ER a bellwether for state of health-care system

Hey there, time traveller!
This article was published 15/06/2024 (848 days ago), so information in it may no longer be current.

The ER is a barometer for how well or unwell the larger health-care system is performing.

We used to say this when I worked at the head office of the Winnipeg Regional Health Authority. It was true then and remains true today. The ER is ground zero for the health-care system and the portal of entry for many people. Dysfunction of the ER affects the larger system and dysfunction of the larger system affects the ER. This is part of the reason why fixing the problems plaguing ERs is so complicated, because, to some degree, it is factors outside the ER causing long wait times.

We have a huge problem. Our wait times continue to increase, especially at St. Boniface Hospital. I can only speculate that being the hub for cardiac care for the province may have something to do with wait times being longer at that site. But regardless, based on the latest data released, wait times are getting worse, not better. This is very concerning.

I’m not going to blame the NDP, as they’ve only been in power for seven months. They inherited a huge mess from the former Tory government. There are so many things that need fixing. ER wait times and working conditions desperately need attention. Otherwise, wait times will continue to increase and we risk losing more staff. We’re burning people out. We’ve been lucky our health human resources are loyal and dedicated and care about patients. But even they can only take so much chaos and dysfunction.

The ER is chaotic. People know it’s bad. People avoid going unless they absolutely have to. How many stories have we heard about people waiting up to 24 hours to be seen? I cried and begged my nurses not to send me to the ER back in March, even though I was going into septic shock, because I knew it was going to be an awful experience. And it was. It was so bad, I started a petition that ended up getting the attention of the local media. I want to make one thing clear, though — it’s not the fault of the people who work in the ERs that it’s so awful. These people are doing their best under impossible working conditions. They are heroes, in my opinion.

One of the biggest problems, and arguably one of the hardest to fix, is access block (being admitted, but no bed being available). The ER has turned into an inpatient ward, which it is not intended to be. Staff struggle to cope with simultaneously looking after actual emergency patients and the patients admitted to the ER. Many of the treatment spaces are tied up — often for days — by patients who are admitted, but waiting for a bed. This means no one else can access that treatment space and wait times go up.

Fixing this means increasing access to beds. There are reasons why beds are scarce. A lot of people are waiting in hospital for what they refer to as alternate level of care (ALC) — things like placement in a personal-care home, a palliative-care bed or a rehabilitation-unit bed. There are transitional beds for people to wait in, but ironically, people often have to wait for those beds. There are also people waiting for home care. It can take a while to get home care organized and services started. But the fact remains, this all contributes to scarcity of beds. If we want to move people out of the ER, we need to move people through the system faster. Waiting is a common theme in the entire health-care system.

The other major problem is resources. There are a lot of staff vacancies in the ER. This results in both heavy workloads and mandated overtime. Both cause burnout, affect morale and run the risk of losing more staff. And the more staff who leave, the worse working conditions will get. It’s a vicious circle.

This isn’t easy to fix either. There’s a shortage of health human resources not just in Manitoba, but nationally and internationally. Also, people know about the ER working conditions, so they aren’t exactly jumping at the opportunity to work there. Morale, culture and workload issues need to be addressed if they want to attract people and keep current staff. They also need to be creative and consider incentives to lure people to work in the ER and retain current staff.

Fixing the ERs is not something that can be done quickly or easily. But some of the pressure needs to be released before it implodes.

I don’t envy the government or the health authority. They have a hard task. However, ensuring ERs are operating properly is their responsibility. Manitobans have been patient and patience is running thin.

Shawna (Shoshana) Forester Smith is a 41-year-old chronically ill, disabled Ojibwe writer and health-care advocate who lives on a chronic-care unit at Deer Lodge Centre.