Fewer patients backed up in hospital emergencies
Albertans still wait for treatment longer than guidelines permit, statistics show
By Jodie Sinnema, Edmonton Journal March 8, 2011 While there are fewer admitted patients blocking emergency stretchers for new arrivals, the actual wait times for emergency care have remained relatively stable in Alberta, new statistics show.
Health Minister Gene Zwozdesky said the number of emergency in-patients -those waiting in an emergency bed for more appropriate beds in other hospital wards -has dropped dramatically since September 2010, by 71 per cent at Calgary's Rockyview Hospital and 67 per cent at Edmonton's Misericordia Hospital. That means more emergency stretchers are freed up for new patients.
"That is absolutely huge," Zwozdesky said. "It's way beyond what anybody thought it would be but it shows you the action plans are working."
Overall, the numbers of admitted patients waiting too long in emergency wards has gone down 42 per cent in Edmonton and 68 per cent in Calgary. Edmonton sees more patients from out of town, who are more difficult to discharge, and also has specialized transplantation programs where patients tend to stay longer.
"We've got a ways to go yet, but at least the trend is going in the right direction," Zwozdesky said.
But Alberta Health Services still has not reached its March-end target to have 45 per cent of all admitted patients out of emergency and into another ward bed within eight hours. In Edmonton, only the Misericordia Hospital hit that target in the week of Feb. 27 to March 5. The week before, none of the five major hospitals in Edmonton hit the target, with doctors succeeding in only 32 per cent to 40 per cent of the cases.
Patients who can be discharged after care are supposed to be seen and out the door within four hours, but only the Misericordia hit the target last week of 70 per cent of all patients. The Stollery Children's Hospital came close, with 69 per cent of patients heading out the doors within that time frame.
Improving wait times will take longer than tracking the number of emergency in-patients blocking beds, said Dr. Chris Eagle, acting CEO of Alberta Health Services.
"The complexity and volume of our cases in emergency departments is anything but simple and that's why length of stay (in the emergency rooms) is and will be a bigger challenge and why it will take longer to reach those targets," Eagle said. But he said patients are seeing the emergency doctors for medical assessments more quickly simply because there are more available beds.
Some patients also need more than four hours of care, said Dr. Cheri Nijssen-Jordan, a pediatrician and emergency doctor in Edmonton. Heart patients, for instance, need duplicate tests to ensure they can go home.
"In some cases, it is absolutely appropriate that a patient is there for a longer period of time," Nijssen-Jordan said. She also said wait times have stayed high because of the winter's seasonal spread of respiratory illness, especially in children.
Even so, more emergency stretchers have been freed up to treat them. In September, there were an average of 80 patients in Edmonton and 68 in Calgary waiting in emergency for beds in other hospital wards.
In February, those numbers sat at 47 in Edmonton -a decrease of 42 per cent -and 22 in Calgary, a 68-per-cent decrease.
New patients are therefore going to hospital and seeing nurses or doctors for faster care, Nijssen-Jordan said. "That is making life in the emergency department a lot better for both the staff, the physicians and most importantly the patients."
"Door-to-doc" times are down, said Dr. Randy Cunningham, an emergency doctor at the Royal Alexandra Hospital who used to see 25 to 30 of his emergency beds filled every day with people waiting for space elsewhere. Now, only about 10 of those beds are filled up each day, he said.
It may take patients longer to get through the system, but "we're seeing people faster and that's really the key issue with emergency care," he said. "You don't
know who's in the waiting room. They could be somebody with a very minor illness or somebody who is going to die within the hour."
Once patients are assessed, some may be moved back into a chair to receive medication or wait for a lab test, Cunningham said. "In emergency we're realizing you don't need a bed to treat a patient."
And patients may be discharged only to sit in the waiting room again, conceded Eagle. But if that frees up space for sicker people, so be it.
Same goes for admitted patients who may be the third patient being cared for in a room meant for two. Eagle said that isn't happening more than it did before new protocols were brought in to free up patient jams in the emergency ward. Nor has he heard patient complaints, since most understand change is needed.
"I also challenge the notion there is a crisis in health care," Eagle said. "Yes, we have challenges to overcome but every health system in Canada is facing those challenges."
David Eggen, executive director with Friends of Medicare, said the problem of overcrowding hasn't been solved.
"This simply means patients are being moved from the hallways of the emergency into the hallways and nooks and crannies of the hospital wards," Eggen said in a statement. "This so-called push protocol just moves the capacity problem from one place to another."
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