Death rate at Health Sciences Centre ER increases; officials try to determine why By: Katie May Posted: 7:00 PM CDT Wednesday, Mar. 15, 2023

The increase in ER deaths at Manitoba’s largest hospital — 21 so far this year — is being blamed on a rise of severely ill patients who show up needing care.

The number of deaths in the Health Sciences Centre emergency room has risen steadily since 2019, and was nearly double last year’s national average.

Shared Health said several factors could be at play: people have delayed seeking care due to a spike in wait times amid the pandemic, COVID-19, the recent consolidation of stroke services at HSC, an increase in drug use and the aging population.

The result is a higher rate of seriously ill, or “high-acuity” patients are showing up at HSC compared to other hospitals in Canada, a Shared Health spokesperson stated.

“More than 3,000 additional high-acuity patients were seen at HSC’s adult emergency department in 2022 than in 2019. The increase in high-acuity volumes is unlike the experience of many similarly sized Canadian hospitals, which saw decreases during the same time period,” the statement reads.

Data provided by Shared Health does not indicate how many of the ER deaths involved high-acuity patients.

In 2022, 170 deaths were recorded in the ER. That includes patients who died shortly before arrival. That’s an annual rate of 0.32 per cent of all ER visits, according to Shared Health data as of March 2, 2023.

So far in 2023, the death rate is at 0.23 per cent. The death rate was 0.16 per cent in 2019, 0.25 per cent in 2020, and 0.3 per cent in 2021. In 2019, there were 114 deaths.

The number has been climbing every year, along with the number of patients assessed as being high-acuity. Even as overall ER visits dropped during the pandemic — falling to nearly 53,000 in 2022 from more than 70,000 visits in 2019 — the number of severely ill patients increased to nearly 15,000 in 2022 from nearly 12,000 in 2019.

In Canada’s emergency rooms last year, more than 18,000 adult patients died — a death rate of 0.16 considering there were nearly 12 million adult ER visits in 2021-22. Of 11,357,600 visits by patients 20 or older, 18,048 ended in death, according to data from the Canadian Institute for Health information. Nearly eight million ER visits were triaged as emergent, urgent or requiring resuscitation.

Stroke services consolidation likely permanent

For the past three years, all stroke patients in Manitoba have had to go to HSC’s ER to see an on-call stroke neurologist.

It may be one of many factors, but the consolidation of stroke services at HSC isn’t behind the crush in the emergency department, said Dr. Dan Roberts, acting section head of neurology at HSC.

“The overwhelming situation in emergency departments has root causes outside of the consolidation of stroke services,” he said.

Roberts oversaw the consolidation after taking over the position in fall 2019, after four of the city’s 17 neurologists had resigned. A shortage of stroke neurologists in Winnipeg — there were only three at the time — meant the department couldn’t keep responding to stroke calls at St. Boniface Hospital in addition to maintaining epilepsy services, Roberts said.

“We didn’t have enough people to do the calls, and we wanted to retain the people that we had, so we were forced to consolidate.”

“We didn’t have enough people to do the calls, and we wanted to retain the people that we had, so we were forced to consolidate.”–Dr. Dan Roberts

The resulting influx of stroke patients at HSC was predictable, and has since stabilized, he said.

Currently, there are six stroke neurologists and a seventh has just been hired. Four more are set to arrive later this year. Overall, the department is expected to have a full complement of 34 neurologists by October. That will allow stroke services to run “comfortably” at HSC, Roberts said.

He said the consolidation is likely permanent, meaning stroke patients will continue to be taken to HSC.

“The strain that the emergency department is under affects all programs, and (the emergency department) has been working pretty hard to make sure that the processes… are smooth, and the neurologists have been making every effort to follow those procedures and help develop them so that patients who come in are well-monitored and rapidly investigated,” Roberts said. “If they require a stroke intervention, then they get it in a timely fashion.”

Work is underway to solve the complex problem of overcrowding in the ER. Roberts said the hospital, like Canada’s health-care system, needs more staff and space to care for patients, and patients need more places to get treatment, such as extended-hours clinics that are open evenings and weekends.

Otherwise, he said, patients go to the ER.

“They languish in the emergency department, they back up in the waiting room, and then you get these situations that are horrendous with deaths resulting in the emergency department. You can’t fix that without planning and attributing some hospital resources.”

A critical incident investigation is being conducted into the death of a patient who was waiting in an ER hallway at HSC overnight from Feb. 27 to 28.

The man arrived in an ambulance, was triaged and waited in the hallway. Within about an hour, his condition worsened and he was pronounced dead. The investigation is expected to determine what the hospital could do to prevent similar deaths. It is required to be completed within three months.

Data showing the number of deaths at other city ERs was not available Wednesday.

katie.may@winnipegfreepress.com

Katie May
Reporter

Katie May is a general-assignment reporter for the Free Press.

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