Problems in ER symptom of bigger issue
But officials say wait times are symptom of larger health-care crowding crisis
The Ottawa Hospital’s quality and innovation vice president made a point of visiting the Civic emergency department Friday morning to check in on staff after paramedics’ frustration with long waits outside the Civic spilled into the public this week.
On Thursday, the city’s general manager of emergency and protective services, Anthony Di Monte, said emergency rooms in the city “are a disaster and there’s no excuse.” He called the Civic the worst offender when it comes to making ambulances wait to transfer patients.
Dr. Alan Forster said he was encouraged to see emergency room staff “doing their work professionally and in good spirits.”
Forster and others argue that long ambulance wait times are a symptom of a larger healthcare overcrowding crisis and it is unfair to place a spotlight on emergency departments. Nor is a long-term solution likely to be found there.
Still, hospitals are taking steps to mitigate the problem, which resulted in paramedics collectively spending more than 37,000 hours last year waiting to be released from emergency departments and 322 “level zero” situations in which every ambulance in the city was occupied.
“We are working with the City of Ottawa and paramedics to try to alleviate the problem,” said Forster. “We are committed to solving this problem.”
The Ottawa Hospital has two dedicated off-load nurses at each of its two campuses 21 hours a day. Forster said the hospital made changes to the way the offload nurses work in emergency in March that have helped lessen the pressure. He described it as “reengineering ” the way they do their work. Last week, he said, the average off-load time was about eight minutes.
The province sets targets of 30 minutes for paramedics to get patients into emergency rooms. In Ottawa, the Civic and Queensway Carleton hospitals are near the bottom of provincial rankings for meeting those targets.
The Civic, Forster noted, is the regional trauma centre. That means a large percentage of ambulance traffic must go there. It also means many of the patients coming to the hospital to be treated for trauma will require a longer hospital stay and may have to wait in hospital for a suitable place to go to, if they need more therapy or special accommodations, for example.
And that, say hospital and emergency officials is the crux of the problem.
“To be clear, the reason for ambulance off-load delays is because of crowded emergency rooms and the reason for crowded emergency rooms is crowded hospitals. You can’t blame emergency staff. This is a problem for the hospitals, the regional authorities and the government to solve,” said Alan Drummond, an emergency physician in Perth who is co-chair of public affairs with the Canadian Association of Emergency Physicians.
He notes that hospital beds in the province were cut by almost one-third in the 1990s.
Overcrowding is a crisis that hospitals in Ottawa, and across the country, have been dealing with for a number of years. The impact on ambulances is a telling, and worrisome symptom of the growing crisis, one that is not sustainable.
Queensway Carleton Hospital has been coping with the crisis, with two internal “Code Orange” situations in recent months in which the hospital had used up all beds, including overflow beds.
Some mornings, said chief of staff Dr. Andrew Falconer, there are 25 admitted patients in emergency waiting to be put into beds, which means there is no place to put patients who come in by ambulance.
It worries everyone, said Falconer.
“We see this as a very serious issue. Paramedics should be out on the road to respond to 911 calls.”
Falconer said more funding from the City of Ottawa so it could have an ambulance off-load nurse on staff 24 hours a day, instead of the current 12 hours, would make some difference at Queensway Carleton.
But he and others say the root of the problem is hospital overcapacity. Not only are hospitals seeing more patients than before, but growing numbers of patients are unable to leave because they lack a long-term care home or suitable housing situation to go to.
That quickly leaves hospitals with little capacity to take in new patients, who often are left waiting in emergency departments for a bed to come free, leaving paramedics waiting to deliver patients in need of an emergency room bed.
“It is a very difficult situation,” said Falconer. “The province is committed to funding more longterm care capacity but it won’t happen very quickly.”
“We do have a bottleneck issue going on here in our region,” added The Ottawa Hospital’s Forster.
“The question is, where is the bottleneck?”