A long time emergency room physician at the Sturgeon Community Hospital said he doesn’t think a new emergency unit at the hospital presently under construction will help alleviate the backlog of patients in the ER because the hospital won’t be getting any additional staff.
It’s just one of the many challenges facing staff at the Sturgeon, according to Dr. Daniel Hryciuk, who was formerly the head of the hospital’s emergency department.
“Alberta Health Services has told us they are not going to staff any more nurses so we will only open about the same number of beds. We will have exactly the same situation as we have today when we open this new department. There will be no difference,” said Hryciuk, who has worked at the Sturgeon since 1980.
Alberta Health Services (AHS) said it hopes to begin a phased-in opening of the new unit by Christmas.
Another serious concern for staff in the emergency department is the lack of adequate admitting services, something he said is unique to the Sturgeon among hospitals in Alberta.
“We are the only department in Alberta who gets stuck with ongoing care of patients. Every other hospital seems to be able to find enough admitting physicians to take care of them,” he told the Gazette on Thursday.
Sturgeon has three admitting services — two general practice and one internal medicine. Hryciuk said the majority of patients at the Sturgeon are admitted through one of these three services.
However, he said each of the hospital’s admitting services will cap the number of patients it will manage in the hospital at around 20.
“When they are at their maximums, they will take no more admissions. Even though the patient needs to be admitted with pneumonia, they will not take them,” Hryciuk said.
“Even if there is a free bed, they will not take them.”
Barb (not her real name), a former nurse at the Sturgeon, said other units in the hospital must keep a certain number of beds free because staff can’t predict how many patients might come through the door.
“If you had emergency surgeries coming in, you were supposed to have a bed for those patients,” she said.
“Which does back up the emergency room.”
Hryciuk said a patient who cannot be admitted to hospital, also called a transfer waiting admission (TWA) is forced to stay in the emergency department.
“They stay in emergency and the emergency physicians transfer the care of that patient every eight hours to the next emergency physician who comes on and this can go on for days at a time,” Hryciuk explained.
Often the majority of those patients were those awaiting long-term care beds. Hryciuk said the government’s failure to make more long-term care beds available is another contributing factor to overcrowding in emergency departments.
“The government has chosen not to build long-term care beds. These are beds where the frail elderly are kept in institutions, long-term care facilities, nursing. The government has made promises of building seniors lodging but they are talking about assisted living, not nursing.”
Barb also witnessed firsthand serious issues of overcrowding at the Sturgeon.
“We ended up on some of the units, I hate to use the word but it’s like stockpiling patients on one unit who are waiting long-term care so that at least on that unit we could have appropriate staffing to look after them,” she said.
“It backs up the whole system. So if we can’t get patients back to either their homes or a home, we also can’t admit patients. As long as all the beds are filled, there is nowhere to put patients in emergency and who need to be admitted in emergency.”
Barb said this puts added pressure on nurses and can potentially create issues with patient safety.
“I think patient safety is always a concern and any time you have any of these systemic issues, you have overcrowding in your emergency department, so your emergency nurses are dealing with far more patients than they should be looking after just because of the number of patients who come through the door,” she said.
According to a third quarter report from AHS, patients at the Sturgeon experienced a median wait time of 19.7 hours from the time when they first received care in the emergency department to the time when they entered the hospital as an in-patient. Sturgeon had the second highest median wait time in the province.
Presently, the emergency department at the Sturgeon has 20 beds but Hryciuk said between one-third and 90 per cent of these beds are routinely blocked.
“The largest portion of backlogs in emergency are because of emergency in-patients — patients who we have found an attending doctor for, who cannot be admitted to the floor in the hospital because all of those beds are blocked and there is no place to go,” he explained.
Hryciuk said the situation at the Sturgeon has deteriorated significantly over the last few years, one of the reasons why he and his colleagues supported the letter sent by Dr. Paul Parks, the Alberta Medical Association’s section head of emergency medicine, to Health Minister Gene Zwozdesky earlier this month. In it, Parks warned of a potential collapse of emergency rooms in Alberta if something wasn’t done soon.
“Every six months it gets worse and worse and we at the Sturgeon got together and wrote our administration on the issue of emergency order crowding and the TWA issue back in 2007,” said Hryciuk.
Another issue, he said, is the fact that the Sturgeon is funded as a rural hospital even though it’s located in an urban area. While he has brought the issue of hospital designation up with senior administration, he said the issue has “fallen on deaf ears.”
“We are funded like Stony Plain, Fort Saskatchewan, Leduc, even though we receive and manage care like an urban hospital,” he said.
“On nights, if people get sick then we can’t get replacements, nobody helps out. We are quite overwhelmed sometimes and underfunding seems to be an issue. We have addressed that,” he said.
Earlier this month, Alberta Health and Wellness unveiled an aggressive strategy aimed at easing pressure on overcrowded emergency rooms that involves opening approximately 250 acute care, transition, hospice, detox and continuing care beds in Edmonton and Calgary and increasing home care funding to help patients avoid going to the emergency department.
The government has also pledged to implement a new discharge process for all hospitals in Alberta and to expand HealthLink Alberta services to provide patients with real wait time information for their local hospital.
After meeting with Parks on Wednesday, Health Minister Gene Zwozdesky, promised to reduce hospital wait times to a maximum of four hours from the time patients arrive at emergency to the time they are treated and sent home. Patients needing hospitalization will supposedly wait no more than eight hours before they are given a bed in another ward.
The targets are slated to be in place by Christmas.
But Hryciuk is skeptical that these targets will be met in the timeframe set out by the province.
“They are very ambitious when we have no admitting services at present, when we have no long term care, when we have no beds to put patients into,” he said. “As an emergency physician who has been involved in this for a long time, I am very skeptical these eight-hour benchmarks can be met.”
Barb agreed.
“I don’t think they have any idea what’s actually happening in hospitals, I don’t think they’re realistic. I don’t think they have a plan in place to deal with the patients that are already in hospital,” she said.
“As long as you don’t have empty beds, and most hospitals don’t have empty beds, then you don’t have anywhere to admit patients.”
