Emergency, urgent care wait times slowly improve in Winnipeg but staff shortages are a burden

Wait times at Winnipeg emergency departments and urgent care centres are beginning to improve but there is a long road still ahead, say officials in the city's health system.

"These patient flow issues didn't materialize overnight and they unfortunately won't be resolved overnight either. These are long-standing issues that existed for years and made exponentially worse by the pandemic," said Shawn Young, CEO at the Health Sciences Centre.

Administrators continue to meet with staff, physicians and site leaders to share ideas on further improvements, including recruitment and retention efforts for health-care workers.

"No stone is left being unturned," said Young.

Young was not able to pinpoint a number to say how the wait times have improved, saying it depends on the level of care required.

"Those patients with life-threatening illnesses that need to be treated within minutes to hours, we've not seen a delay in their access times," he said.

Those acutely ill patients are listed as 1-2 in a scoring scale of 1-5, known as the Canadian Triage and Acuity Scale (CTAS). The 3-5s on the scale are where the waits have been most prolonged.

The median waiting time across all Winnipeg sites over the last seven days has averaged 2.55 hours, according to Mike Nader CEO of the Winnipeg Regional Health Authority.

That is a significant improvement over the last couple of weeks and continues to improve, he said. As of Wednesday, the median time was 2.28 hours. 

Emergency department data obtained by CBC News earlier this month showed that through April and into May, there were times when the median wait for admission was more than 24 hours, with some patients waiting in emergency three or four days for a hospital bed.

Nader attributes the improvements to "new and expanded" initiatives to improve patient flow, such as better defining the expected date of discharge and moving patients from hospitals to long-term care facilities.

"These patients are frequently long-stay inpatients who no longer require hospital care but could be appropriately cared in other settings with appropriate supports," he said.

WRHA staff have also been working with other health regions in the province to move patients who live outside of Winnipeg, but require specialized care in the city, back to their home regions.

"This both frees up space in Winnipeg while allowing patients to continue their recovery at sites closer to home and their respective support networks," Nader said.

Through May, 162 patients have been returned to their home regions, which is an improvement over the 139 in April.

More staff are also returning to normal duties following COVID-related redeployment, which has increased home care supports. That has allowed some patients to be discharged more quickly and opened up space in hospitals for others who need acute care.

Those moves have had a positive effect on emergency departments and urgent care centres by creating more inpatient space, Young said.

"We've also benefited from lower sick times among staff, which, however, still remain quite high but definitely trending in the right direction," he said.

Still, there are patients at the far end of the wait-time list, sitting for closer to 5-8 hours to see a nurse or doctor. That doesn't sit well with Nader.

"We're residents of the community, we require these health services. We're not happy with the times that people are having to wait, particularly those who are CTAS fours and fives," he said

The challenge, though, is not an issue that presents itself within the emergency room, but rather in the system's ability to transition patients to the different levels of care, Nader said.

"I don't want to give you the impression that everyone's happy about what's happening in our emergency rooms but we have started to see the improvement and we've turned the ship, I hope, in terms of what what we should expect to see with regards to emergency room wait times for those that are coming in."

Aging workforce and aging population

Despite the improvements, changes in how processes are managed can only take things so far. The biggest block is staffing.

"We've got very high vacancies. So until we can actually stabilize that workforce, it's going to be difficult to predict when we actually do get to our baseline [wait times]," said Young.

And those vacancies are increasing because the workforce is aging, noted Nader. Across the Winnipeg area, the vacancy rate in the system is 14.5 per cent "which is quite, quite high," he said. 

At the same time, the general population is aging. Those two factors could create a major strain on the system.

"What can we do to mitigate it? We can look at things working with our union partners and others around flexibility, opportunities for staff to work casual and to be able to fill roles that would meet their needs once they've chosen to retire or not work full time," said Nader.

"So there is a lot of work that we still need to do on that, and that is an area for sure that we're keeping a very close eye on."