Health authority tries to have it both ways

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This article was published 03/02/2009 (6376 days ago), so information in it may no longer be current.

Two recent news items about medical tests for cardiac patients highlight the difficulties facing the Winnipeg Regional Health Authority in providing diagnostic procedures.

Staff at smaller city hospitals have complained that they are required to carry out EKG tests during overnight shifts, without formal training in the procedure. Patients requiring the more complex echocardiogram face lengthy waits, unless they choose to pay US$799 for the test themselves at a North Dakota clinic, which was barred from opening a branch in Winnipeg.

The health authority has framed both issues in terms of personnel. Small hospitals, they claim, do not have the resources for an overnight EKG technician, and long waits for echocardiograms have been blamed on a shortage of staff in that field.

In fact, both situations reflect a lack of transparency and accountability, and require administrative changes, not just more money.

The duty of the WRHA is to provide medical care in line with best practices. If the judgment of medical staff is that administering EKGs requires specialized training, it isn’t acceptable that lower standards are applied during the night shift. Hospitals that can’t justify an overnight EKG tech could transfer patients who need this test to another facility, or arrange to have qualified staff on call.

On the other hand, if an EKG is so straightforward that other medical support staff can be taught to give them safely and effectively, why not provide this training to as many staff as possible? This would reflect the collaborative-care model being adopted around the world as a team-based, efficient and effective way of providing medical care.

In either case, the WRHA should be open about its policies, and prepared to make the case that they are sound, both medically and in terms of cost-effectiveness.

The situation with echocardiograms, which produce images of the heart in motion, reflects a different sort of administrative failure.

Almost 4,000 patients are on the WRHA waiting list for this test, and some of them will wait for nine months or more. The provincial government has prevented a private clinic from providing this service within the province. Hundreds of Canadians, fed up with the wait and desperate for timely care, have travelled to the U.S. for the scan and paid for it themselves.

A Manitoba Health representative suggests that the lengthy waits are due to a “global shortage” of technicians trained to do echocardiography. While shifting the focus away from the performance of the local authority, this explanation doesn’t hold water.

First, wait times are much shorter not only in the U.S., where most patients get the procedure within 24 hours, but also within Canada, including other RHAs in Manitoba. If a widespread lack of qualified staff was the problem, patients in other jurisdictions would endure similar waits.

Second, a significant increase in staff isn’t required. Most echocardiograms take between 30 and 45 minutes. Adding two more slots per weekday at each city hospital — one more shift per week — would be sufficient to process the whole backlog within a year and provide the procedure to all patients within 30 days, the standard of care recommended by the Canadian Cardiovascular Society, thereafter.

Here, too, the WRHA must become transparent and accountable. Its goal is to provide an echocardiogram to all urgent patients within 48 hours. Does it achieve this, and if not, what is the shortfall? How are patients categorized as urgent, and do these criteria make sense from a medical perspective? All of this information should be publicly available and regularly updated.

Demand for health care is tremendous. Demographic and lifestyle trends mean that this demand will only increase in the future. Significant efficiencies and innovation are needed if our already overtaxed system is to keep up, and to its credit the WRHA is working to meet this demand; the Misericordia Urgent Care Centre is a successful example of adapting existing resources to changing needs.

While the WRHA struggles to provide consultations, diagnostics and treatment as promptly as possible, it must be open about its successes and its ongoing problems.

Publishing timely information about resources, shortfalls, waiting times and decision-making criteria will help those of us who rely on the WRHA to see how well it is functioning, and increase the organization’s accountability to its users, funders and the government to which it ultimately answers.

Rebecca Walberg is a Winnipeg writer and policy analyst.