Wednesday, October 27, 2010

Zwozdesky commits to reducing Alberta ER wait times

Patients should be in and out of emergency ward faster

By Jodie Sinnema, October 27, 2010 4:05 PM Comments (7)
StoryPhotos ( 2 )

edmontonjournal.comEDMONTON — The minister of health has committed to bringing in aggressive wait time targets tied to administrative performance goals that will see patients in and out of the emergency ward faster.

But although the new policies will be formally put in place by Christmas — they were first proposed as key solutions by Alberta emergency doctors in March 2009 — Health Minister Gene Zwozdesky said hospitals won’t be able to meet those targets for some time.

“They have to start aspiring toward it,” Zwozdesky said of administrators down to front line workers of Alberta Health Services. “That will not be accomplished before Christmas.”

The new wait time benchmarks will see patients waiting no longer than four hours from the time they arrive at emergency to the time they are treated and discharged home. Patients who need to be admitted to hospital are supposed to wait no longer than eight hours in emergency before they get a bed in another ward.

Current wait times often exceed 20 hours in big urban hospital such as the Royal Alexandra or University of Alberta hospitals. The father of Dr. Raj Sherman, parliamentary assistant to Zwozdesky, waited four days in emergency before he received a proper hospital bed.

Zwozdesky’s commitment and directive to Alberta Health Services came after a Tuesday evening meeting with Dr. Paul Parks, president of the emergency medicine section of the Alberta Medical Association, whose letter sparked provincewide concern over a “potential catastrophic collapse” of emergency care if actions weren’t taken immediately.

“This is not a negative situation,” Zwozdesky said. “This is a situation that calls for improvement and address and that’s what we’re doing.”

He said several things will be happening to get wait-times down. New hospital beds will be opening, although he didn’t know when the emergency ward in the Eastwood Health Centre would be functional, or when newly constructed but empty wards will be staffed in Calgary’s Peter Lougheed and Rockyview hospitals.

Alberta Health Services will also be regularly required to report actual emergency wait times for each hospital site instead of averages for the entire province, both to the front line workers and to the public.

And a more clear communications line will be set up so when doctors and nurses start predicting an upcoming crisis in the emergency ward due to lack of beds, one single on-site director can make on-the-spot decisions to find more beds across the hospital.

“Greater accountability is necessary,” Zwozdesky said. “It’s just taken some time to get to this stage.”

Without setting harsher consequences to meet the wait-time targets, Albertans won’t take the health ministry’s commitment seriously, said Edmonton-Strathcona NDP MLA Rachel Notley.

“I think it’s unrealistic and if the government wants us to buy it, here’s the measure of accountability: if they haven’t met it by December, the minister resigns,” Notley said. “If that’s not the measure of accountability, I don’t have any time for this because it’s more of the same.”

She said more problems in health care aren’t reaching the minister’s ear because employees feel gagged by Alberta Health Services.

“A public letter is the only way to capture the attention of the minister,” Notley said of Parks’ September letter to the minister, which outlined hundreds of cases where patients waited too long for emergency care. “I congratulate these ER doctors for having the courage to come forward but the fact of the matter is there is a lot of other people in this health-care system who have stories to tell about how it’s not working but are unable to because they don’t have the job security these ER docs have.”

Zwozdesky said health administrators already can lose their bonuses if they don’t meet care targets.

“I’m not going to ask anybody to resign over this. Let’s give it a chance,” he said.

But Parks said he isn’t sure if losing a bonus is sufficient to ensure improved emergency care.

“We’re asking that we may need more than just that on the line,” he said.

Dr. Felix Soibelman, president of the Edmonton Emergency Physicians Association, said too many administrators have their performance measured against emergency room wait times.

“When you have a diffusion of accountability like that, it’s very hard for one individual person to take ownership of the problem and say yes, I am responsibility solely for this and that is what we would like to see,” Soibelman said.

Yet Parks said the minister’s commitment to tackle the problem is a good start.

“We have put forward an aggressive agenda for Alberta Health Services, but it’s one our patients deserve,” Parks said. “We need action and we need it in days and weeks, not just months or years. … And to all Albertans, if you have to go to the emergency department, please be assured that our emergency care teams — doctors, nurse, technicians and others — will provide you with the very best treatment and care that we can.”

Without new money, more staff or a better plan to improve that care, David Eggen, executive director of Friends of Medicare, has his doubts the targets are feasible.

“If these ER docs did not have the bravery to come up and speak, none of this would have happened,” Eggen said. “This is very reactionary. … I think the government wants to look like they’re doing something on this file.”

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