Overcrowding at QEH has led to 'dangerous situation' in ER, says Health PEI official

Overcrowding has led to a "dangerous situation" in the emergency department of the Queen Elizabeth Hospital in Charlottetown, according to emails from health officials tabled in the legislature Thursday.

"We are a mess with overcapacity. This has been a long time coming," wrote Health P.E.I. CEO Michael Gardam at the end of an email chain that started with a call for action from an ER nurse whose name was redacted.

It was Gardam who forwarded the email chain to MLAs from the PCs, Greens and Liberals. Liberal MLA Robert Henderson tabled the emails in the legislature.

Multiple emails describe an emergency department which on Wednesday was housing 26 patients who were waiting to be admitted to other units in the hospital, but couldn't be moved because those other units are full.

"We only had the eye room available to assess the 40+ patients in the waiting room," an unnamed RN wrote in another email, tabled by Liberal MLA Gord McNeilly. That email was addressed to McNeilly, PC MLA Zack Bell and Premier Dennis King.

The eye room, the nurse explained, is where patients having vision problems are assessed, and "doesn't even have a stretcher for someone to lay down on." All the other rooms were full with patients waiting to be admitted.

"The emergency department is a sinking ship," the nurse wrote. "We are all drowning and are desperately seeking help … before there are no nurses left."

Hospital filled with long-term care patients

"The issue … causing the dangerous situation in the [emergency department] is an unprecedented number of [alternate level of care patients] in our hospital and in all hospitals in P.E.I.," wrote Charles Duffy, medical director for the QEH and acting head of the emergency department there.

Alternate level of care patients are those awaiting placement in another facility — in this case, patients who have technically been discharged from hospital but are awaiting placement in a long-term care facility. Duffy wrote there were 52 such patients in the QEH last week.

On Wednesday, Minister of Health Ernie Hudson said 42 beds in government-run long-term care facilities had been shut down because of a lack of staffing.

The results are people waiting up to 13 hours to see a physician. It puts nurses well beyond the safe staff-patient ratio: one nurse for 40 patients, sometimes.- Gord McNeilly, Liberal MLA

On Thursday he said even more beds have been closed at private facilities for the same reason.

On Thursday the minister also told the legislature the QEH had reached level 4 overcapacity, which according to Health PEI policy documents is to be invoked "in an emergency crisis situation."

Health PEI officials first confirmed, then denied the situation had reached level 4, but said such a designation had been discussed and acknowledged the situation with overcrowding was "really bad."

Another problem leading to overcrowding at the QEH, according to Duffy, is the closure of 10 inpatient beds at Prince County Hospital in Summerside "with no date for reopening."

Lack of options forcing people to ERs, says MLA

"Twenty thousand people on the patient registry, limited access to walk-in clinics, virtual health care in shambles right now, a lack of primary care options have led to skyrocketing demand at our ER," said McNeilly during question period.

"The results are people waiting up to 13 hours to see a physician. It puts nurses well beyond the safe staff-patient ratio: one nurse for 40 patients, sometimes."

The key to fixing the situation, Hudson replied, is to recruit more staff.

"That, in and of itself, provides relief to the frontline workers that are there right now."

Hudson also explained Health PEI has a plan to reopen 21 long-term care beds within the next two weeks, which will free up beds in hospitals.

A spokesperson for Health PEI outlined a number of other initiatives currently underway or being developed, including the creation of a follow-up clinic to check in on patients who have been recently discharged.

Some surgeries cancelled, more could be

Nurses have been asking why elective surgeries have continued while the hospital is overcapacity.

In his email, Duffy said some surgeries had been cancelled over the past two weeks, but that "even cancelling one surgery can cause significant harm to this patient who may have waited up to two years for this procedure."

With long-term care beds reopening, Duffy wrote he "will be making decisions as to whether limiting elective surgeries may serve as a bridge until some of these LTC patients can be discharged."

But he warned, "there are just too many inpatients and not enough LTC beds to make a significant difference in the [emergency department]."

In response, Gardam said fixing the problem will take time.

"To steer ourselves out of this is going to take time and quick fixes almost always have unintended negative consequences," he wrote.