ER doctor details politically 'downplayed' crisis facing Saskatoon hospitals during 4th wave
'There's a chance of a bad outcome if we don't do something now': Dr. Paul Olszynski
Dr. Paul Olszynski has been working in Saskatoon emergency rooms for 14 years and he's never seen the system under as much strain as it is right now under the fourth wave of the COVID-19 pandemic.
"There's a chance of a bad outcome if we don't do something now," he said.
On Wednesday, Saskatchewan's Ministry of Health reported 321 new cases of COVID-19 and four more deaths from the disease.
There are 134 infected people in hospital across the province, including 30 people under intensive care — the highest number of concurrent ICU patients since early May during the pandemic's third wave.
Nearly half of those currently hospitalized with COVID-19 — 44 people — are lying in Saskatoon's Royal University, St. Paul's and City hospitals, where Olsynzski works in the emergency departments.
"Unequivocally, we are under significant strain," he said, noting that it's a combination of non-COVID and COVID patients that's causing so much pressure, resulting in staff burnout.
"People just unable to pick up shifts, take on more shifts, and in some cases, people pulling back a little bit because they don't feel like they're working in a safe environment or don't think they can provide the care that they think they should be able to," Olsynzski said.
Then there's the added challenge of a virus running "completely unchecked" among about 300,000 unvaccinated people, Olsynzski said.
"That's essentially like unleashing the virus on all of Saskatoon."
Further complicating matters is what Olszynski describes as a lack of support and recognition from the Saskatchewan government.
"Our government officials have not identified the situation and presented it to the public," he said.
In a candid and wide-ranging interview, Olszynski began by outlining how he treats a wide spectrum of COVID-19 patients: from people who are only showing mild symptoms but come to emergency rooms anxious about it, to "people really at a critical stage of illness presenting after maybe being home sick for some time and actually needing immediate lifesaving care."
CBC: Are some people maybe waiting too long before they present to hospital while infected with COVID?
This is the really challenging part of this disease and also some of the fallout from the politicization and controversies around it is that, yes, I do think we're finding some patients who maybe are waiting too long and they might have their reasons for. I'm not sure what that might be, but they're coming in quite sick. And then other people, like I said, coming in with milder symptoms.
Patients can actually have quite low oxygen levels and not really be aware of the fact that they have such low oxygen levels. It's one of the kind of peculiar manifestations of this disease.
On Monday, during Premier Scott Moe and chief medical health officer Dr. Saqib Shahab's first joint news conference about COVID-19 in several weeks, Shahab spoke a little bit about the general trend they're seeing, which is most of the people showing up in the hospital were unvaccinated and middle-aged. Is there any sort of anecdote or experience you can recount that helps put a face to this person and might explain to the public why we're seeing so many people end up in emergency rooms right now who are unvaccinated?
Concepts like vaccine equity and availability are pretty complex. We know there are people in the community who simply don't have the opportunity to get access to vaccine, are struggling with other issues that seem to be a greater priority to them and very much likely could be. That's why it's encouraging to see pop-up clinics. There is also a subgroup of patients who I think want to be healthy but for various reasons have been misguided or misdirected on the nature of, for example, masking as well as vaccination. So we're working hard to get the real evidence out.
I recently cared for a patient who used ivermectin, and that was certainly, I don't think, helping the situation. It really is about supporting the evidence, making sure people understand how safe the vaccines are, how effective masking indoors is, and that those are ways we can mitigate this virus, especially as we enter a school season with a large population of children who aren't eligible for vaccination at this time.
I continue to, obviously, wear appropriate personal protective equipment when we're taking care of patients in the emergency room. But I also continue to wear masks when I go into public places and when I go into stores. And that's partly because I know that even with immunization, there's a chance that I could be exposed to the virus and then pass it on to someone. And I have friends and family with children under the age of 12 who can't yet be vaccinated. And so to decrease the number of people getting the virus, it's a small, small thing that I can do to decrease transmission.
Our emerg was so full last night that I interviewed patients outside the front doors! We are trying to give good care but it gets a little harder every day. <a href="https://twitter.com/hashtag/indoormasking?src=hash&ref_src=twsrc%5Etfw">#indoormasking</a> <a href="https://twitter.com/hashtag/agitate?src=hash&ref_src=twsrc%5Etfw">#agitate</a>—@Joanna_jds114
One of your colleagues, Dr. Joanna Smith, tweeted on Tuesday that the emergency room at Royal University Hospital was so full she had to interview patients outside the front doors. Can you expand on what she's describing and whether you have had the same experience?
When an emergency department is at capacity, it means that essentially every dedicated patient space, every bed, has been occupied. We've been working in that kind of a state now for several weeks, where, for most of the day, almost all, if not all, beds are occupied. So we start something called waiting room medicine. We'll go out to the waiting room. We'll see the triage stack. There'll be a list of patients waiting to be seen. And what we try to do is figure out which ones do we need to see in the waiting room and pull them from the waiting room and get the interview going, maybe get even lab work started.
It is far from ideal, and I would say even just substandard.- Dr. Paul Olszynski on Saskatoon's crowded ERs and the resulting impact on some patient interviews
Sometimes, to be able to get a reasonable interview, we really need to create some sense of privacy. We're pulling people behind curtains in hallways or in this case, maybe even seeing them outdoors, because you're trying to establish a therapeutic relationship. You're trying to get their history in a confidential way. And there's really no room in the department to do that. And so I think this was a situation where Dr. Smith felt like she needed to talk to the patient and this was the only place that she felt that she could do so with some sense of confidentiality.
