Emergency doctors want action on ER blockage
One of the busiest hospital emergency rooms in the province can be found at Chilliwack General Hospital, say a group of emergency doctors.
Although the new ER is well-designed and spacious, it’s still over capacity more than it should be, says Dr. Marc Greidanus, an emergency doctor at CGH.
“We are running this hospital at 100 per cent plus capacity, but hospitals are designed to run at 85 per cent,” he tells The Progress. “So that if bad things happen, we have to adapt.”
If someone arrives with lacerations to be stitched at a busy time, they could be waiting, two, four, or up to six hours.
Dr. Greidanus is one of the B.C. emergency physicians launching an information campaign in the media and at bcemergencycare.com to raise public awareness on the issues.
Next to his hospital ID, the emerg doctor sports a big button that reads: “Tired of waiting in the ER? Ask me about bcemergencycare.com. Send a message now.”
Chilliwack's ER earned a failing grade on the online report card at bcemergencycare.com. It received a “fail” for overcrowding and in-patient access blocking, which occurs when people get stuck in the waiting room for a bed.
The treatment areas are sometimes congested with admitted patients waiting for a bed to open up in the upstairs wards.
“I would like Chilliwack to realize their brand new ER is not currently working as efficiently as it could be,” Dr. Greidanus says.
The ER is not always choked, he says, but the over capacity protocol has gone into effect a number of times recently.
“If you’re running at 100 per cent capacity or over, what happens if you get a flu outbreak?” the doctor asked.
“What happens if there’s a huge traffic accident with multiple victims? Or an E.coli outbreak?”
He made it clear that Fraser Health has officially acknowledged the problem. They responded by coming up with the Over Capacity Protocol, and have been actively working toward finding solutions to ER blockages.
When the numbers start backing up in the hospital, they institute the Over Capacity Protocol.
Every floor in the hospital springs into action at that moment. Each one sending one nurse to another ward. It’s a flex measure that frees up beds when they’re needed.
“We fill it and all of a sudden there are beds freed up in the emerg. But the problem is that we have to send one of our ER nurses. So not only are we stuffed but we have to run short-staffed.”
There’s a five-point plan being touted as the emergency doctors’ plan, that includes everything from increased physician staffing, to enforcing standards for to how long a patient can wait for a bed in the ER.
“We are one of the busiest hospitals in the Fraser Valley on a per capita basis looking at our staff,” said Greidanus. “Our nurses work very hard and we get more through-put than our neighbouring hospitals.”
But it’s not really about staffing levels as much as capacity, the doctor says, but they are in fact looking at adding another emergency doctor to face the busy 2013 summer season.
“There are some days when the hospital operates quite efficiently. When numbers are low, things work reasonably smoothly. I’m estimating that’s about a third of the time that we actually have beds and can move them upstairs.
“Another third is the normal Canadian emergency room situation. It’s not really cool but what we work with what we’ve got, so we’re moving people into weird places, and moving out oxygen tanks to make room for beds. Nurses are working very hard. They’re making things work.
“But another third of the time, it’s totally stuck and no one can move.”
The problem is, it’s getting worse — not better, says Dr. Greidanus. The provincial government agreed to tackle this all-too-common situation years ago with fiscal incentives for getting admitted patients to the floor. This is a practice that’s seen some success in the U.K. and Australia.
If people feel the ER is important, they should let their MLA know.
“Let them know this is an issue, and that you support the BC Emergency Care Plan.
“If we can get the government behind us to create some of these incentives, to get some of these people upstairs.”
Chilliwack is actually in better off position relative to other neighbouring facilities because of the extra space it has. It wouldn’t cost any more money, he says, it’s just about changing how the money flows.
“We have the space in Chilliwack, we can do it. We just need the will to do it.”
Connie Meskas, site director for Chilliwack General Hospital, confirmed that 51,000 people came through the ER in 2011-12.
That’s a hike of 34 per cent in ER visits over the past five years, and up nine per cent over the numbers seen in 2010-11.
“Chilliwack is a growing community,” she said. “We expect that number to go up continually.”
But comparing with other hospitals is tricky, more like comparing apples and oranges.
“Some sites provide a higher level of care than we do,” she said. “But yes, we are one of the busiest non-tertiary hospitals.”
They do typically run over 100 per cent capacity, but are very focused on moving people through, and getting them home sooner.
Regarding the over capacity protocol, Meskas said it’s only been called twice at CGH since it was rolled out at all Fraser Health sites at the end of January.
The call is made only when every physical bed in the hospital is filled, as well as half the stretchers in the ER that are used to assess patients.
They are fortunate to have adequate space that allows them to open six beds in an existing ward when they’re over capacity, which in turn allows six others to move upstairs.
The action does free up emerg personnel to look after new patients coming into the ER, she says.
“What I can tell you is that all the staff here is really engaged in making sure we have flow in the ER. We manage congestion very well at Chilliwack hospital,” she says.
They never put patients in hallways, she underlines, because they have ample room in empty spaces.
“All of us are working hard to ensure people are not staying longer than they have to,” Meskas says.
But it’s a fine line because they have to ensure a patient has enough home support after they’re released.
Regarding the financial incentives for moving admitted patients, Meskas said she wasn’t sure if they would work in a public system.
“Our emergency doctors and nurses provide great care,” she added. “I have every confidence in their ability to provide care to the Chilliwack people.”