According to 2016 data from Fraser Health’s report card on hospitals

According to 2016 data from Fraser Health’s report card on hospitals

Chilliwack ER among busiest in Fraser Health

Growing community puts additional stress on emergency care in Chilliwack.

When Richard Ogilvie felt stomach pains in early December it was a bad sign, if not unusual, for the Chilliwack man with a history of ulcers.

He was constipated and taking his proper medication, but the pain just got worse. So he went to the Chilliwack General Hospital (CGH) emergency room (ER), a move that turned out to be the first of seven visits over four weeks that began with a botched prescription and ended with a four-day coma and surgery.

After a few visits in early December, Ogilvie was able to get scans that showed his pancreas was slightly enlarged, he was told. A doctor at CGH prescribed an anti-inflammatory drug, Ketorolac, and he was sent home.

But things just got worse.

As Christmas approached, the pain intensified so he went to his family doctor and told him what he had found on the Internet. The very first link that comes up using Google takes users to a website with a description of the drug’s uses and side effects.

“Do not use keterolac if you have a stomach ulcer or a history of ulcers or severe stomach problems,” according to Drugs.com.

“Nobody ever asked me about any ulcers,” Ogilvie told The Progress. “It’s not even like an in-depth medical search. I just went to Google and clicked on ‘Keterolac.’”

Ogilvie said his first ulcer was diagnosed in 1999 so, yes, he’s got a history of ulcers.

On Christmas Eve, he was near catatonic and his wife couldn’t revive him.

“She sounded like she was 1,000 miles away,” he said.

Then the blood started flowing and off to the ER he went again. He was seen, released, seen again and released again. On his seventh trip in the morning on Jan. 2 he was finally admitted and moved up to the third floor. In the early hours of Jan. 3 he started bleeding out again.

“I had four litres of blood in my stomach when they cut me open,” Ogilvie said.

He was put into a medically-induced coma for four days, he says, and two days later sent to Abbotsford for a colonoscopy.

Finally out of the coma on Jan. 6, he was released on Jan. 13, and he is not impressed with how he was treated even then. Adding insult to literal injury, he says CGH wanted him out on the 11th.

“They tried to get rid of me right away,” he said. He had been on a liquid diet for weeks, he just had surgery and not had a normal bowel movement, and his doctor and surgeon didn’t want him released until things were normal. But five days after surgery, Ogilvie says “they want to kick you out.”

While clearly Ogilvie’s experience was less than ideal, it might have even been extremely rare. But what concerns him and others who are watching hospitals in Fraser Health is that cases like this might be a side effect of ER congestion in the region.

 

CGH not nearly the worst

As part of a series on issues with the ER at Abbotsford Regional Hospital (ARH) published recently in the Abbotsford News, Dr. Alan Drummond, co-chair of public affairs with the Canadian Association of Emergency Physicians said that in addition to hygiene worries and risks that come with more sick people in a confined area, congested emergency rooms also lead to more physician errors.

“It’s a tough job on a good day,” Drummond said. “It’s even tougher when you’re trying to see patients in suboptimal conditions or a rushed manner. We try and fight against that and recognize that the patient in front of us is the most important patient in the room, but it’s human nature.”

According to 2016 data from Fraser Health’s report card on hospitals, fewer than one in four visitors to the emergency department at Chilliwack General Hospital are admitted within 10 hours, the lowest rate of any hospital in the Fraser Health region. At 22.7 per cent, it is well below the Fraser Health average of 37.1 per cent and less than half of the region’s target of 55 per cent. Even that target has been lowered in recent years from 70 per cent.

A spokesperson for Fraser Health pointed to how Chilliwack is a growing community, with two per cent population increase year over year since 2011 when the ER was renovated. Over that same period, there was a 4.5 per cent year over year increase in ER visits.

“This translates into about 27 more patients per day than six years ago,” Fraser Health public affairs consultant Tasleem Juma said.

Six years ago the ER saw about 138 patients a day. That is up to 165 per day now.

