News

This is a crisis'
Patients walking away from emergency rooms in frustration after failing to obtain timely treatment.
Jodie Sinnema, The Edmonton Journal
Published: Friday, January 26 2007

EDMONTON - A growing number of patients are leaving emergency departments before they receive care because of long waits to see a doctor, says a veteran emergency room doctor.

"This is a crisis," said Dr. Raj Sherman, who works out of the Royal Alexandra Hospital and is president of the emergency medical section of the Alberta Medical Association. "The patient in greatest danger is the person sitting in the waiting room, who may not have been seen by a doctor and they leave. They could die if they leave without treatment."

He estimates that at peak times on the busiest days, 20 to 30 percent of patients are leaving the emergency waiting room because of frustration and impatience. Those busy days happen more frequently, said Sherman, who can't remember a single day in the last two months when the 56 beds in the Royal Alex's emergency department weren't at least half-filled with admitted patients who couldn't be moved elsewhere because of gridlock.
People often doze off waiting in a hospital's emergency room.

Sherman is hopeful the situation will improve soon since Capital Health is set to make an announcement in the next few weeks that will help deal with the worsening problem.

"We're ready to try pretty much anything," said Steve Buick, spokesman for Capital Health. "We're opening beds as fast as humanly possible, but we're still seriously short on any given day."

He said the region is considering what emergency doctors call a "full-capacity protocol." Under that plan, emergency patients would be moved to a non-emergency area of the hospital within four hours of being admitted, even if it means they remain in a hallway. That way, emergency doctors say patients will have access to expert medical professionals rather than generalists in emergency.

Currently, patients are waiting an average of 10 to 12 hours -- some up to 11 days -- before vacating their emergency bed for one elsewhere in the hospital. That creates the backlog at the emergency doors.

Sherman said the patients most at risk in emergency departments are not the increasing number of severe and critical patients. Those in cardiac arrest, who are comatose or not breathing, continue to get immediate care.

Nor is the danger to the least critical patients who doctors can sometimes check in the hallways or in the waiting room if necessary.

It's those in between -- assessed at level 3 on a triage scale of 1 to 5, with one being the most critical -- who are not being properly cared for, Sherman said.

That could include a pregnant woman with bad cramps, someone with stomach pain or chest pain, or a child with a fever, Sherman said. They are supposed to be seen by a doctor within 30 minutes, but on bad days when hospitals are clogged, they wait four to six hours before receiving care from a doctor, he said.

The triage nurse would keep a close eye on them, but that nurse must also assess everyone else arriving at emergency doors.

"The responsibility should be on the system, not them," said Sherman, noting that frontline nurses see the brunt of people's frustrations and are often subject to abuse. "When people are made to wait in waiting rooms, it's not safe."

Sherman said a relative of his went to emergency with chest pain and had to wait 50 minutes before receiving an electrocardiogram and another five to six hours to see a doctor. Such patients are supposed to have an ECG within 10 minutes and see a doctor within 30 minutes.

Sherman said he sometimes arrives at work to see six ambulances waiting to offload patients, but unable to do so because all the beds are full.

In December, situations like that led to 14 Red Alerts where no ambulances were available to respond to the next call.

Buick said most people are receiving good care in a reasonable time. He said on average between five and six per cent of patients left emergency departments across the region in the last year.

Worst off were those at the busy Northeast Community Health Centre and the Royal Alexandra Hospital, where an average of 10 per cent of patients left this past year. All would have been assessed by a triage nurse upon entering.

Buick said changes are coming, but couldn't guarantee Capital Health will introduce the four-hour maximum time limit for admitted patients to be moved elsewhere. He said the region may decide to set a different benchmark, such as always having a certain percentage of emergency beds not tied up with admitted patients.

The region is constantly trying innovative things to ease the backlog. Last year, ambulance workers tested a new system where they could leave people with minor problems in the waiting rooms. One pilot project, in which an Emergency Medical Services staff person worked in the U of A Hospital emergency and coordinated ambulance staff, was discontinued because it didn't ease the crunch.

Another pilot project, in which a physician worked at the triage desk with the nurse and assessed people arriving, has been encouraging.

There is talk of having one ambulance team take care of several patients at once. Right now, hospital staff also occasionally take over EMS patients from the ambulance workers so the ambulance is free to drive away. But all those are short-term solutions to a much bigger problem of bed shortages.

Heather Smith, president of the United Nurses of Alberta, said more beds, more staff and more resources are needed. She said she needs to see Capital Health's upcoming plan before giving approval. If admitted patients from emergency are transferred into the hallways of non-emergency wards, they won't have call bells. They may need to have suction and oxygen equipment, and enough nurses to care for them.

"It's not just about the emergency department," Smith said. "You shouldn't be putting people in hallways anywhere without providing staffing resources. We have real issues about patient safety that can't be ignored."