INDEPTH: HEALTH CARE
Calgary difference: A booming population and strained hospitals
CBC News Online | October 5, 2006
Miscarriages in Calgary hospitals
July 2006: Rick and Rose Lundy repeatedly asked for help for three hours, but were told they'd have to wait for a bed.
September 2006: Margaryta Marion, 27, said she miscarried after waiting more than six hours.
September 2006: Erin Wilson began miscarrying in the packed emergency room and was denied a private place to go despite asking for help. She had waited for six hours.
It's an event that easily grabs attention. A woman has a miscarriage in a crowded Calgary emergency waiting room. Days later, it's revealed that another woman also miscarried in an emergency room in the same city, awaiting treatment. In three months, it's the third reported case.
The city's regional health authority apologizes, and announces that it'll provide more social work support in these emergency rooms. "Due to high patient volumes and increasingly complex situations, meeting patient expectations within our emergency departments is often difficult," Calgary Health Region President Jack Davis said in a statement after the incidents.
In Calgary, it's boom time, with a population that has exceeded the one million mark — and prosperity is the name of the game. But there's also another story, about a health care system that is being pressured. The Calgary Health Region has already made plans for the future, embarking on major capital projects to increase beds and capacity. Although there are similar problems in emergency rooms across the country — a shortage of physicians and beds — there is a Calgary difference.
|Calgary emergency department visits
|% 5-year growth
The Calgary difference
The makeup of Calgary's population is unlike that of other major Canadian cities.
For one, it is a younger city. In 2004, 13 per cent of Canada's population was over the age of 65. In Calgary, the percentage of its population of seniors was at 9.4 per cent. Other major cities are closer to the national average, such as Montreal (15%), Toronto (13.3%) and Vancouver (12.2%). But, notes Don Stewart, a spokesman for the Calgary Health Region, there are also more older people coming into Alberta from other provinces.
And this is happening in a city that is also experiencing a bit of a baby boom. Census figures show its population growth in the past year was the strongest in its history, jumping by 35,681 citizens. Much of that growth was due in part to a high rate of births. This year, about 15,200 babies are expected to be born in Calgary — a number officials didn't anticipate would be reached for another four years. Provincewide, Alberta's birth rate is matched only by Ontario's.
Dr. John Cowell, the CEO of the Health Quality Council of Alberta, told CBC.ca that the challenge for Calgary is to build the "instant infrastructure" to go along with a booming population. His organization has been asked to review Calgary's hospital care services and to make recommendations on how to improve emergency and urgent care.
"The population growth only intensifies the emergency room problem," Cowell said. "I'm absolutely sure you see it in every emergency room."
More patients who need urgent care
In the past five years, the number of visits to Calgary's four urban emergency departments, including the children's hospital, rose three per cent, or to 258,800 from 251,200. In that period, patients with urgent but non-life-threatening needs have had longer waits. At the Foothills Medical Centre, the median wait time was 56 minutes last year, compared with 34 minutes in 2002. In another hospital, the Peter Lougheed Centre, the median wait time went to 40 minutes last year from 27 in 2002.
Calgary also sees more patients who need urgent care compared with other emergency rooms across the country, according to a study by Canadian Institute for Health Information. Hospitals typically rank incoming patients by a five-level system — with the top three deemed as urgent and the bottom two as non-urgent. In Calgary, 71 per cent of its patients fall into the top three categories — they are in need of urgent medical care. Compare that the to situation in Toronto, where 63 per cent need urgent care, and to the rest of the country, in which 44 per cent of patients need urgent care. Thus, patients who enter Calgary emergency rooms are more likely to actually need emergency care.
On top of that, says Stewart, Calgary hospitals have a very high admission rate — 25 per cent. "The sickest people are seen first, and the most critical cases as well," Stewart told CBC.ca. "That leads to a longer wait time for others. That's just the reality of how emergency rooms work."
Cowell agrees that there is "considerable stress" on Calgary emergency rooms as a result of the growing population. Each of the three major hospitals has about 200 people come into the emergency room every day. "The real emergencies, those cases which are heart attacks or life threatening situations, they are seen extremely quickly," Cowell said. "For those cases that are in the lower end of the scale, there is a fast-track system to move them, but the real problem is that vast group of people that [don't fall into the category] of emergency."
What's the cure?
Calgary already has a major capital plan under way and it cites nine separate projects in the city. One plan that would address the need is the South Health Campus, a research and teaching institute, that is being built in the city's south end. Once it's up and running by 2010, it will add another emergency department and 350 beds. From 2000 to 2006, the health region boosted its total number of bed spaces by 21 per cent, or more than 1,200 extra beds.
Other measures, Cowell said, include addressing the shortage of family doctors and walk-in clinics, especially during weekends and during the evenings. The CIHI study found that during regular weekday hours, 23 per cent of people go to emergency rooms for minor health problems. But that percentage soared to 53 in evenings and weekends and up to 93 per cent during the night time.
Alberta also has a Health Link program — a 24-hour telephone line answered by nurses to give people medical advice. "Programs like this are emerging, but they are not growing fast enough," Cowell said.
Since the report of the first patient's miscarriage while waiting for treatment, the region has looked to have staff observe patients more closely, train nurses to communicate with patients and review how to treat patients experiencing a miscarriage.
Despite the news coming from the strained system, the perception is that Calgarians are happier with emergency room service. A survey by Cowell's council says 55 per cent of Calgarians found they were satisfied with the emergency services that were provided in 2006, compared with 40 per cent two years earlier. Meanwhile, at the other end of the scale, a quarter of residents surveyed say they were dissatisfied with their emergency services, down from 39 per cent two years ago.
"Overall, Calgary is doing a better and better job in its emergency services," Cowell said. "But unfortunately, the recent events do highlight that there are lots of areas for improvement and situations that are regretful."