Diversion of emergency surgery patients a growing problem, Alberta doctors warn

·5 min read
Alberta Health Services has implemented four emergency general surgeriy diversions Calgary's Rockyview General Hospital this week. So far six patients have been transported to other hospitals as a result. (Oleg Ivanov IL/Shutterstock - image credit)
Alberta Health Services has implemented four emergency general surgeriy diversions Calgary's Rockyview General Hospital this week. So far six patients have been transported to other hospitals as a result. (Oleg Ivanov IL/Shutterstock - image credit)

EDITOR'S NOTE: This story has been updated since it was originally published on June 16, 2022.

Calgary's Rockyview General Hospital is diverting emergency surgery patients for the fourth time in a week and the situation is raising concerns about patient safety.

Staffing shortages have prompted another emergency general surgical diversion protocol to be put in place, lasting from 5 p.m. on Monday until 8 a.m. on Tuesday, meaning patients will be sent to Calgary's three other adult hospitals during this time.

Diversions implemented overnight last Tuesday and through the afternoon and night on Thursday resulted in six patients being sent elsewhere.

According to AHS, a similar protocol through the weekend resulted in no patients being diverted from the Rockyview for emergency surgery.

"All patients received the care they needed when they needed it," AHS spokesperson Kerry Williamson said in a statement emailed to CBC News last week.

These diversions impact emergency general surgeries which can include treating potentially deadly problems such as a ruptured appendix, bowel obstruction or intestinal perforations.

Other procedures such as emergency orthopedic or urology operations are not impacted, according to AHS.

WATCH | Dr. Anthony Gomes explains what a delay in care could mean for patients:

And the situation at Rockyview extends further now, potentially impacting patients who are already admitted.

"Inpatients at Rockyview needing emergency surgery may also be transported to another hospital for their procedures. This will be determined on a case-by-case basis in consultation with the on call general staff surgeon," Williamson said on Friday.

AHS has described the diversions as a common practice used to "distribute patient volumes to the most appropriate location to balance system pressures."

Increasingly common

But doctors say diverting emergency surgery patients is not a normal practice in Calgary.

They say it's a symptom of a healthcare system under intensifying pressure and, while it is unusual, it is happening with increasing frequency.

"It's actually really quite uncommon ," said Dr. Chris Armstrong, a general surgeon at Rockyview General Hospital.

"It's been happening more frequently in Calgary. There's multiple pressures from that."

Submitted by Chris Armstrong
Submitted by Chris Armstrong

And diverting these patients is something, until recently, he hadn't witnessed in his nearly 10 years working as a surgeon in Calgary.

"Any unnecessary delay with surgical care could potentially impact patient outcomes in a negative way. So I think it's incredibly important to minimize those unnecessary transfers," he said.

'That's a dangerous thing' - Dr. Christopher Armstrong

"When all of the sudden one of those [Calgary hospitals] is diverted, it puts undue pressure on those three other centres that are already busy. That's a dangerous thing. And it's a dangerous direction, that if it continues it needs to be addressed."

The Red Deer Regional Hospital has been under a surgical diversion of its own since April 29 resulting in the transfer of more than 100 patients to either Calgary or Edmonton so far.

That's exacerbating the pressures in Calgary as hospitals absorb patients from the central Alberta facility.

Armstrong believes there are a number of factors contributing to the shortage of staff, including burnout after two years of the pandemic, a drop in the number of medical trainees who assist the surgical team, and funding changes.

It takes three people to properly run an emergency surgical service safely, he said, including the surgeon and someone to assist in the operating room as well as another provider to care for patients on the ward.

According to Armstrong, there are upcoming nights where surgical teams are short staffed and he's concerned this could happen again.

"I'm worried. I don't foresee this situation getting better quickly. I"m worried that its going to get worse and this might become a more frequent occurrence," he said.

He said staff find ways to treat the most urgent cases — those that can't wait to be transferred — when they arise.

Hospital strain

These diversions are another sign of the stress facing the province's hospitals, according to Dr. Vesta Michelle Warren, president of the Alberta Medical Association.

Health-care facilities, she said, are dealing with a high number of COVID-19 patients, an influx of people who are sicker due to delayed care, a surge in viral illnesses, and ongoing staffing shortages.

And they've been forced to move patients around in an effort to cope.

"The solution to that is one that I think is going to be more difficult to solve," she said.

Submitted by the Alberta Medical Association
Submitted by the Alberta Medical Association

Warren, who has a family practice in Sundre, receives regular notices about hospital diversions.

"This year we're getting these diversions for multiple services, not just surgeries. We're seeing it for other areas as well, and we're getting it multiple times a week," she said, adding staff are doing their best to care for patients and urging people to go to the hospital if they need care.

Meanwhile, CBC News asked AHS how often these types of diversions have been put in place since December and which hospitals have been impacted.

The health authority did not respond to those questions.

According to AHS, the recent diversions are caused by staffing shortages, including absences due to illness.

"Last week, a total of six patients were diverted, out of about 120 emergency general surgeries done in the Calgary Zone in a typical week, and a total of about 1,800 surgeries of all kinds," Williamson said.

AHS said it has not reduced budgets or staffing and it's working to hire more people as quickly as it can.

"More than 300 [full-time equivalents] are planned to be added in the next 18 months to aid in increasing surgical activity within the Calgary Zone," said Williamson.

"We regret any imposition on patients and their families, but we emphasize, patients who receive surgery at another site receive timely, safe and appropriate care."

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