November 14, 2019

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ER chaos, bed crunch at St. Boniface cause for alarm: physician

When emergency room physician Paul Doucet arrived at work at St. Boniface Hospital on Wednesday morning, he was alarmed at what he saw.

At 11 a.m., there were 22 admitted patients in the emergency department who were waiting for a hospital bed. Eight of the admitted patients were in the department's high-acuity area. Two were being assessed for admission to intensive care. The number doesn't count all those who were waiting in the waiting room.

"We didn't have the capacity to respond to additional critically ill patients," Doucet said Friday.

St. Boniface ER Paul Doucet said staff were at 'a critical state in the emergency department' on Wednesday morning.

RUTH BONNEVILLE / WINNIPEG FREE PRESS

St. Boniface ER Paul Doucet said staff were at 'a critical state in the emergency department' on Wednesday morning.

When he came on shift at 11, he phoned the administrator who was on-call, alerted the director of the emergency department, the bed co-ordinator and other staff. The memo that would be leaked to the media Thursday, with the subject line '24 hour Emergency Redirection,' was the result of those calls.

It recommended temporarily redirecting people who go to the ER for follow-up appointments or non-emergency treatment elsewhere.

Doucet contacted the Free Press Friday after seeing the way the situation was characterized in the media by Winnipeg Regional Health Authority president and CEO Réal Cloutier and Martine Bouchard, president and CEO of St. Boniface Hospital.

Cloutier said the situation had to do with "managing patient flow within the emergency department," while Bouchard said the memo's language, in hindsight, was alarmist. Neither of them captured the chaos of what had occurred in the St. Boniface ER, Doucet felt.

WRHA boss clarifies statement

Réal Cloutier, president and CEO of the Winnipeg Regional Health Authority, said he takes concerns raised by physicians and other staff very seriously.

In a statement to the Free Press on Friday he said he was referring to overall patient numbers when he previously described Wednesday as not being an unusually busy day at St. Boniface Hospital.

“Our analysis of the data shows that June 12 was a busy day at the St. Boniface Hospital emergency department... While overall visits were below average, there were a higher-than-average number of patients who were waiting to be admitted from the emergency to in-patient units when the day began,” he said.

Réal Cloutier, president and CEO of the Winnipeg Regional Health Authority, said he takes concerns raised by physicians and other staff very seriously.

In a statement to the Free Press on Friday he said he was referring to overall patient numbers when he previously described Wednesday as not being an unusually busy day at St. Boniface Hospital.

“Our analysis of the data shows that June 12 was a busy day at the St. Boniface Hospital emergency department... While overall visits were below average, there were a higher-than-average number of patients who were waiting to be admitted from the emergency to in-patient units when the day began,” he said.

Cloutier said he did not have a full analysis of the situation on Thursday when he met with the media.

“That data has now been analyzed, and no unusual surges of patient arrivals have been identified. Patient volumes and acuity were not outside the range of what could typically be safely managed by established surge protocols. It must be noted, however, that an emergency department can be an unpredictable, complex and dynamic environment, and statistics cannot adequately describe the individual scenarios of the patients who presented on that day. We therefore accept and take very seriously the concerns expressed by staff and physicians at St. Boniface Hospital, and would like to reinforce that we encourage staff and physicians to continue escalating concerns when they arise.

“Busy days are not unexpected in emergency departments, and there are well-established protocols both in our system, and in the field of emergency medicine in general, to safely manage the unpredictability of surges in volume and higher acuity. The system is designed with this in mind. WRHA and St Boniface Hospital leadership are now working to identify the specific factors that led to Wednesday’s redirection being called at the hospital, including what established overcapacity protocols in the site and region could and should have been utilized.”

The WRHA had appeared intent Thursday on containing the situation. Before the news conference took place, a communications official warned a Free Press reporter against stirring up public fear.

But, for doctors and nurses at St. Boniface Hospital, there was cause for concern.

"We were at a critical state in the emergency department," said Doucet.

"(Bouchard) characterized the memo as alarmist... but I've worked for 32 years in emergency departments in Winnipeg and I was alarmed."

At one point on Wednesday, with both of the ER's resuscitation beds occupied and one "active resuscitation in progress," another patient in the department suffered a cardiac arrest in the hallway. One of the patients in a resuscitation bed had to be moved.

"It was chaotic," Doucet said, noting that these situations occur from time to time. "We work in a chaotic environment. There's always going to be things like that."

However, he doesn't want the situation that arose this week to be minimized either.

"We didn't have adequate capacity to respond to those situations on Wednesday because of the lack of capacity in the system," he said, referring to St. Boniface Hospital and the city's hospital network as a whole.

Doucet said Health Minister Cameron Friesen was correct when he stated on Thursday that such surges in demand are nothing new. The longtime ER doctor said he's encountered days like Wednesday "episodically" throughout his career.

Health, Seniors and Active Living Minister Cameron Friesen

SASHA SEFTER / WINNIPEG FREE PRESS FILES

Health, Seniors and Active Living Minister Cameron Friesen

"That should be almost more alarming in that it's not a new problem and we don't have effective ways of dealing with it in a timely fashion," he said.

Doucet said he has empathy for Cloutier, Bouchard and Dr. Bruce Roe, the WRHA chief medical officer who was removed from his job this week, because they're placed in situations where they're not given the tools to adequately deal with the problems.

"They have a role and they have to say what they''re saying. They don't want to be alarmist... but the people in the emergency department are alarmed for patient safety," he said.

Doucet said situations such as the one that occurred this week are hard on patients, their families and hospital staff.

"The nurses are placed in unbelievably stressful conditions, where (they're) faced with over 30 people in the waiting room and really no capacity to look after them safely. It's very stressful on nursing staff," he said.

Doucet said the issue at St. B arose this week due to a shortage of hospital beds. There was a crunch in the ER because there was no place for admitted patients to go.

"In the final analysis, it's a political issue because if we're talking about capacity and beds we're talking about money. It's a question of resources," he said.

Doucet said he didn't want to comment on the merits of the Pallister government's hospital ER consolidation plan.

However, he is concerned about bed shortages and staffing levels, noting that a number of nurses who were to arrive at St. Boniface as the result of the closure of the Concordia Hospital's ER are now staying put to work in the newly announced urgent care centre there.

If Seven Oaks Hospital's ER is transitioned to an urgent care centre in September, as planned, he said he and most of his colleagues in the St. Boniface emergency department believe that the situation they experienced on Wednesday "will be more frequent and worse."

"You're taking more of the capacity out of the system. With the way it's structured now, going forward, I would think things will continue to get worse," he said.

larry.kusch@freepress.mb.ca

Larry Kusch

Larry Kusch
Legislature Reporter

Larry Kusch didn’t know what he wanted to do with his life until he attended a high school newspaper editor’s workshop in Regina in the summer of 1969 and listened to a university student speak glowingly about the journalism program at Carleton University in Ottawa.

Read full biography

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