Winnipeg physicians continue to schedule about 1,000 adult-patient visits per month in city hospital emergency rooms despite recommendations a decade ago the practice be eliminated.
The emergency care task force, established in the wake of two serious incidents in city ERs in 2003 and 2004, urged scheduled emergency-room visits be done away with "as soon as possible" to reduce workloads and patient wait times.
Patients attending Winnipeg emergency departments often face excruciatingly long waits for care, and paramedics can wait an hour or more after pulling up to emergency departments before they can transfer patients to hospital staff.
Progressive Conservative health critic Myrna Driedger said the government should have ended the scheduled ER visits long ago, as it promised to do.
"It's an abuse of the ERs. These are not emergency patients," she said this week after raising the issue in the legislature.
Health officials point out the number of scheduled ER visits has declined over the past decade -- there were 14,400 in 2005, compared with close to 12,000 in the past 12 months -- even as total ER visits increased.
"We do think that emergency rooms should be there for emergencies," said Health Minister Erin Selby, noting scheduled ER visits account for less than five per cent of all emergency-room traffic.
She said those who used to go to ERs for wound care or to receive intravenous antibiotics, for instance, are now being diverted to other locations.
"We've been building capacity to be able to allow some of these procedures to be moving out (of ERs). We think they should be done elsewhere. We're looking at ways we can move more things into the community," Selby said.
The task force that recommended the elimination of scheduled appointments in emergency rooms was struck after two high-profile incidents. In September 2003, 74-year-old Dorothy Madden died in a city ER after waiting six hours without being seen by a doctor and without being reassessed after her initial triage. She had gone into cardiac arrest as a result of a heart attack she suffered three days earlier. The following January, a 20-year-old suffered a miscarriage in a city ER after waiting almost four hours without seeing a doctor and again without being reassessed after her initial triage. Within days, several women came forward to share similar stories.
At that time, reasons for scheduled visits included IV anti-infective therapy, wound care, post-operative assessments, blood transfusions, referrals to specialist services such as plastic surgery and orthopedics, blood tests and referrals from physicians for more timely access to diagnostic tests.
Lori Lamont, vice-president of interprofessional practice and chief nursing officer for the Winnipeg Regional Health Authority, said whittling away at the number of scheduled visits at ERs has proved to be a "complicated" task.
She said the WRHA has been able to implement a number of initiatives to bring the numbers down, including providing certain lab work on weekends and establishing a clinic for followups for plastic surgery patients.
She said there will always be "a small number" of visits scheduled by ER physicians who may legitimately want to see a patient again the following day to ensure a treatment has been successful or to recheck an abnormal lab result.
The creation of more Access Centre and QuickCare clinics staffed by nurse practitioners will ease the load on ERs, she said, as will the formation of primary-care networks that involve a broad spectrum of health professionals in a patient's care.
An area where the system could improve, she said, is to find easier ways to provide patients with specialists and advanced diagnostic testing without having this done in emergency rooms.
Visits with specialists, she said, are often arranged while they are at hospitals instead of at their offices.
"We still have, unfortunately, a system where sometimes the family physician believes that the best way is to arrange (for a patient) to see the specialist in the emergency department," she said.