METRO VANCOUVER – When more than 100 patients overflowed the 48 beds in the Royal Columbian Hospital’s emergency room late Monday and early Tuesday, officials looked across the hall at a Tim Hortons outlet and started moving stretchers in.
ER doctor spokesman Dr. Sheldon Glazer said it was better than the alternative of treating more people in hallways, as it allowed for better care and privacy.
Overflowing emergency rooms have been a long-standing problem in Lower Mainland hospitals. The problem is in part due to delays in transferring people out of emergency to beds in other wards.
The provincial health ministry measures the length of time it takes patients who are admitted through emergency rooms to get a bed. The provincial target calls for 80 per cent to be transferred within 10 hours.
None of the hospitals in the Fraser Health or Vancouver Coastal Health region have met the target so far this year.
Fraser Health Region CEO Dr. Nigel Murray said all hospital ERs in the region are 10-per-cent busier this year over last because of population growth, but “[Monday] was an exceptional day with traumas related to motor vehicle accidents, including three patients who were transported by helicopter.”
“At one point, doctors were resuscitating three severely injured citizens. All hands were on deck and the great news is that our staff performed exceptionally well.”
While Murray and acting health minister Colin Hansen were supportive of the decision to use the café, the incident raised a storm of comment on Tuesday.
B.C. Nurses’ Union president Debra McPherson said the Fraser Health Authority has to “wake up and smell the coffee” and CBC comedian Rick Mercer plans to do a sketch on it for a future episode of his show.
In total, five patients Рsome of whom were ill enough to need hospital admission Рgot medical attention while on stretchers in the caf̩ after it closed at 9 p.m.
With the consent of the café owners, it was converted into an overflow ER space with six stretchers. The area was sanitized, tables and chairs moved out, stretchers moved in and privacy screens installed.
Patients started occupying the beds about an hour after the outlet closed to the coffee and doughnut customers.
Glazer, who was not on duty when the café was used for patient care, said: “It was actually a brilliant idea to open up the Timmy’s area.
“The patients got better care there than they would have in the hallways where we are often putting them two and three deep. At least they had some privacy.
“Treating patients in hallways offers them no level of dignity. You can’t examine them appropriately because we can’t get them undressed,” Glazer said.
Fraser Health spokesman David Plug said strict infection control measures were in place and none of the patients placed in the café had communicable diseases.
“We have never used the Tim Hortons before. And we will have to look at whether we will use it again,” he added.
Glazer said there is nothing new about congestion in the ER at RCH since the problem has persisted for several years. But it is getting worse because of population demographics in the aging and quickly growing region. A capital plan to expand the ER is not being contemplated for several years.
“Our ER is perfectly adequate,” Glazer said, “but the stretchers are filled with patients who need to be admitted to beds on wards upstairs. So, in effect, the ER is holding patients who should be admitted to other beds.”
Minister Hansen conceded the situation is far from ideal but didn’t question the decision to use the café. “The Tim Hortons area is space that can be used in cases of severe overflow and, from the perspective of medical staff, appropriate care was provided.”
Plug said the ER has 18 stretchers, 23 overflow beds, three trauma beds and four pediatric beds and they were all full Monday night. Over a 24-hour period, there were 191 patients in the ER, nearly 20 more than usual. There were several trauma cases because of weather-related motor vehicle accidents, he said.
“There are peaks and valleys to ER volumes in the winter because of the flu. But ironically, flu has not been that much of a factor lately,” Plug said.
Other hospitals in the Lower Mainland have overflow contingency plans but none have resorted to nearby coffee shop areas.
Tracy Tang, a spokeswoman for Provincial Health Services Authority, which operates BC Women’s and BC Children’s Hospital, said there are contingency plans that dictate when additional space should be used.
“BC Women’s, in partnership with BC Children’s, has an emergency management plan for those extreme cases [such as a major earthquake] where the “˜walking wounded’ including adults, might present for medical care since it’s a medical facility. In that kind of situation, there are spaces on the site that could be turned into patient care areas.
For example, a triage/patient care area may be set up in the lobby of the Ambulatory Care Building, she said.
Dr. Eric Grafstein, an emergency physician at St. Paul’s Hospital and spokesman for ERs in the Vancouver Coastal Health region, said he knows RCH has significant problems managing patient volumes because it is a designated trauma hospital and it also treats children. Although there is a coffee shop adjacent to the St. Paul’s ER, Grafstein said he can’t imagine a scenario in which it would have to be used.
“We’ve talked about using a long stretch of empty corridor nearby if we really had to find extra space.”
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