Creative explanations aside, task force clear on cause of ER crisis… more than five years ago Consolidation has supercharged existing hospital capacity crunch, blamed for worsening patient outcomes in PC-commissioned 2017 report By: Tom Brodbeck Posted: 7:00 PM CDT Thursday, Mar. 16, 2023

Opinion

There is another explanation behind the spike in severely ill patients showing up at Health Sciences Centre’s emergency department in recent years: the province closed three ERs in Winnipeg.

Officials at Shared Health said this week there are several reasons why Manitoba’s largest hospital has been flooded with more acutely ill patients since 2019. Increased drug use and delayed care during the COVID-19 pandemic are two possible reasons. That may be leading to more ER deaths, Shared Health says.

Death rate at Health Sciences Centre ER increases; officials try to determine why

Maybe. But there’s another reason: the Progressive Conservative government closed three emergency departments in Winnipeg between 2017 and 2019 as part of its hospital consolidation plan. HSC is one of three acute-care hospitals left in Winnipeg, down from six prior to consolidation. Not surprisingly, the three facilities are seeing an increase in high-acuity patients as they absorb patient volumes from other sites.

The number of severely ill people seen at HSC increased by more than 3,000 in 2022 compared with 2019, according to Shared Health.

Trouble is, the province failed to provide those sites with adequate funding to increase hospital-bed capacity. As a result, admitted patients are piling up in ERs, patient care is suffering and the risk of medical errors and neglect is increasing.

That’s the side of the story government is not eager to talk about.

The data shows more severely ill patients are showing up at the three facilities — HSC, St. Boniface Hospital and Grace Hospital. Since 2017, all three have seen an increase in the number of patients deemed sick enough to be admitted to a medical ward. What they haven’t received is a commensurate increase in funding to boost the number of staffed hospital beds on those wards.

HSC had 777 hospital beds in 2016-17, the year before consolidation. That fell to 762 during the first year of the hospital mergers. It increased slightly to 780 in 2021-22, according to Shared Health data. Capacity at HSC has remained largely unchanged, even though the facility is seeing more acutely ill patients.

In 2015-16, HSC had an average bed occupancy rate of 88.5 per cent. That jumped to 94.8 per cent in 2021-22. It now has less capacity to absorb spikes in patient volume.

Given those realities, it’s no surprise patients awaiting a bed are backing up in the ER. That’s driving up wait times and compromising care.

It’s worse at Grace and St. Boniface.

St. Boniface had 493 staffed hospital beds in 2016-17. That number fell to 464 beds in 2021-22. Grace saw its bed count decline from 235 in 2016-17 to 227 in 2021-22. Patients are also piling up in those ERs.

Meanwhile, government continues to peddle the falsehood that almost 40 per cent of people who show up at ERs and urgent-care centres could have received treatment elsewhere, suggesting it’s causing ER overcrowding.

The 40 per cent figure is the portion of patients triaged as Level 4 or 5 patients, the least ill patients on the Canadian Triage and Acuity Scale. That doesn’t mean everyone triaged as a Level 4 or 5 could be treated at a doctor’s office or a walk-in clinic. Some have complex medical issues that may require a hospital stay. Government is spreading erroneous information to divert attention away from the poor management of its hospital-consolidation rollout.

Manitoba’s 2017 Wait Times Reduction Task Force, commissioned by the Tory government, confirmed that Level 4 and 5 patents are not the main cause of ER overcrowding.

“CTAS 4 and 5 level patients have been identified by media, politicians, many ED staff, and fellow ED patients as the ‘black sheep’ of emergency care,” the report says. “There is an enduring, persistent belief that they are the fundamental problem in (emergency department overcrowding). If they can be dealt with elsewhere, all will be well. That is a myth.”

The report, written by experts in the field, found the main cause of ER overcrowding is the growing length of time patients are spending in emergency departments — often on gurneys in hallways — waiting for a bed on a medical ward. That leads to poor outcomes.

“There is clear evidence that prolonged ED stays contribute to increased illness (morbidity) and death (mortality), as well as prolonged hospital stays as an admitted in-patient,” the report found.

That may not be something government officials are willing to acknowledge publicly. But it is in their own report.

tom.brodbeck@freepress.mb.ca

Tom Brodbeck
Columnist

Tom has been covering Manitoba politics since the early 1990s and joined the Winnipeg Free Press news team in 2019.

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