The inquest into Brian Sinclair's death has heard patients brought to the ER by ambulance get moved ahead of sicker patients awaiting care to save money. Manitoba Nurses Union president Sandi Mowat's claim is news to the Winnipeg Regional Health Authority, the agency's lawyer said.
If true, it is another example of policy trumping planning in city hospitals. The WRHA a year ago set deadlines to move ER patients through the ward -- releasing them within four hours, or admitting them within eight -- without the means to get the job done. Dubbed a matter of simply setting priorities, the WRHA this year has conceded its ambitions outstripped strategy.
An ambulance off-loading target was set after the City of Winnipeg said it will charge the WRHA for the time attendants were tied up with patients in ER halls. Ms. Mowat said hospital officials now order ER nurses to move those patients into treatment ahead of others who, though sicker, got there on their own.
Ms. Mowat was describing the pressures on ER nurses, but backlogs cannot entirely explain why Mr. Sinclair died in 2006, sitting 36 hours in his wheelchair awaiting care. There were times he was all but alone in the waiting room; other times citizens tried repeatedly to get hospital staff to help him.
Ms. Mowat should give her evidence of the queue-jumping directives to the WRHA, which must find a better means of getting those on gurneys off.
The current phase of the Sinclair inquest, however, got some insight into why city ERs get backed up. The city -- and Manitoba as a whole -- still needs more personal care homes for elderly patients who should not be in hospitals.
One WRHA official said something as simple as housekeeping adds to backlogs -- available beds sit empty for want of cleaning.
Care homes and clinics are key to lifting pressure off the ER, but the dirty-bed problem indicates a need for better resource management. Before the WRHA hires more nurses to manage at the gate, it needs to pinpoint where, and why, the backlog starts.
First, though, it must resist the dangerous reflex to set unreasonable targets that merely crank up pressure on front-line staff.