Manitoba health minister reacts to ER criticisms

Manitoba's health minister is defending changes made in emergency rooms since Brian Sinclair's death five years ago.

Theresa Oswald urges nurses to speak out but touts changes province has made

Theresa Oswald said many initiatives have been put into place since the 2008 death of Brian Sinclair but she urges healthcare professionals to come forward with any other concerns that need to be addressed. ((CBC))

Manitoba's health minister is "deeply concerned" about the health of our hospital emergency rooms and the health care staff who are afraid to talk about it.

"I strongly encourage them to bring that forward, I don't think that they should fear reprisal," Health Minister Theresa Oswald told CBC News on Monday.

She was reacting to a CBC series that looked at Winnipeg's emergency rooms, particularly how they've fared since the 2008 death of Brian Sinclair, who died in the Health Sciences Centre's ER during his 34-hour wait to be seen by medical staff.

An inquest is currently being held into Sinclair's death, to expose and repair the weaknesses in the healthcare system that led to Sinclair's death.

The CBC series, which ran last week, quoted several nurses, past and present, who described dysfunctional conditions highlighted by chronic short-staffing, a  chronic bed shortage, and a chronic risk of subpar patient care.

Nurses told CBC they are understaffed and can't meet policy guidelines.

"Well, certainly in the shadow of the Sinclair inquest, I'm deeply concerned in the fact that I want Manitobans to get the best possible care in emergency rooms," Oswald said on Monday.

"And there were lots of initiatives that were put into place, you know, in the days, weeks and months following his death. But we want to make sure that those initiatives … are sufficient … and indeed that staff are feeling supported in the incredibly challenging work that they do."

Whistleblower protection

She also said protection is in place for staff who described a climate of fear, where speaking out about the conditions could lead to dismissal.

"I am keenly interested in what they have to say and in any changes we can make," Oswald said.

Manitoba was the second province in the country to introduce critical incident reports  a protocol in place for staff to record and assess incidents where patient care has suffered. That, combined with another NDP initiative that protects whistleblowers, should reassure fearful health care workers, Oswald said.

There's no really possible way of improving the situation if no one's willing to talk.- Theresa Oswald

"Frontline professionals can come forward if they see a mistake, if they see something is compromising patient care, where they can come forward, tell their story and that they don't need to fear that there will be reprisal because their name is splattered about everywhere," she said.

In fact, there has been a significant jump in the number of critical incidents being reported, she noted.

"(Critical incidents) were being swept under the rug; they weren't being talked about, and there's no really possible way of improving the situation if no one's willing to talk," Oswald said. "So it is good to see an increase."

She also cited the change to triage service, where a second nurse can now be assigned to work a waiting room and re-assess patients waiting to see a doctor, is another example of their efforts to improve services.

However, nurses told CBC that's relatively ineffectual, since most often they're far too busy with a backlog, to be freed up to re-assess patients.

They also told CBC those critical incident reports rarely get properly addressed, even though Oswald said they're supposed to acted upon immediately and transparently.

"If indeed that reassessment task is not happening most of the time, then there is the authority for the RHAs [Regional Health Authorities] to hire additional staff," Oswald said.

Criticism "respectfully" dismissed

She also responded to criticism from Alan Drummond, of the Canadian Association of Emergency Physicians, who said one of the key causes of overcrowded ERs is a chronic bed shortage, and the refusal by RHAs to address it.

It's criticism that Oswald "respectfully" dismisses. She said they're taking pressure off the hospitals with "hospital hometeams" initiatives, wherein doctors pay house calls to "frail, elderly clients," reducing their visits to ERs by 50 per cent.

While she said the NDP government fulfilled its 1999 promise to add 100 beds to the system she did not commit to a further increase, saying adding more beds is not the only solution.

Special clinics like the mental health crisis response centre, and a soon-to-be-opened quick care cancer clinic, will help to reduce the pressures on the ER, she said.

"Beds, additional staff, expert triage, alternative places to go, making sure we have more long term care facilities in the system," Oswald said are all examples of efforts they're making to reduce the strain on the ERs.


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