Closing ERs in Winnipeg an idea 'doomed to fail,' says emergency department doctor

'There are risks': ER closures could bring needed change, health-care providers say

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If Manitoba wants to reduce wait times and save money, the solution isn't converting emergency rooms into urgent care centres, warns an emergency room doctor.

Dr. Alan Drummond says any approach must include increases in hospital bed capacity and personal care homes if the goal is to save money or create efficiencies.

"The concept that we are going to solve overcrowding by making places more like urgent care centres or walk-in clinics is doomed to fail," said Drummond, a veteran Ontario-based doctor who is also the co-chair of public affairs for the Canadian Association of Emergency Physicians.

"All of those strategies have universally failed."

Drummond has been paying close attention to current talks in Manitoba, which have swirled around the possible closure of emergency departments in Winnipeg.

An announcement today by the Winnipeg Regional Health Authority is expected to put those rumours to rest one way or another.

Peachey report front and centre

Premier Brian Pallister and Health Minister Kelvin Goertzen have been consistent in their messaging: big changes are coming today, led by the expert opinions they have received since taking government.

"Decisions that could be made tomorrow or other days are always made because of patient care, but they are not always made because of what is easy on a day. It is what is good for the system in the future," Pallister told reporters Thursday.

The expert opinion comes from Nova Scotia-based physician Dr. David Peachey, whose recent report to government called for the closure of three community hospital emergency departments in Winnipeg.

The emergency departments would be converted to urgent care centres like the Misericordia Health Centre. Urgent care centres do not typically take trauma patients and generally treat non-life-threatening medical emergencies.

The Peachey report also suggests home-care services be upgraded and expanded.

Quality, not quantity, key for ERs

The four community hospitals in Winnipeg are Concordia Hospital, Grace Hospital, Seven Oaks General Hospital and Victoria General Hospital. There are two "tertiary" care hospitals in Winnipeg: Health Sciences Centre and St. Boniface Hospital. Both are larger teaching hospitals that offer specialized services.

Drummond said the solution to reducing wait times in ERs is found when patients can to be transferred from the emergency department to the necessary ward. The longer it takes to move one patient out of the department, the longer the other patient must wait to be seen.

The ability to end patient backlog and reduce wait times requires an occupancy rate for hospital beds of 85 per cent or lower, he argues.

Concordia, which serves northeast Winnipeg, and Seven Oaks, which serves northwest Winnipeg, have the worst capacity rates in the city. The hospitals had an average occupancy rate of 94 and 95 per cent, respectively, for 2015-16. Concordia has the fewest beds in the city at 185.

Concordia also had the longest ER waits in the country in 2015, with 10 per cent of people — or approximately 2,960 individuals — waiting for 6.8 hours or longer before being assessed by a physician, according to the most recent  Canadian Institute for Health Information report.

There are no national or provincial standards for how many emergency rooms should exist based on population densities.

Drummond argues in an urban area such as Winnipeg, the number of open emergency rooms doesn't necessarily matter.

"It is not the number of hospitals, it is the quality of care provided. So what is the exact number for Winnipeg? I have no idea," he said.

Nova Scotia model for rural ERs?

It is unclear if today's announcement will also cover an overarching plan for rural hospitals, but Drummond said all signs point to the province moving towards the "Nova Scotia model" for rural centres.

It's no secret that rural emergency rooms throughout the province have been plagued by doctor shortages, leading 28 rural ERs to be temporarily closed for over 24 hours in the last year.

Nova Scotia has been experimenting with a model that converts rural emergency departments into "collaborative care" centres. They are staffed overnight with nurse practitioners, while any trauma cases would be sent to the closest open emergency department.

He calls it the "darling" model that every provincial health minister is looking into. However, he notes it has been problematic in its implementation, with nurse practitioner shortages and patients unhappy with the service.

"But don't pretend," he warned. "It's not 'emergency department light,' it's 'primary care plus.'"

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