I find myself bringing patients into hallways. I'm sitting close to them, trying to bring down the volume, so to speak, so that we can have a conversation about their chief concern in a way that doesn't completely compromise their privacy. It is far from ideal, and I would say even just substandard.
The emergency room at Royal University Hospital is newly designed, correct?
Correct. It's a significant improvement on the previous department. But it's hard to plan for something like this. I think we've been doing our best with the space. There are some shortcomings. We frequently hear concerns about the size of the waiting room. But the physical space isn't actually the main constraint, it's really that we're running out of human resources. We are unable to staff our departments today.
St. Paul's Hospital is six nurses short in the emergency room. But we know that that's beyond just emergency room. We know the wards are short staffed. I think that's attributable to the fact that we've been doing this for so long and we're starting to see the effects of burnout.
I wouldn't mind sharing what it means for me and maybe my colleagues would agree.
[In] emergency and acute care, there's always been a component of adrenaline, of tense moments and a vigilance. That's the nature of the profession. Emergency teams have to be able to ramp up, move in faster and coordinated ways to choreograph the resuscitation of a critically ill patient. And if you ask most of my colleagues, nurses, physicians, respiratory therapists, they'll tell you that has always been actually some of the more rewarding work. But of course, that adrenaline starts to run in short supply.
WATCH | Dr. Paul Olszynski on the danger of staff burnout
During a typical shift pre-pandemic, you would have maybe one or two such resuscitations during an eight-hour shift. The resuscitation might last an hour. You kind of take a moment. The team kind of winds down a bit and then you move on to taking care of the next patient and preparing for the next resuscitation. So that level of vigilance can come down a bit. But when we're in a state that we're in right now — where we're in a perpetual overcapacity state, when we've had to completely rearrange the resuscitation choreography to accommodate the fact that we have patients coming in with an airborne virus that is potentially lethal — then you start to see that actually that level of vigilance is being sustained.
After days and days and days of that kind of high vigilance, I think you start to go numb.- Dr. Paul Olszynski
You can only sustain that kind of vigilance for so long. So then what happens? Well, after days and days and days of that kind of high vigilance, I think you start to go numb. And I think we feel and it's certainly for me, the minute I start to feel numb, I start to worry that I'm going to miss things. Because, again, once you're numb, it's hard to trigger that adrenaline response because it's just not there anymore. And so you start to think, 'Geez, I'm not reacting to this chest pain patient and I'm not initiating the kind of care that I normally would be. I'm not getting them on a monitor as quickly as I normally would be. And for the safety of patients, I need to step back.' I think that's what you're seeing.
What message do you have for our province right now about what it can do to help you and your colleagues?
I think what makes burnout worse is a feeling of being abandoned or not supported. And I do feel like the crisis in our emergency departments is being downplayed. And that's tough. That's frustrating because we are struggling. When we look around, we don't seem to get the kind of support that we feel like we could benefit from. And I think that's why a lot of people are reaching out or agreeing to speak with media, even if you're someone like myself who has no media training. And I think it's because we're compelled to raise attention to this issue. The departments are at a critical straining point. There are things that the province and that the public can do to help us.
Simple measures work. Masking in crowded spaces works to decrease transmission. The evidence is abundant and strong: masking will decrease transmission rates, which will decrease the number of patients present in the emergency room with COVID symptoms. Vaccination is a very safe and effective way of preventing significant illness and critical illness from COVID. That is another key piece.
I'd also encourage patients to consider reaching out to the community-based resources if they're experiencing mild symptoms. We want them going to the testing centres. We do want them seeing their community-based physicians if they're feeling sufficiently well.
But at the same time, we want to make sure that people do understand that in emergency departments, we are never on bypass. We will always have our doors open and we will do our best to give them the best possible care.
Just to be clear, are you saying the crisis in emergency rooms is being downplayed by the provincial government?
That's a challenging question. It strikes me that our government officials have not identified the situation and presented it to the public. They have not acknowledged it and raised the issue and so we're reaching out to raise the awareness.
The ‘health’ of the emergency department is a bellwether for the state of the entire healthcare system. The fact that ours is very, very sick should concern us all because one way or another, it will likely end up affecting you or someone you love. <a href="https://t.co/14CjsFSwEC">https://t.co/14CjsFSwEC</a>—@hinz_tamara
How much longer can these emergency departments bear this unprecedented strain you've described?
We're going to try to keep being there for people as long as we can. Unfortunately, I fear it will be a bad outcome, a critical incident that will happen, that will result in a harm that didn't need to happen. And that's what I think most of us are afraid of, and I think that's why we're speaking because we really don't want it to get to that point. We're seeing things happen that we know are stretching us.
The system is designed to have redundancies so that even if there's a slip or a gap in one aspect of care, somewhere else it's kind of blocked. But as we continue to be understaffed [and] further experience burnout, those layers are slipping. There's a chance of a bad outcome. That's what I think is imminent if we don't do something now. We had the incident in Manitoba recently at St. Boniface emergency department. If we don't do something, it's a matter of time where we're going to have that kind of a critical event.
What's the worst-case scenario?
I think we're afraid of patients suffering a cardiac arrest in a waiting room, whether that's related to a cardiac event or whether it's related to an uncontrolled infection. I think the fear is that something's going to happen. And because we're so stretched, we might miss the opportunity to act where we could have acted. And I think the people that work in Saskatoon are among some of the best. And I certainly have always really cherished working with the team here. We work by supporting each other. We communicate to each other.
But when we're stretched like this, it's almost impossible to just keep tracking everything, especially when your waiting room starts to fill up.
The interview has been edited for length and clarity.