Alberta’s emergency departments are “at the breaking point,” according to a new report from the province’s doctors.
The Alberta Medical Association released the latest in its care deficit assessment series on Friday, looking at the widening gaps in care in the health-care system. The latest report looked at emergency departments across the province, how bad the situation is and why.
“There’s too many patients and not enough people to look after them –- ultimately, that is the fundamental concern and the fundamental problem right now,” Dr. Warren Thirsk, an emergency physician at Edmonton’s Royal Alexandra Hospital, told Global News. “And it doesn’t have to be the emergency department.
“There is a shortage of people to do the job. And that means the rest of us are trying to do the job without the number of people and the hours in the day that are required to do it, which leads to the backlog and the wait.”
It’s become a daily phenomenon for Thirsk to start his shift by seeing patients who have been waiting 12 or more hours in the emergency department.
And his hospital is one of many in the province’s cities that are frequently at or above capacity.
That’s a problem Health Minister Jason Copping addressed during recent COVID-19 pandemic updates.
“Emergency departments and EMS are under strain in particular due to high call volumes and delays in offloading delays that happen because some of the hospitals are full, particularly in the emergency departments, and emerge just can’t take the next patient as quickly as they would wish to,” he said on Tuesday.
Alberta Health Services (AHS) data shows visits to ERs dropped by one quarter during the 2020-21 fiscal year, what the health authority called “a drop in volume that is unprecedented.”
But in the second quarter of 2021-22, emergency departments saw a 12 per cent increase year over year.
The physician advocate organization said patients are “being forced to wait too long for essential, urgent care” after arriving sick, injured, afraid or confused, and often in pain.
“Despite the best efforts of health-care workers, front-line physicians report that the care in emergency departments is often sub-optimal because of the growing pressures on our hospitals,” the paper reads.
“The result is missed diagnoses, poorer outcomes and even death.”
Doctorless patients using ERs instead
On Tuesday, AMA president Dr. Vesta Warren provided an update to AMA members of what the board heard from delegates at a weekend forum. She drew a direct line between increased demand for emergency room services and a lack of family doctors in the province.
“Without access to family doctors, more Albertans are showing up in emergency and acute care when adequate primary care would have prevented or mitigated disease or death,” Warren wrote.
Thirsk had a patient come into the Royal Alex’s ER who had a cough for about a year and a half. That patient delayed seeking treatment early in the pandemic and did what they could to improve their health, including stopping smoking and improving their diet.
“They were hoping these other lifestyle things would make the cough go away and it didn’t. And so they finally came in when they couldn’t breathe at all,” Thirsk said.
When Thirsk was able to finally see that patient, they were on oxygen waiting in a hallway.
“And after doing a chest X-ray, I had to tell this person that they had metastatic cancer and their lungs were filled with cancer. And then we had a conversation –- once again in the hallway because of lack of resources in our emergency department –- about what this means.”
Seeing increased numbers of more acute patients has been an added weight doctors like Thirsk have had to carry.
“I had to give devastating news to someone whose lifespan is now being measured in weeks to months in a hallway in an emergency department,” he said.
“If they had had a primary care physician who had seen them with that cough a year and a half ago, we don’t know what state that cancer would have been in, but we would anticipate that it would be less (and) possibly more treatable.”
Dr. Tim Gash, an emergency physician at the Red Deer Regional Hospital Centre, said ER doctors like him can’t provide the same sort of care a family doctor would.
“When you think about the wait times and the deficiencies in terms of what can be provided in an emergency department versus longitudinal follow-up with a family physician who knows you and knows your medical history and is co-ordinating care for you – it’s an incredibly difficult thing to do on a single centre visit,” Gash told Global News.
And he’s seen the full emergency departments spill over into EMS service.
“In the past month, we had 14 ambulances lined up trying to provide patients to the hospital, but with nowhere to offload them to, which has been a major struggle,” the Red Deer doctor said. “And efforts are ongoing to try and figure out this offloading difficulty, but the problem remains.
“The problem is not EMS offloading. The problem is hospital overcapacity. And there’s nowhere to physically put patients and have them cared for.”
How to build capacity
In February, the province announced a $1.8-billion expansion for the Red Deer Regional Hospital Centre.
“They were talking about an eight-year plan. And unfortunately, we’re in a crisis and we need room now,” Gash said.
Both Gash and Thirsk said announcements of adding capacity via beds to the health-care system will help, but replacing doctors, nurses and other staff who have left the province or retired isn’t as quick a fix.
“To get new people trained to replace (doctors) is a six- to 10-year thing to do,” Thirsk said. “You can find a nurse and put them in nursing school today. They would take four years to train and then probably a year or two on the job training before they can come and work in the emergency department as a fully independent, functioning nurse.
“It takes so long to train someone to do these highly technical jobs that the short-term decisions that are made in terms of funding or funding cuts, they can’t be rectified or changed quickly.”
Health ministry spokesperson Steve Buick said a major factor of health-care stress is a “rebound” in demand that was previously deferred. He also pointed to efforts to increase staff and capacity across the system.
He said AHS has 270 more emergency department staff provincewide compared to a year ago.
“But the strain of two years of the pandemic means staff are still less available at some times, especially at smaller sites,” Buick wrote in an email to Global News.
An AHS statement said staff illness or exhaustion have been the largest factors in the staffing challenges.
“Provincially, our ED staff vacancy rate is higher than at any time over the past four years,” the statement reads.
The health authority hopes reduced COVID-19 levels will deliver some reprieve for emergency departments.
“As has been the case throughout the pandemic, the best way to protect our hospitals is for people to follow public health guidelines, stay home when sick, and most importantly, get immunized (including a booster).”
Compared with two years ago, 230 more paramedics are working in the province, with 20 new fully-staffed ambulances soon to start in Calgary and Edmonton.
Staffing the 19 new permanent ICU beds – 250 positions in total – has been done, Buick said.
And, according to the health ministry, 1,800 more registered nurses are working today than pre-COVID.
A statement from AHS said the health authority is working to fill frontline vacancies in an effort to continue delivering quality care through the entire system.
AHS assured Albertans they will get the care they need, encouraging people to consider other levels of care if they are not experiencing a medical emergency. A call to Health Link at 811 can help people in the province determine whether they should call 911 and/or visit an ER.
“We know that working in times of overcapacity can be stressful and tiring for our staff, and we are tremendously grateful for their unwavering dedication to patients during these times,” the statement read.
Both ER doctors said they are seeing the health-care system in the worst shape they’ve ever seen in their decades-long careers.
“Not having that resource to care for patients is shocking — and without any clear plan for how do we fill that gap?” Gash said.
“Right now, we’ve got some providers that are trying to almost singlehandedly keep the ship afloat by working just incredible hours to provide patient care. And it’s not sustainable.”
“The system is in crisis,” Warren wrote to the province’s doctors. “This was the message that your leaders conveyed over and over. COVID and the care deficit are a big part of it, but most issues predate the pandemic and are now much worse.”