A central Edmonton hospital has introduced new rules in the emergency department where a stabbing took place earlier this month.
Alberta Health Services says all patients and visitors to the Royal Alexandra Hospital will now be limited to one bag per person before they are allowed to enter the ER.
Those who work in the major trauma centre’s emergency room, which staff say is the busiest ER in Edmonton and sees about 200 patients a day, are optimistic about the changes — as long as they are implemented with some common sense.
“As long as it’s done compassionately, I’ll be the first in favour,” said Dr. Louis Hugo Francescutti, an emergency physician at the Royal Alex and professor at the University of Alberta.
“I work there just like everyone else does and we want to be safe working, but we also want our patients and visitors to be safe while they come to the emergency department.”
AHS said security will have methods in place to securely store extra bags if needed — something Francescutti said is going to be key for a large sector of the population that specific emergency room sees.
“We proudly serve the inner city, and these men and women — trust me — it’s hard for them to go into the emergency room unless they really need it,” he said. “If they’re bringing their three bags and everything they own is in those three bags, it’s almost impossible to separate them from it.
“We can’t, because of one unfortunate incident, punish everyone that comes to the emergency department.”
AHS said the hospital’s security team will search all bags before entering the ER to ensure no weapons or prohibited items are brought in, which is something the United Nurses of Alberta has asked for.
Francescutti said that’s where compassion and discretion will play a factor.
“If you’re going to limit people to one bag, what are you going to do with folks that are houseless and everything they own is in two bags or three bags? It’s our responsibility to make sure that we safely secure their limited possessions till they’ve finished their medical visit and then give it back to them.”
Many of the patients showing up at the Royal Alex emergency room are from Edmonton’s inner city, Francescutti said. Some are living in poverty or homelessness, and don’t have their own family doctor.
“We are their primary care providers,” he said. “So what we need to do is say, ‘How can we better meet the needs of our patients?’ It’s not up to them to meet our needs. It’s up to us to meet their needs.
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“So security enhanced, yes — but there has to be compassion and there has be a little bit of latitude.”
Reducing the number of bags laying around will help by keeping floors clear of tripping hazards, AHS said, as well as ensuring chair and table space is available for patients and whoever accompanies them.
Exceptions will be made for those who require additional bags for medical devices or supplies, or child care items, which Francescutti said is reasonable when families show up.
“What about a mom who’s got three kids with her? She’s probably going to need more than one bag of supplies,” he said. “The last thing we want to do is turn it a fortress.
“I think it’s well-intended and I suspect that our security personnel are going to use their discretion to make sure that we’re not you know singling out someone and punishing them just for showing up to the emergency room.”
The emergency medicine team at the Royal Alex, in Francescutti’s words, runs a pretty tight ship and doesn’t put up with abuse — which he noted has been on the rise lately.
The UNA says nurses face “threats of violence almost daily” and has advocated since 2023 for a weapons detection system at the Royal Alex and other Alberta hospitals with busy ERs.
A UNA survey of members last year found four in 10 nurses experienced physical violence in the previous 12 months, which included being hit or punched.
The province said a request for proposals for a weapons screening program for the Royal Alex has closed, and the government is “working to accelerate implementation timelines.”
The policy changes come after a stabbing occurred in the packed Royal Alex emergency room waiting area on Friday, April 3. A fight broke out between two men, leading to a 42-year-old man suffering serious, life-threatening injuries.
Police said the other man was found with three “edged weapons” and has since been charged. Francescutti said that was an exceptional circumstance.
“By and large, it is a safe environmental. That incident was unfortunate. The waiting room was crowded at the time. You know, stuff happens.
“I mean, the emergency department’s not where you go to expect to be stabbed, right?”
After the stabbing, the UNA also called on the province to acknowledge violence in emergency departments is linked to overcrowding and lack of capacity.
In addition to the new bag policy, AHS says going forward, all patients seeking care in the ER may only be accompanied by one visitor or support person.
AHS said that limit will help reduce noise and provide more space for those who need to be there.
“The one visitor, per patient, I can tell you where it’s not going to work — if a young child comes in,” Francescutti said. “Most of the time, both parents will show up in emergency. So what are you going to do? You’re going to pick one parent over the other. So it’s not going to work there.”
The ER doctor said there may also be situations where a patient requires emotional support, a translator or advocate.
“Sometimes you’re going to have to bend the rules and you know more than one person should be able to accompany that (patient).”
Exceptions may be made in some circumstances, AHS said.
While the changes are a good start, Francescutti said it’s still just a band-aid solution to the gaping wound that is the state of emergency care in the province.
“The real question is, why are there so many patients? And what can we do to prevent so many patients from showing up and, at times, using the emergency department as a shelter?
“What can we do to better meet their needs outside of the emergency department?”
The ER at the Royal Alex is consistently running over capacity with lengthy wait times to see a doctor, Francescutti said, and will continue to do so until they get a new or expanded space that can handle greater volumes.
The province is listening to their concerns though, he noted.
Earlier this month, Hospital and Surgical Health Services Minister Matt Jones spent an evening ER to see first-hand how it runs.
“We’ve had four ministers visit the emergency room. Deputy ministers are visiting on a regular basis. The CEO of the acute care sector spent time there. So I think they’re acutely aware that the infrastructure just isn’t meeting the needs of our patient,” Francescutti said.
Those are complex issues that aren’t new in Alberta and won’t be solved easily — so in the meantime, Francescutti approves of the enhanced security measures.
“There’s going be less tolerance for abuse amongst patients or to staff. And, you know, we’re going to continue to do the best we can.”
General visiting hours for most AHS locations aside from the emergency department will be 7 a.m. to 9 p.m. Exceptions may include end-of-life care, pediatric patients, patients with disabilities and cultural/spiritual supports.
AHS said people with questions about the one bag or one visitor policy can reach out to its patient relations team online or at 1-855-550-2555.
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