ER overcrowding may force MDs to examine patients in waiting room
U of A Hospital asking doctors to help move patients through 'unsafe' ER
The University of Alberta Hospital is asking its doctors to see patients in the emergency waiting room in an effort to solve a growing, potentially dangerous problem with overcrowding.
But doctors at the hospital are worried about their patients’ care, given the long waits and low bed turnover in the emergency department.
An internal email sent Monday by the head of the hospital’s emergency department to all of its doctors was leaked to CBC News. In the email, Dr. Bill Sevcik acknowledged physician concerns but said doctors should do more to help manage patient flow.
"Our waiting room is a very unsafe place," Sevcik wrote. “Leaving our nurses and paramedics out in the waiting room unsupported is completely unacceptable. Any argument to the contrary ignores the moral imperative to care for those in need in the moment.”
Help from doctors could speed the process, he wrote, and allow paramedics forced to wait beside patient gurneys to get back on the streets more quickly.
According to the email, backlog during one shift forced 14 EMS patients and at least 28 EMS workers who were supervising them to sit in the waiting room for up to nine hours while hospital staff worked to catch up.
Physicians have now been asked to step in earlier and help triage nurses determine priority patients in the hopes they can get beds more quickly.
“The reality is that patients are in need at that moment. We have to meet them – that’s our mandate, that’s why we went into this job,” Sevcik said in an interview with CBC.
He said he does not condone doctors asking patients personal questions within earshot of others, and recommends that physicians take patients in the waiting room to a semi-private area near the triage desk before treating them.
Health Minister Stephen Mandel said the government is taking measures to solve the problem but it will take time.
“It is a challenge, I’m not arguing about that," he said. "But at the same time we need to be realistic about what we can accomplish in a very short period of time."
Liberal leader Raj Sherman, a medical doctor, said that the province needs to get staff and open acute beds immediately.
He says people are enduring third-world conditions by getting treatment in a hallway or in a waiting room.
“That’s simply wrong in the wealthiest place in the country," he said.
No easy fix, says ER chief
While Sevcik admits the solution is not ideal, he said there is little that can be done immediately to correct the overcrowding.
“We have to get to our patients, and unfortunately with pressure to the system we have a lot of access block,” he said.
The current crisis is the result of 20 to 30 years of slowly building problems, which could take a long time to fix, he said.
In his email to staff, he wrote: "In a perfect world, I would never have to practice any form of waiting room medicine. Unfortunately that is not our reality now, nor for the foreseeable future.”
Throughout his email, Sevcik made it clear the final decision about whether to venture into the waiting room rests in the hands of physicians.
“I will leave that to your conscience,” he wrote. “Regardless of what each of us decides, what I am advocating, as your Site Chief, is that we support our nurses, especially our triage team, and we keep our patients as safe as possible.”
He also admonished doctors who say they are too busy.
“If the plethora of recent pictures of ED MDs sitting around in the back ‘with nothing to do’ is an indication of current times, then that argument isn't valid anymore.”
Not the 1st time for MDs in waiting room
Kerry Williamson, a spokesperson for Alberta Health Services, said the province is aware of the overcrowding and is “working to address capacity challenges in our emergency departments.”
Williamson said emergency rooms in the city are being kept particularly busy right now because of the cold weather and flu season.
He said the precedent has already been set for sending doctors to see patients in the waiting room.
“Physicians working with patients in the waiting room is not a new or unique strategy and has been used in the past,” he wrote in an emailed statement.
“Physicians working in waiting rooms can help expedite diagnosis by ordering lab work and diagnostics such as ultrasounds and ECGs that can then shorten a patient's waiting time in the department for a diagnosis, treatment, admission or referral to a specialist.”
According to doctors at the hospital, the practice was last put in place in 2010, when emergency room doctor Paul Parks warned of a potentially catastrophic collapse in urgent care.
Other measures now being put in place at the U of A Hospital to help with overcrowding include a request that some “low acuity” patients – such as blood transfusion patients – be shifted to other units, and a bid to open a small number of additional “winter beds.”
Emergency room doctors will meet with management to discuss their concerns on Dec. 18.
With files from Michelle Bellefontaine