The Manitoba Nurses Union says its members are painting a picture of a health-care system in increasing disarray.
Communication seems to be absent or lacking substance, says president Sandi Mowat, at a time when the Winnipeg Regional Health Authority should be ramping up efforts to explain the impact pending changes will have on health services.
"The front-line staff has not been really part of any of the process," Mowat said Friday.
She pointed to a Free Press report earlier this week about renovation plans for a new minor treatment area in the ER at Winnipeg's Health Sciences Centre, saying it was the first nurses there had heard of it.
It is frustrating, Mowat said, because they’re currently experiencing a high volume of visits to the ER and can’t quite wrap their heads around how closing other city ERs will improve the process at HSC.
Patients with no hospital beds
Just last week, she said, 20 or so ER patients had to be admitted -- but with no beds in the hospital they were left occupying space in the ER.
"That impedes the flow as well," Mowat said. "How are these changes going to impact that, and how is this going to improve patient care?"
Carol Legare, director of patient services for the emergency program at HSC, didn’t dispute the union's story, adding while it’s not ideal to have such a large number of admitted patients, it’s also not uncommon.
"A typical day in an emergency department can vary," Legare said, noting recent volume is on par with most summers.
As for communicating with staff, Legare said there are lots of conversations. On a formal note, there are staff meetings and leadership meetings; less formal, there are "huddles before shifts."
"It’s really important from a leadership perspective that in the conversations that we’re having with staff we’re not making promises that we can’t follow through on," she said. "So the information that we’ve been relaying to them… is that we are going to see additional patients. We are having conversations about if we need additional space, where is that space going to be."
But there seems to be a gap, Mowat said, given nurses have asked about space needs around the same time as the WRHA put out a request for proposals for someone to design it.
"They’ve raised issues about their capacity," she said, "and all they were told is, ‘Yes, we have to expand,’ but there were no details."
Until the minor treatment area the WRHA is looking to add to the current HSC emergency department is ready, Legare said staff will use "process improvements" to handle any influx of patients prompted by other city emergency centre closures.
An example of that, she said, is how a doctor and nurse work together as a team to see patients quickly and to figure out which department is best for the patient to be sent to.
"We keep them vertical," Legare said of people arriving in the ER. "If a patient can be seen in a chair as opposed to a stretcher, that’s how they’ll be seen… then the initial assessment can be done in a faster manner."
Legare also noted HSC’s ER will get extra staff during both phases of the system-wide overhaul, including physicians, nurses and other support staff.
But, Mowat said, that doesn’t quite address the gaps in communication.
Postcard sent by WHRA causing confusion
The union has heard stories anecdotally about people driving by an ER to go to another one because they mistakenly think it’s already closed, as well a doctor rerouting patients because he believed a facility to be already closed.
Mowat said a "Healing our Health System" postcard mailed out by the WRHA last month and arriving now in people’s mailboxes, seems to raise more questions than it answers.
"Fall 2017," the card reads, "What’s changing and when?"
However, beyond the early July date when Misericordia Health Centre’s urgent care centre modified its overnight hours, the postcard includes no actual dates. It says there will be new clinical assessment units opened up at Grace Hospital and St. Boniface Hospital, and notes an expansion at HSC to "support assessment and observation, and to accommodate increased volumes."
"I don’t understand what that means to me as a patient," Mowat said.
A WRHA spokeswoman clarified the bulletin should say "work will start in Fall 2017" on those projects, not that they will be ready this fall. However, she said, "we will continue to be able to comfortably accommodate those who need services at HSC and any additional people who need services while we work on the expansion."
The postcard is part of the WRHA’s initial public information campaign. It was mailed out Winnipeg residents July 18, although some are only getting the cards this week. Winnipeggers can expect a second postcard sometime mid-September on the subject of what signs and symptoms should direct them to seek urgent care and what signs and symptoms should direct them to the emergency room.
"Up until now, the public awareness campaign has focused on explaining the patient care case for making the changes," the spokeswoman said. "Now that changes are being implemented, we want to shift the focus of the information being offered to help people understand where to seek care."
They better hurry up, Mowat said, after all, "the changes are already happening."