Calgary emergency rooms are “in a state of critical overcapacity” ahead of the anticipated peak of flu season — and to cope with the surge and wait-room crowding, officials are urging doctors to speed up their decisions on whether to admit patients, according to a memo obtained by CBC News.
The situation is “only expected to worsen,” according to the note sent Friday to Calgary acute care doctors.
“While all sites are mobilizing all available resources, we are consistently operating in an environment where all funded ED (emergency department) treatment spaces are occupied by admitted patients, leading to severe access block,” wrote Dr. Catherine Patocka, the clinical department head of emergency medicine for Alberta Health Services’ Calgary zone, along with her deputy, Dr. James Andruchow.
Adding to the crunch and staff strain is a current mandate for paramedics to quickly offload patients in emergency rooms to let those ambulance crews handle additional calls, the memo states.
“This combination of extreme overcapacity and unpredictable influxes of seriously ill patients from EMS results in prolonged delays in care and major safety risks for … patients awaiting assessment and treatment.”
Officials had warned about the risks of overcrowded hospital emergency wards during respiratory virus season. Hours before this “critical overcapacity” memo was circulated in Calgary hospitals last Friday, Hospital Services Minister Matt Jones said officials had expected Alberta’s influenza season to peak on Dec. 21, with hospitalizations to continue rising for an additional week.
The respiratory disease known as RSV, which can also send patients to hospital, is forecast to keep rising until Jan. 11, according to provincial modelling.
The memo states that to help keep patients safe and improve system flow, they will ask residents and attending decisions to take no longer than four hours for “disposition decisions” — whether to admit or discharge patients.
Doctors will receive special alerts regarding that target, and emergency department administrators may step in to help if any decision goes beyond the four-hour mark, the memo states.
“While we recognize there may be no available inpatient beds, identifying patients appropriate for admission in a timely fashion helps to identify bottlenecks … and supports safe, system-level decision-making and equitable risk management during this period of heightened demand,” Patocka and Andruchow wrote to their colleagues.
Dr. Joe Vipond, who works in Rockyview Hospital’s emergency department, says “it’s really bad in the emerg right now.”
“There are times where people are waiting eight, nine hours to be seen. Some of those people are sick and getting sicker — it does feel dangerous.”
Emergency room leaders inserting themselves into doctors’ decision-making on admissions is unusual, though sometimes they step in when there’s uncertainty about where to send a patient, according to Vipond.
“I think this is our administration trying to figure out how to best manage the problem.”
Dr. Eddy Lang, former head of the Rockyview emergency unit, said “extremely high” levels of flu are circulating as people gather for holidays, which is bringing many elderly Calgarians to hospitals with respiratory issues.
“Across the city, emergency departments are holding a lot of admitted patients who have been diagnosed, they’ve started treatment, they’re on oxygen, but they just don’t have a bed to go to upstairs because the upstairs is full,” he said in an interview.
“And this creates a backlog, which affects even the paramedics who are trying to drop their patients off and get back on the road.”
An AHS spokesperson sought to downplay the urgency of this memo.
“This memo has been shared … over the past year on several occasions including last winter’s respiratory season and during Stampede when increased volumes are anticipated,” Kristen Anderson wrote in an email to CBC News.
The four-hour mark is an ordinary target for emergency patient flow, and the zone leaders’ memo was meant to serve as a reminder, she added.
Province-wide, Alberta Health Services had 130 temporary hospital beds ready for a surge during respiratory virus season. Of those, 123 have been opened across the province, Anderson stated in her response to CBC News.
However, there are still beds available within AHS hospitals in Calgary, she added.
According to the province’s respiratory virus dashboard, 1,635 Albertans have been admitted to hospital with influenza since the flu season began in the fall, with 116 requiring treatment in intensive care units. Forty-seven people in the province have died of the flu.
With files from Jennifer Lee and Karina Zapata
