The emergency room at the Brandon Regional Health Centre sees about 27,000 patients per year — though many of those visits are unnecessary.
Out of the 23,803 registered ER patients between April 16, 2013, and, March 17, 2014, 551 of those visits were marked under the catch-all "minor complaints" category, according to a complaint summary obtained by the Brandon Sun through a freedom of information request.
"Are there people that shouldn’t have ever come? The answer is yes, absolutely yes," said Brian Schoonbaert, the hospital’s chief operating officer.
"In fact we do, on a regular basis, tell people that this can wait until a doctor’s clinic is open."
The number of inappropriate visits has slightly decreased in recent years, Schoonbaert said, but the number of serious high-level acute medical issues has gone up.
The top reasons for visiting the ER — abdominal pain (2,428 instances), lacerations and punctures (1,171) and shortness of breath (1,065) — aren’t out of the ordinary for any ER.
According to the Canadian Institute for Health Information, the top three reasons in 2012-13 for visiting emergency rooms nationwide were abdominal/pelvic pain, pain in throat and chest, and acute upper respiratory infection.
Some of the reported health problems may not, on the surface, seem to merit a trip to the ER, but the hospital’s top managers say there’s always a chance the symptoms could point to bigger health issues.
According to the document, of the more than 160 complaint categories listed, there were two instances of someone going to the ER complaining of hiccups, 117 cases of epistaxis (also known as a nosebleed), three ring removals and 40 wheezing complaints.
"Some of those are very legitimate," Schoonbaert said. "There might be cases that are very legitimate and some are not legitimate," though he didn’t want to estimate how many visits could be deemed inappropriate.
In some cases people will simply lie about symptoms as a means to get treated faster, according to Seema Roberts, the hospital’s manager of critical care.
"People learn the system and know they’ll get in sooner if they say they’re having chest pains versus what they’re really here for," Roberts said, though she insisted it’s a minor issue.
A lack of family doctors and the inability for some to get primary care means more people are going to the emergency room.
"If they don’t have a family physician, they see emerg as their primary area to come in for treatment," said Debbie Poole, the hospital’s director of acute care. "It’s really important for folks that don’t have a family physician to try to get one."
For others, their work hours don’t allow them to get into any of the city’s walk-in clinics or to a doctor’s office.
"So, the only place they have is to come to emergency," Poole said, noting the province’s goal for every Manitoban is to have access to a family doctor by 2015 through primary care networks.
BRHC is also a regional referral centre and patients in need of specialized treatment often end up in Brandon — which puts more pressure on the ER, which serves some patients from as far west as the Saskatchewan border, north to Swan River and as far east as Carberry.
Doctors outside the city will refer patients to BRHC specialist and simply tell them to wait in the ER, an issue the hospital is currently battling.
If someone from out of town has a casted broken foot and needs orthopaedic surgery, many times they will be directed by their doctors to wait in the ER in an effort to see the specialist faster — often that means waiting in a bed, not the lobby, Roberts said.
That’s one less ER bed and added work for the nurses on duty, of which there are between four and seven depending on the time of day.
"There are patients coming out who are only there because they’ve been consulted to see a specialist," Roberts said. "They (the doctor) already know what needs to be done, but now they’re bringing them through emerg and we have to hold the patient until the surgeon has time to come and see them."
Only about 16 per cent of those patients who enter the ER are admitted and have to stay overnight at the hospital.
The ER summary also included 200 complaints of foreign objects in eyes, ears, rectums, skin, noses, and vaginas.
Aside from physical issues, the ER contends with a whole slew of patients with mental issues as well, parsed into several categories.
Of the more than 800 mental health-related complaints in the summary, the ER took in 331 cases of depression, suicide, or deliberate self harm, and 347 cases of anxiety.
There is also a small number of patients with "social issues," likely, according to Schoonbaert, referring to homeless people in search of warmth on cold nights (there were 11 cases of frostbite).
Prairie Mountain Health started using a new system to track ER health complaint data in April of 2013 at the behest of Manitoba Health. Prior to that, the health authority didn’t use a standardized system and the same ER health complaints were categorized in different ways, depending on how the nurse entered the information.
It’s just one small piece of data the hospital uses to try and tweak the system to get patients in and out of the ER as quickly as possible.
Right now, Roberts said, hospital management is looking at staffing levels and there are preliminary plans to provide same-day care outside of the ER. For instance, a broken ankle may not mean taking up an ER bed.
"Is there a different way to provide that treatment in the health centre rather than the emergency room?" Roberts said.
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Mental health-related complaints between April 16, 2013, and March 17, 2014
• Anxiety/situational crisis: 347
• Depression/suicide/deliberate self harm: 331
• Bizarre/paranoid behaviour: 85
• Confusion: 76
• Hallucinations/delusions: 27
• Violent behaviour: 9
Complaints related to substance issues:
• Substance misuse/
• Substance withdrawal: 79
Complaints related to pregnancy or infants:
• Floppy child: 6
• Pregnancy issues less than 20 weeks gestation: 590
• Pregnancy issues greater than 20 weeks gestation: 36
Foreign objects in ...
• Eye: 106
• Skin: 47
• Nose: 18
• Ear: 17
• Vagina: 9
• Rectum: 2