Attacks on our public system wreak their grim harvest

Plan revealed to 'decongest' Alberta hospital wards

Health official says open beds will shorten ER waits

By Matt McClure, Calgary Herald October 29, 2010
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Dr. Grant Innes, AHS's head of emergency medicine for Calgary region, said his "overcapacity protocol" is a proven method of improving the flow of patients within the health-care system.

"When the emergency wards are full, it's a way of getting the sickest people into a bed," Innes said.

"You push out the in-patients who don't need to be there. When a medical or surgical unit upstairs has to find a space because someone is landing in their lap, they usually do."

Health Minister Gene Zwozdesky committed this week to reduce the average wait time for patients who show up at emergency wards requiring admission to eight hours, but emergency physicians say they're waiting to see how hospitals will meet those targets.

Seriously ill patients who show up at Calgary emergency wards are now waiting an average of up to 20 hours before they are admitted. Doctors say many are enduring unnecessary pain, suffering poor outcomes and even dying on occasion because they aren't seen in a timely fashion.

Dr. Eric Grafstein, head of emergency medicine at St. Paul's Hospital in Vancouver, said patients at facilities there faced similar waits four years ago. After five patients died in emergency waiting rooms in a one-month period, overcapacity measures were introduced that quickly cut wait times in half, from 20 to 10 hours on average.

"It's a way to decongest in a hurry when you get crowded and share the burden of overcrowding," Grafstein said. "We can get eight to 10 patients out of our ward and upstairs inside an hour."

He said wait times have dropped even further since then, with the introduction of a pay for performance program that rewards hospitals for meeting wait time targets. Hospitals that admit patients within 10 hours of their arrival in emergency get $600. When they treat and discharge those who don't need a bed within four hours, they get $100.

"Doctors are now seeing patients within an hour," said Grafstein, "and deciding a lot sooner who needs to be in hospital and who doesn't."

He said there has been grumbling from hospital wards that now have to handle extra patients, but he said that so far there have been no incidents of negative outcomes because of poor care or premature discharges.

Innes said his overcapacity proposal for Calgary hospitals received a favourable reaction when he presented it this week at a meeting of medical department heads.

He said it's now being reviewed and considered by senior officials inside AHS.

Dr. Paul Parks, emergency section president with the Alberta Medical Association, said he supports the idea, but stressed it will only work if there is increased accountability inside AHS.

"Sharing the burden of overcrowding won't be popular," Parks said.

"There needs to be someone inside every hospital with the authority to make this happen."

Despite repeated requests for an interview, top bureaucrats at the provincial health authority wouldn't speak about the proposal.

AHS has said it plans to solve emergency room overcrowding by expanding home care and reducing the number of people -- nearly one in five Albertans -- who often rely on emergency wards for primary care because they have no family doctor.

The provincial health authority is also increasing the number of long-term care beds. By adding over 500 spaces across the province between now and the end of March, it hopes to free beds in hospital wards that are now clogged with chronically ill patients.

But Innes said adding more beds won't end emergency ward overcrowding. When the 200-bed facility at Garrison Green in Calgary opened in June, he said hospital wards emptied and emergency waits shortened temporarily.

"By September the backlog in our emergency wards was worse than it had ever been," he said.

"Additional beds may be part of the answer, but we also have to change rules about who gets them."

Emergency physicians have warned in a leaked letter that Alberta's health system is facing "potential catastrophic collapse" because of hospital overcrowding, but new figures from the Canadian Institute for Health Information show the province spends more tax dollars per capita on health care than any other province but Newfoundland.

Despite a relatively young population, Alberta is forecast to spend $4,295 per capita this year on health care, well above the national average of $3,663.

David Eggen, executive director of Friends of Medicare, said the numbers shows there's gross mismanagement of public health-care budgets by AHS.

"While the lines in our emergency wards have grown longer," said Eggen, "we're spending too much on prescription drugs and contracting out long-term care to the private sector."
mmcclure@calgaryherald.com