HSC ER swamped when patient died in hallway

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This article was published 02/03/2023 (965 days ago), so information in it may no longer be current.

The Health Sciences Centre ER was dealing with double the usual number of high-acuity patients when a male patient was pronounced dead in an ER hallway about an hour after arriving in an ambulance early Tuesday, hospital officials said Thursday.

The extreme backlog of patients waiting to be admitted to a hospital bed prompted the ER to enact “over-capacity protocols” later that day.

For the first time Thursday afternoon, hospital leaders publicly acknowledged the patient’s death, saying a critical incident investigation is underway.

“We acknowledge that events like this shake the public confidence in the health-care system,” said Dr. Shawn Young, chief operating officer of HSC.

Young and Jennifer Cumpsty, executive director of HSC’s acute health services, held a brief news conference.

No details about the patient’s age or identity were released, however, the Free Press has confirmed the deceased was a man.

He arrived at HSC via ambulance and was taken in by EMS around 11:30 p.m. Feb. 27. He was triaged and was waiting in the EMS hallway. Within roughly an hour after his arrival, staff became aware the man’s condition had worsened, and he was declared dead shortly afterward.

No family members accompanied the patient to the hospital, Young said.

The investigation will look into whether a first responder or hospital staff member was monitoring the man as he waited, as will provide details about how hospital staff were alerted to the man’s deteriorating condition. There will be a “detailed and thorough gathering of information,” Young said.

“The details of the patient’s time in our emergency department are subject to a critical incident investigation. This is both to identify areas where we could have done something differently, but also to identify lessons that we can implement to ensure this does not happen again,” Young said.

At the time of his death, ER patients were waiting a median of two hours to be seen.

“This is historically high, but in a range that unfortunately has been the case over the last year,” Young said.

There were approximately 25 ER nurses on shift, which is about the baseline staffing level for the department.

The Manitoba Nurses Union stated, in a Twitter post Thursday, that several nurses were working overtime that night and that about 40 patients had been in the ER waiting room for more than 12 hours, while some patients waited more than 20 hours to be admitted to a hospital bed.

Hospital staff had to move patients who were close to being discharged to make room for the influx of newly admitted patients from the ER, as per “over-capacity protocol,” Young said.

The protocol was implemented Tuesday “when we reached an extreme state of access block.”

Young said he couldn’t release the number of admitted patients who were waiting in the ER for a bed at the time the patient was declared dead in the hallway.

An HSC ER doctor, who spoke on the condition of anonymity, said there were between 30 and 40 such patients waiting for a bed at the time.

That means roughly half of the 66 beds in the ER were occupied by patients who needed to be on a ward, which is becoming more common, the physician said.

The backlog causes long waits for ER patients, some of whom will end up waiting in the hallway. Waiting patients are supposed to be checked on and reassessed regularly, but often ER staff “can’t keep up,” the doctor said.

“The reality is that there’s so many people being triaged, and there’s so many people needing to be re-assessed, you can’t keep up. So even though that’s supposed to be in place, we physically just can’t keep up with it because there’s too many people.”

The physician said the use of the hallway as a holding area for patients predates the pandemic. Patients in the hallway are typically on stretchers, having been taken in by paramedics, or they can’t be in the main ER waiting room for some reason, including if they’re under the influence of drugs and have been violent towards staff.

Paramedics wait with individual patients for a certain amount of time, but they’re not required to stay for the duration of the patient’s wait, the ER physician said.

A health-care aide or other staff member will be tasked with monitoring patients in the hallway. The aides are “fantastic” but they often aren’t highly trained to recognize subtle changes in vital signs that could point to a patient getting worse, the doctor said.

ER staff have repeatedly warned about unsafe workloads, fearing that someone would die on their watch.

“From our perspective, we’re doing everything that we can, but we’re sinking,” the physician said.

Staff shortages and patient flow are not the only problems. The hospital was stretched thin in the best of times, the physician said, and policy makers need to take responsibility for the current situation.

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“What are we doing to make sure that patients are getting into beds in a timely fashion so that they can be assessed before they get sicker, before they get worse, and before they die?

“What are we doing for all of those patients who are waiting in the emergency department, waiting for beds upstairs? Why is it that the emergency department is the location of where we manage overflow?”

Young said this week’s patient death is the only critical incident investigation he’s aware of involving a patient dying while waiting in the hallway.

He said 50 to 100 patients die at HSC every month, on average, and many of them die while in the ER.

katie.may@winnipegfreepress.com

Katie May
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Katie May is a multimedia producer for the Free Press.

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