A doctor who is an expert in emergency-room overcrowding has written a prescription to cure what ails the Health Sciences Centre's emergency department.
Dr. Grant Innes, an emergency room physician in Calgary, a professor at the University of Calgary and a member of the Canadian Association of Emergency Physicians, said the main reason for overcrowding in any emergency room is the inability to move critically ill patients from the area.
Innes, testifying at the inquest looking into the 2008 death of Brian Sinclair in the HSC emergency waiting room, said patients who have minor injuries don't clog emergency rooms.
"The overwhelming cause is blocked patients," he told provincial court Judge Tim Preston on Monday.
"Too many patients waiting too long in the wrong place."
The key to freeing up emergency-room beds is to transfer ER patients to wards where they can be treated and getting patients who don't need to be in hospital into long-term-care beds or discharging them, Innes said.
Pulling out a single sheet of paper, which was handed to the judge, Innes gave five recommendations that would solve overcrowding.
- Creating a process of accountability for access and flow, which not only includes the hospital, but also community long-term care.
- Having a demand-driven overcapacity protocol.
- Matching capacity to demand, including having patient discharges seven days a week and having specialists available later in the day.
- Implementing performance targets, including having a patient triaged within 10 minutes of entering the ER, and discharge or transfer times of four hours for the most critically ill patients or two hours for minor treatments.
- Having better access to long-term and community care.
- It's important because if the average hospital stay can be cut by three per cent -- or four hours -- that creates 161,000 emergency-room stretcher hours per year, he added.
Sinclair, 45, died in Sept. 2008, after waiting in the HSC emergency waiting room for 34 hours.
A coroner has testified Sinclair, a double amputee who used a wheelchair, may have died up to seven hours before he was noticed.
Sinclair had gone to the hospital because his urinary catheter was blocked. He died from a treatable bladder infection.
The inquest, which has been holding hearings on and off since last August, is in its final week.
Innes produced studies from North America and around the world that conclude if non-urgent patients are diverted to other places, it does little to free up ER access.
Creating more urgent-care facilities -- thinking it will get patients out of ERs -- is "a fundamental mistake," he said.
It would it do little to address problems in the ER.
If all patients with minor problems are diverted out of the ER, it could lead to physicians "sitting there doing nothing," he added.
"I hope the effort to do that isn't distracting them from dealing with the problem," he testified.
Innes criticized a move by the HSC to set up a pre-triage waiting area for patients, in which they would be seen before going to the regular waiting room.
"Enshrining a line to the triage process by creating a waiting area makes the hair on the back of my neck rise."
Earlier, Innes said the case of one patient -- who had a scratched cornea -- illustrates how blocking occurs because it took almost three hours for the patient to be seen and treated in the ER.
Innes said when he had a similar ailment and was seen by an ER doctor he knew, the treatment time was nine minutes.
He said the patient with the scratched cornea spent the rest of the time being repeatedly questioned by health-care staff who documented the ailment.
"This type of inefficiency shouldn't be allowed to exist."
Two more witnesses are to testify about ER overcrowding this week.
The inquest is to conclude Thursday after the Winnipeg Regional Health Authority, the Manitoba Nurses Union and the Sinclair family have made their recommendations.