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ER protocols haven't erased problems

It's been two months since Alberta Health Services (AHS) launched new overcapacity protocols aimed at easing patient backlogs in emergency rooms, and while hospital officials claim the measures have resulted in improvements, others say challenges per

It's been two months since Alberta Health Services (AHS) launched new overcapacity protocols aimed at easing patient backlogs in emergency rooms, and while hospital officials claim the measures have resulted in improvements, others say challenges persist.

"They're kind of limping along. Many days they work and some days they don't," said Dr. Daniel Hryciuk, an emergency room physician at Sturgeon Community Hospital.

"There is certainly a commitment to try to implement [protocols] during the day, anyway."

Since the protocols were introduced on Dec. 20, staff at the Sturgeon have identified 10 beds throughout the hospital where patients in the emergency room can be moved if one of six triggers are met: the ER being more than 110 per cent full; a 100 per cent capacity for the hospital overall; percentage of patients being treated in emergency exceeds 35 per cent of beds; more than five ER patients have been waiting longer than eight hours, among others.

Wendy Tanaka-Collins, the Sturgeon's site director, said the new provincial protocols have assisted in the movement of patients through the hospital.

"We feel that the flow has improved," she said earlier this month.

"I certainly think the … plans have really helped in terms of identifying when patients are having to be moved or need to be moved."

But Hryciuk said sometimes in-patients are moved out of the ER but staff are unable to find them beds in other parts of the hospital.

"So they go to the IV therapy clinic or to the out-patient department during the day but then when those departments shut down in the evening, those patients come back to emergency if they haven't been able to find a bed upstairs," he said.

"They try to do things as best they can but some days, there are just no places upstairs for the patients to go," said Hryciuk.

Tanaka-Collins said it's difficult to know how many times the triggers have been met in the last two months.

"The plans are always in place, and whether we trigger, it varies," she said, adding that sometimes the hospital is triggered only for a short period of time.

Nighttime wait

For the Sturgeon, exceeding 35 per cent of ER beds or when five or more patients have been waiting more than eight hours for a bed are both are common triggers.

"Typically for Sturgeon, when that happens it's usually because the patient is admitted around 8 p.m. in the evening. We don't see a lot of discharges through the night," Tanaka-Collins said.

Although those patients have usually been waiting more than eight hours by 7 a.m. the next day, Tanaka-Collins said they're moved immediately following the hospital's 9 a.m. bed meeting.

Although the new protocols have helped create additional capacity, Tanaka-Collins noted that doesn't mean the hospital never has any admitted in-patients in emergency.

"We might start the day off with eight admitted in-patients in [emergency], but by the end of the day, we will have moved at least four or five of those patients to an in-patient bed," she said.

"Ambulances continue to come, patients continue to come so then they will come into the department."

Frustrating wait

One of the most frustrating aspects of Sturgeon's ER is not knowing how long the wait will be, says St. Albert resident Lee Hammond.

When he took his daughter to the ER with a broken nose earlier this month, Hammond said it took between 5.5 and six hours to see a doctor.

"The big problem is they don't give you any indication of how much longer you're there," he said.

"And with a broken nose, you can't just give up and go home, you've got to make sure it gets set if it needs to get set," he said.

Although Hammond said his daughter was sent for X-rays within 30 minutes, it was several hours before she was assessed by a nurse. While waiting for a doctor, Hammond said he was "lectured" by a nurse when he pressed for more information on how long the wait would be.

"I'll admit it, I'm not the word's most patient guy but by this point, we'd been sitting there for five and a half hours," Hammond said. "The last thing you need is a lecture from a nurse. You need a little understanding and you need people to say, OK, there are three people head of you, it's probably going to take two hours."

After seeing the doctor for "two minutes," Hammond said his daughter was finally sent home. He said the next time he needs to take his daughter to the emergency room, he'll go to the Stollery Children's Hospital in Edmonton.

"If you want attention in the emergency department, I hate to say it, but you've got to be the squeaky wheel cause they'll let you sit there all night if you don't say anything," he said.

Currently, AHS does not post ER wait times data on its website for hospitals outside Edmonton or Calgary.

Health Minister Gene Zwozdesky told the Gazette earlier this month AHS is working on making more information available online.

"Alberta Health Services has committed to posting as much information as quickly as possible so that everyone will be able to watch and monitor and so on," he said.

Zwozdesky said the province's five-year Health Action Plan will increase transparency and create a stable, predictable planning tool.