fund more surgeries without the trade-off between surgery and emergency.
And it says it's aggressively recruiting across the entire system, including its emergency departments.
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