Lack of long-term care beds adding to Alberta's ER woes, doctors say

By Jodie Sinnema,

Doctors say the problems in Alberta's hospital emergency rooms are worsening, though a year has passed since physicians warned the province about a potential collapse of the system.

Frontline staff and Alberta Health Services administrators have improved the flow of emergency patients out of stretchers and into more suitable beds so that severely ill people are no longer having heart attacks or dying in the waiting room, as they were one year ago.

But with a September spike in emergency stretchers being plugged by patients who no longer need emergency care, Alberta is once again at risk of a crisis unless more long-term-care beds open, physicians say.

“You can only stretch an elastic band so far before it snaps. We’re starting to get there and we’re seeing a scary trend,” said Dr. Felix Soibelman, the new Alberta Medical Association section head for emergency medicine, who also works in the University Hospital’s emergency department.

“I’m concerned we’re just at the start of the upswing here.”

In September, an average of 56 emergency beds in Edmonton hospitals were filled each day with people stuck there because there were no other hospital beds available. That’s up 37 per cent from the previous month after fairly steady decline — due to the creation of medial assessment units and other in-hospital efficiencies, as well as seasonal spring and summer lulls — since October 2010.

This past weekend, one-half to two-thirds of emergency beds at the Royal Alexandra and University hospitals were blocked by patients waiting for more suitable beds, Soibelman said.

Those patients can’t move because too many other hospital beds are filled with seniors waiting to move to community long-term-care facilities, Soibelman said.

“We’re still backed up in our hospitals,” he said. “There’s still not enough long-term-care capacity in our system.”

Things will only get worse in October and November, when cases of flu flood emergency rooms for care, said Dr. Paul Parks, whose warning letter last October to the then-premier, health minister and top health administrators detailed cases of patients waiting too long for care. One patient with a spine fracture waited six hours while strapped to a board. A man committed suicide in the Royal Alexandra Hospital after a 12-hour wait.

Dr. Ann Colbourne, division chief of general internal medicine for Alberta Health Service’s Edmonton zone, said they are making plans to to deal with the expected surge flu cases. More hospital beds and community beds are expected once funding is finalized.

“We’re working as hard as we can, as fast as we can and a whole lot of people are engaged to try and get the work done,” Colbourne said.

She led a successful pilot project at the University Hospital that reduced emergency and overall hospital stays for patients with problems such as pneumonia or heart failure. That program is now being rolled out in more wards.

Colbourne said Albertans need to remember that although the province saw an increase in the number of blocked beds in September, the trend has been downward over the past year, even though hospitals like the Royal Alex and University admitted 30 to 50 per cent more emergency patients than last year.

Health Minister Fred Horne said this “was a long-term issue in development in Alberta and I think improving the results is a long-term proposition.”

Parks said more long-term-care beds are vital.

He will be meet with other emergency room physicians Saturday to discuss concerns at their annual conference.

He said he needs to know how many of the 1,000 continuing care spaces to be built this year are publicly funded, long-term-care beds with around-the-clock nursing care, compared to private spaces, where patients may only get minimal nursing care for additional fees.

“I don’t think the government has made a true commitment and addressed the back end at all,” Parks said.

Horne said continuing care remains a top government priority. He said facilities now being built contain a mixture of care options.

“My expectation is the new units that are opening are able to accommodate their care needs,” Horne said. “We’ll continue to work with physicians to make sure that those spaces are there.”

But Parks wondered what the public thinks when the province and Alberta Health Services don’t meet targets they set for themselves.

By March 2012, 60 per cent of patients who are severely ill are supposed to be admitted from emergency into hospital beds within eight hours. That target reflects how the entire health system is functioning to allow access to care.

For the week of Oct. 9 to 15, 23 per cent of such patients at the Royal Alexandra Hospital and 33 per cent at the University Hospital received care in that time. Only the Stollery met that goal with 68 per cent of patients.

That’s similar to one year ago before new protocols were introduced. From Oct. 31 to Nov. 6 in Edmonton, doctors were able to meet the eight-hour target 21 per cent of the time at the Grey Nuns and Misericordia hospitals, and 28 per cent of the time at the University and Royal Alex.

“Am I concerned we could go back to exactly where we were? Yes. I’m concerned,” Parks said. “If the bottleneck has stayed exactly the same as a year later, then we could very well be as bad as we were before. … The onus is on the government and perhaps (Alberta Health Services) as well to prove that they’ve fixed the bottleneck that we identified right from the get-go.”

Horne said he’s ultimately accountable to the premier and Albertans, but he doesn’t believe people want to assign blame.

“Can we do better? Absolutely,” he said.

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