Better systems, capacity what hospitals really need

Opinion

Hey there, time traveller!
This article was published 09/07/2024 (455 days ago), so information in it may no longer be current.

It doesn’t seem to matter which political party is in power in Manitoba when it comes to managing health care – they all come to the same false conclusion about how to reduce emergency room overcrowding.

It appears to be no different with the new NDP government, which took office last October after winning the fall provincial election. Like previous governments – both NDP and Progressive Conservative – the Kinew government is opening new minor injury clinics staffed with doctors and nurses and pronouncing publicly that those will reduce ER wait times.

It’s a claim that flies in the face of what experts, including ER physicians, have been saying for decades: that diverting low-acuity patients away from emergency departments does little or nothing to reduce wait times.

That point was reiterated last week by Dr. Alecs Chochinov, a longtime ER doctor who works at St. Boniface Hospital. Try as he and other ER physicians might to explain to governments and the public that opening clinics is not the answer to long ER wait times, it falls on deaf ears. Politicians ignore the advice and continue to peddle the falsehood that opening clinics will alleviate hospital overcrowding.

History has shown that approach does not work. Both the previous NDP government in the early 2000s and the former Tory government thereafter tried it in various forms and both failed to reduce ER overcrowding. Meanwhile, ER wait times have grown to record levels. Despite that, the Kinew government is pursuing the same path.

The reason diverting low-acuity patients away from hospitals does not reduce ER overcrowding is because it doesn’t address the real problem: access block. Patients sick enough to be admitted to hospital through ERs are waiting hours and sometimes days for a hospital bed on a medical ward. They are waiting on gurneys in emergency departments because there are no beds immediately available for them. The longer they wait, the more patients pile up. That leaves ER doctors and nurses with less time to treat new patients, which drives up wait times.

That phenomenon has been studied extensively, yet governments keep ignoring the findings. Instead, they come up with simplistic solutions that don’t work, like opening up clinics for people with sprained ankles and ear infections.

There is nothing wrong per se with expanding the availability of clinics for people with minor injuries or ailments. That can be beneficial on many fronts. But it will do virtually nothing to reduce access block in hospitals.

So why do governments keep doing it despite the overwhelming evidence? Because it’s relatively easy to do and it gives the appearance that government is doing something about a serious problem. Intuitively, it seems to make sense to the public: divert patients away from ERs and it will take enough pressure off hospitals to help reduce wait times. Except in the real world, for reasons already mentioned, it doesn’t have the desired effect.

Governments such as the NDP (and the Tories before them) claim they are listening to experts in the health care field, when in fact they are not – at least when it comes to finding solutions to solve hospital overcrowding.

The current government is taking some action to alleviate ER wait times, like bringing in weekend discharge policies at hospitals to improve patient flow (which helps reduce access block). But that’s a small step that will have only a minor impact. Hospitals need greater capacity and better systems to improve patient flow. That’s where governments should be focusing their attention, not by perpetuating myths that opening minor injury clinics will bring down ER wait times.