One of the problems, according to doctors, is the hospital administration’s policy of running the hospital as close to 100 per cent capacity as possible.

In the third quarter of 2013/14 — the most-recent time period for which hospital occupancy rates are publicly available — only one of Fraser Health Authority (FHA) hospital was operating below 100 per cent. In the third quarter of that year, CGH was at 113.8 per cent occupancy.

And none of this is new. Four years ago, Dr. Marc Greidanus, an emergency doctor at CGH and ARH, was outspoken about the problem and was part of a B.C. emergency physician information campaign to raise public awareness about the problem.

According to a report card on the website created for the campaign, bcemergencycare.com, CGH got a failing grade.

The analysis said the fact that CGH is choked at over 100 per cent capacity has remained unchanged “under the present unrealistic government idea: that you maintain and staff hospitals based on 100 per cent utilization of capacity: thus in spite of population growth our hospital has the same number of rooms as a decade ago.”

That was four years ago and little has changed.

Some of the pressures in emergency can trickle to other departments, although some of the hospital’s performance measures may have nothing to do with that. In addition to being the hospital with the lowest number of patients seen in ER in 10 hours, CGH has the lowest rate of hip fracture surgeries within 48 hours, at 78 per cent, out of eight hospitals. Overall Fraser Health performance is 89 per cent with a target of 90 per cent.

And for women going to CGH to have babies, the 22.6 per cent rate of low-risk Caesarean sections is higher than the Fraser Health average of 19.2 per cent, ARH at 17.3 per cent, B.C. at 16.7 per cent and Canada at 14.1 per cent.

CGH also had a higher rate of medical patients readmitted to hospital at 16 per cent than Fraser Health (15.1 per cent), B.C. (14.4 per cent) and Canada (13.6 per cent).

Many Chilliwack residents who use the ER tell positive stories of fast, attentive treatment by caring nurses, doctors and staff.

“I have never had to wait longer than 45 minutes to see a doctor at CGH and have always received excellent care,” Britt Hailstone replied to a call for comments on the ER.

Caroline KG on Facebook said she has gone more frequently than desired for numerous reasons including, heart attack, vertigo, dog bite glass in eye and stroke, and each visit has been quick.

“I feel nothing but respect and gratitude to the doctors RNs, LPNs and first responders at CGH,” she said. “I thank each of them enormously.”

There are, indeed, some bright lights in the Fraser Health data on CGH, but mostly to do with getting patients of the hospital as quickly as possible. Something broadly sought after by administration, but something that patients such as Ogilvie feel is doesn’t make for good patient care.

The so-called “alternate level of care days,” how many extra days patients spend in hospital, CGH was fifth lowest out of 12 hospitals in Fraser Health, and as for the average in hospital length of stay in days, at 6.78, only two hospital had lower rates and the Fraser Health average was 8.09.

Fraser Health CEO Michael Marchbank said in early March that he was confident that conditions in the health authority were improving and that congestion would ease in the spring.

Juma pointed to a number of initiatives Fraser Health has underway to ensure quality ER care in a timely fashion, namely: a geriatric emergency nurse in the emergency department; a pediatric observation unit; the “Use the ER Wisely campaign,” community outreach nurses and the Home First program.

As for Ogilvie, he feels he was sent home from the ER repeatedly when he should have been admitted, and he feels like they wanted him out too quickly after his surgery.

After his ordeal over the holidays, he finally started back at his job as a corrections officer on March 13, two months after leaving CGH’s ER, albeit with an abdominal binder and a 14-inch scar on his torso.

He plans to file complaints with the College of Physicians and Surgeons and Fraser Health, although he hasn’t done so yet, something Juma encourages him to do so the agency can make improvements.

Then there is the $240 in ambulance bills he received.

“My wife is like, ‘they are going to pay for that because they kept sending us home,’” Ogilvie said.

– with files from Tyler Olsen, Abbotsford News

paul.henderson@theprogress.com

@PeeJayAitch

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