The Sturgeon hospital emergency room is seeing an increasing number of patients languishing in its beds waiting for admission.
Dr. Dan Hryciuk, a physician who has been in the emergency room for three decades, said there had been improvements over the last year but things began to slide back the last few months.
"In the last two to three weeks we have had more than 50 per cent of our emergency patients blocked with patients who are admitted or are waiting to be admitted."
Hyrciuk said during one of his recent shifts, 17 of the unit's 19 beds were blocked with patients waiting to go to other parts of the hospital. The recent problems come after a year of relative successes at the facility.
Alberta Health Services (AHS) data reflects the trend, showing a steady decline in the number of emergency inpatients; those waiting for a bed somewhere in the hospital, starting last fall. In May however, that trend turned around and there has been a steady incline coming close to the levels present last fall.
Provincial report
Hyrciuk's comments come as the Health Quality Council of Alberta (HQCA) released their secondary progress report on their investigation into emergency room wait times, cancer care and physician intimidation.
The council's report said there were significant concerns about emergency room wait times and that the problem got consistently worse between 2005 and Sept. 2010, before there was a significant improvement over the last year.
They said despite that improvement there has been a decline over the last month.
John Cowell, executive director of the HQCA, said the panel has done 70 interviews and reviewed hundreds of patient charts looking into the three areas they were asked to review.
The HQCA reviewed patient charts from the University of Alberta Hospital to try to find instances where wait times may have had an impact on patient health.
Cowell said they didn't find any instances where a patient died because they waited too long, but they found many worrying cases.
He said in one case a patient with a life-threatening condition waited for five hours before giving up and then came back the next day, very close to death.
"The margin of safety was stretched to the limit. It ended up having a happy ending, but it easily could have been a death."
Cowell said if the patient had waited longer to come back or if the emergency staff hadn't seen the individual immediately, the patient easily could have died.
Dr. Chris Eagle, president of AHS, said the emergency rooms did slip backwards earlier this fall, but he believes they are back on track.
"These numbers are again trending in the right direction and we are continuing to make progress."
In the Calgary and Edmonton regions generally, AHS's numbers show an improvement, but the number of patients stuck in Sturgeon emergency beds is on the rise.
One of AHS's other targets is to have 75 per cent of emergency room patients seen, treated and discharged within four hours; the Sturgeon stands at 63 per cent.
Hryciuk said the Sturgeon is simply not meeting the standards set out by national organizations for specific medical conditions and how quickly people should be seen.
"We never meet them, we meet them sometimes if you are in that one per cent of patients who are actually coding and are going to die within the next half hour, we will see those."
One of Hryciuk's concerns is that the over-capacity protocols that are supposed to be used when an ER gets clogged aren't being used often enough. He said the over-capacity protocol is only used once a day and the ER frequently fills back up with patients before it is used again.
In an emailed statement, Wendy Tanaka-Collins, the hospital director said that isn't the case.
"They are enacted as required, when triggers are hit. That is the same as any other site in the province," she wrote. "Capacity protocols are enacted at Sturgeon on a regular basis, when certain triggers are hit. The aim of the protocols is to improve access and have been successful at all of our sites since they were first implemented late last year."
Physician intimidation
The other area the HQCA is studying is the issue of doctors being intimidated for advocating for their patients.
Cowell said that in the 70 interviews they have conducted so far they have found widespread reports of doctors feeling intimidated when they spoke up.
He said not all physicians had the same experience when they pushed for their patients.
"For some it was an incredibly negative experience, for others they had no problem with it."
The variance is part of the reason the council is doing a survey of all physicians in the province with questions about their experience advocating for their patients.
Cowell said another problem they have encountered is that with the changes in the structure of the health system over the past two decades, physicians often don't know where to bring their concerns.
"This is a complicated system. It is confusing to all of the participants as to what is the role of government, what is the role of ministers, what is the role of the health system."
Eagle said he doesn't know anything specific about the intimidation cases, because of the arm's length approach of the council, but he wants physicians to be able to speak up.
"I don't know what the issues of intimidation were specifically; all I know is that patients are served best when physicians and nurses are able to advocate for their patients."
The council's full report on emergency rooms and doctor intimidation is expected to be released in February of next year. That report will include recommendations on how to improve the system.
