‘The most unsafe shift of my career’

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This article was published 19/10/2023 (689 days ago), so information in it may no longer be current.

A critically ill patient received intensive care unit-level treatment in a Health Sciences Centre hallway last week because there was no other space available.

The mounting patient-flow crisis at Manitoba’s largest hospital triggered the transfer of 19 previously admitted people from outside the city back to their home communities.

Two HSC emergency nurses raised concerns about the Oct. 12 hallway incident with the Free Press.

However, Shared Health stated it had no record of ICU-level care being administered in a hallway, “nor has any incident been flagged as a possible critical incident.”

Speaking on the condition of anonymity, both nurses said it’s unacceptable for the province’s flagship hospital to have so few treatment spaces open to look after incoming emergency patients and accept urgent transfers from other health-care centres — something they said is a long-standing problem.

The HSC adult emergency department was overflowing the day in question, mostly with admitted patients waiting for a hospital bed or placement elsewhere, both nurses said. The resuscitation room was already full of patients, so several had to be looked after while they waited in the hallway.

One of them required care normally only administered in an ICU, one nurse said, describing it as “the most unsafe shift of my career.”

“We were paralyzed as a department that night to only utilizing one of the 58 treatment spaces for emergency medicine,” the ER nurse said.

There were, at one point, more than 120 active ER patients in a department built for the 58 treatment spaces, and wait times were as long as 36 hours.

Another ER nurse working Oct. 12 — a Thursday — said that night shift was “particularly awful,” but not uncommon. The problem tends to happen heading into the weekend, the nurse said.

“Every Thursday, this is a predictable problem. The hospital is at capacity, all of our beds are bed-blocked by (patients waiting to be admitted to other hospital departments), so we can’t see anyone.

“It’s outrageous. This is like Third World-country stuff. How do you continue to accept ambulances and transfers from other facilities?”

Patient volumes have “remained at relatively consistent levels” over the past two weeks, Shared Health stated. However, patient-flow problems have worsened.

There were 156 patient visits to the adult ER on Oct. 12, and earlier this week — Monday and Wednesday — that number reached 181, Shared Health said.

Last week, a provincial response was triggered to free up capacity by moving 19 patients out of HSC back to their home health regions, including three who were transferred to communities out of province. (HSC also serves parts of Nunavut and northern Ontario.)

The transfers happened as part of internal capacity management plans, a Shared Health spokesperson said.

“We can confirm that internal capacity management plans have been frequently used in recent weeks, and were escalated last week to a provincial response, resulting in the repatriation of 19 patients from HSC to hospitals outside Winnipeg in a patient’s ‘home’ health region that could appropriately meet their care needs.”

The HSC emergency department and the entire health-care system needs more staff, Shared Health acknowledged.

That the hallway incident happened while patient volumes were consistent shows “how broken the system is,” one HSC nurse said.

Experienced staff on duty likely prevented a worse outcome, the nurse added. “It’s a systemic issue that has filtered down and ended up in the emergency department.”

Manitoba Health Coalition director Thomas Linner said such incidents “are not one-offs.” He said the public deserves “radical honesty” about what is happening in the provincial health system, including regular updates on availability of hospital beds, use of private-agency nurses and the number of shifts missed because of sick calls or other reasons, in addition to wait times.

Manitobans need a clear picture of the state of the system, Linner said.

“I think that’s a culture change that needs to happen, and needs to happen pretty quick.”

The need to improve patient flow through the ER to the rest of the hospital was an accepted recommendation in the findings of an internal critical-incident report after a patient died in the HSC ER hallway earlier this year.

The man died Feb. 27 during a time when staffing levels in the ER were at baseline and more than double the average number of seriously ill patients needing life-saving care were brought in.

HSC chief operating officer Dr. Shawn Young was not available for an interview Friday. Young has previously stated the health-care system continues to be in a staffing crisis and the hospital needs more nurses in order to have more beds available.

The problems with patient flow also mean more people are leaving the ER without being seen by a doctor. At HSC last month, 34 per cent of emergency patients left after registering but before seeing a physician. In 2019, that figure was only 13 per cent, according to data provided by Shared Health.

For the 30-day period ending Oct. 5, 34.1 per cent of patients left without being seen at HSC’s adult emergency department; 22.5 per cent left the St. Boniface ER and 15.7 per cent left the Grace Hospital ER.

“When anyone goes into a hospital in Manitoba, they need to know that they will receive the care that they deserve,” newly installed Health Minister Uzoma Asagwara said in a statement Friday.

“After years of cuts to our hospitals and mistreating the health-care professionals that keep them running, we have seen many instances of hospitals unable to provide the care people need…. We will increase investments in retention, recruitment and training of more workers in our facilities, adding capacity and ensuring people in Manitoba get the care that they expect and deserve.“

katie.may@winnipegfreepress.com