Doctors say Alberta’s plan for ‘triage liaison physicians’ can help, but isn’t cure for slammed ERs

An Alberta government pledge to bring the position of “triage liaison physicians” back to some emergency rooms could help ensure sick patients are better prioritized, some doctors say.

Alberta Medical Association (AMA) president Dr. Brian Wirzba said the positions will be welcomed by emergency room doctors. He called the role “an important Band-Aid, but it’s not dealing with the root cause.”

Hospital and Surgical Health Services Minister Matt Jones announced the plan at a news conference on Thursday.

The promise comes after an Edmonton man died in the Grey Nuns Community Hospital’s emergency department last month. His family says he had waited nearly eight hours to see a doctor about his chest pain.

Jones said Thursday that he asked Alberta’s justice minister to call a fatality inquiry into the death of Prashant Sreekumar, a 44-year-old father and husband.

Sreekumar’s death prompted health-care workers to ask the provincial government to declare a public health emergency in response to overcrowding in Alberta hospitals. Jones has said he doesn’t need the additional powers that such a declaration would afford him.

As of Feb. 1, Acute Care Alberta, which oversees hospital services in the province, will pilot test triage liaison physician (TLP) positions in five urban emergency rooms: the Grey Nuns and University of Alberta hospitals in Edmonton, and South Health Campus, Peter Lougheed and Foothills hospitals in Calgary.

“To launch the role as quickly as possible, the positions will be staffed with existing AHS (Alberta Health Services) physicians,” Jones’ press secretary, Kyle Warner, said in an email on Friday.

“Recruitment for new physicians will begin as soon as possible.” 

The former Edmonton-area health authority Capital Health tried a one-year pilot of the triage doctors in 2007.

Warner said that pilot “demonstrated the potential to significantly reduce emergency department length of stay and the number of patients leaving without being seen.”

He said the program didn’t continue at the time because it lacked a permanent funding source. He added that the new iteration of TLPs would be the first provincewide trial.

There have been North American studies of the value of TLPs over the past 20 years. The reviews report mixed success with improving patient wait times or decreasing the number of patients who leave the ER without being seen.

On Thursday, Acute Care Alberta’s chief medical officer, Dr. Aaron Low, described the TLP role as a physician working alongside triage nurses, and beginning diagnosis and care in the waiting room where appropriate. They can order bloodwork or medical imaging before the patient gets a bed.

“This will also allow us to better stratify which patients need to be seen sooner and can’t afford to wait,” Low said.

Alberta government creating triage doctor role

Dr. Raj Sherman, a longtime ER physician who has also served as the Alberta Liberal Party leader and has run as a United Conservative Party candidate, said he worked as a TLP during the pilot, years ago.

“It’s an ER doctor who walks in the waiting room looking for patients who might be dying, and ordering tests in other patients,” he said.

It’s an approach designed for crisis situations, which he said best describes the current status of Alberta ERs.

Sherman said he and other doctors have been asking the provincial government to bring back the positions.

However, he said he wonders where health agencies like AHS and Covenant Health will find new ER doctors trained and willing to work in the role.

Sherman also questioned whether a TLP will have dedicated nurses to deliver the necessary care in hospital waiting rooms.

Wirzba said doctors working as TLPs would also have to be paid differently. Rather than billing fee for service, employers would have to pay an hourly rate or a salary, because only the treating ER doctor could bill for patient care.

The hospitals minister’s office did not answer questions on Friday about how many physicians would be required to staff the pilot project at the five initial sites, how many hours a day a TLP would be on shift in each ER, or how the doctors will be paid.

Louis Francescutti, an ER doctor at Edmonton’s Royal Alexandra Hospital, said it makes sense to have a seasoned doctor out front to get any urgent investigations started right away.

But the province also needs a health system that diverts non-urgent patients away from emergency rooms, he said. Francescutti added that if ERs had the power to send patients with minor ailments and non-urgent needs to medical clinics operating for extended hours, it would help reduce the crowding.

The province must also improve promoting disease prevention and immunization, which help keep patients out of the ER, he said.

Dr. Scott MacLean, also an ER physician at the Royal Alex, as well as the Northeast Community Health Centre, said crowding has become unsafe in emergency departments, adding they have received capacity warnings from the fire department.

MacLean said he believes the TLP approach might be “misguided.”

“I would argue that my colleagues and myself are already doing this triage physician role,” MacLean told CBC’s Hanomansing Tonight on Thursday evening.

MacLean said he already treats some patients in waiting areas, hoping triage nurses have time to help with their care.

“Naming that program doesn’t provide those resources, provide those care spaces and provide the nursing staff that I need to to care for those patients,” he said.

Many ER doctors who spoke to CBC News said the province needs a better way to get patients waiting for long-term care out of hospital beds to stop the backlog in ERs of patients awaiting hospital admission.

Sherman also criticized the UCP government’s decision to cancel plans for a new hospital in south Edmonton. The province instead intends to add patient towers at Edmonton’s Grey Nuns and Misericordia hospitals, and build a standalone children’s hospital.

Sherman said the number of inpatient beds per population in the city is critically low.

NDP hospital and surgical health services critic Sarah Hoffman said the amount of hospital space for Edmonton’s growing population is so paltry, the province needs to build the towers, a new Stollery Children’s Hospital and a hospital in south Edmonton.

“I think everyone’s just so frustrated and feels like the government doesn’t take their responsibility seriously,” she said on CBC Radio’s Edmonton AM Friday morning.