Emergency room closures, urgent care centres won't overcome need for more beds, ER doctor says

Task force recommends closure of 4 western Manitoba emergency rooms

Shutting down emergency departments and replacing them with urgent care centres may streamline services and cut down wait times, but it won't tackle the overall issue of a lack of beds, says Dr. Alan Drummond, a veteran Ontario-based doctor who is also the co-chair of public affairs for the Canadian Association of Emergency Physicians.

"I would suspect really the number of emergency departments in the city of Winnipeg is probably not the major issue. The issue is timely access to … quality health care," Drummond said.

It comes down to hospital bed capacity, not the number of ERs, he said.

On Friday, the Winnipeg Regional Health Authority announced its plan to close three emergency departments, converting two into 24/7 urgent care centres.

"Right now, many patients wait too long for care, stay too long in hospital or need to visit multiple sites to get the care they need," WRHA president and CEO Milton Sussman said on Friday.

"With this announcement, we begin the process of healing our health system, taking important steps that focus squarely on our patients," he said.

"Both significant and sensible, these changes address systemic challenges that have hindered quality care and taxed our resources."  

One reason for the change is that 85 per cent of people heading into the ERs have "fairly low-level types of injuries," WRHA health officials said.

Drummond disagreed, saying it has "little to do with over-utilization or inappropriate utilization."

"If you need to address what's happening in [emergency] you have to address what's happening in the system," he said.

Need more beds

If patients who need chronic care or rehabilitation are no longer occupying beds in the three hospitals, that should help address "the prolonged waits for emergency care that have been historically associated with Winnipeg," Sussman said.

But that can only be achieved if there are more beds, he added.

However, a minimal number of new hospital beds will be added, said Lori Lamont, the WRHA's president of inter-professional practice and chief nursing officer, on Friday.

If there aren't enough beds, hospitals become overcrowded and admitted patients can't be transferred to wards, Drummond said, so they are stuck waiting on ER stretchers, causing further backlog in the ER.

Across the country, about 20 per cent of current hospital bed capacity is used by "alternative level of care" patients, which means their acute-care needs have been met but there's nowhere for them to go.

On average, one alternative level of care patient occupying a bed in the emergency department denies access to four patients per hour, according to a 2005 report by the Canadian Association of Emergency Physicians.

"You could have an emergency department in your backyard but if it isn't of a certain standard of timeliness and quality then there's not much value in having it," Drummond said.

Alberta urgent care centres a 'victim of their own success'

In Alberta, urgent care centres have become "a victim of their own success," said Sandra Azocar, executive director of Friends of Medicare, a public health care advocacy group in Alberta.

An Alberta Health Services report in 2014 said the centres were struggling to keep up with demand. Azocar said they also have to compete for funding dollars.

"The government needs to ensure that if you are going to create that level of care that you do not leave it underfunded and these places are not competing necessarily with the resources that are being … allocated differently to the major hospitals," she said.

Although they can be a good alternative, Azocar said urgent care centres aren't tackling the root causes of ER wait times — including a lack of beds.

"We still have concerns about the other parts of the health-care system that ultimately impact the wait times in ERs," she said.

Brett Skinner, with the Canadian Health Policy Institute, says urgent care centres have shown success in areas with concentrated and dense populations.

But he's concerned about what might happen if the trend toward the centres expands to rural Manitoba.

"It's great if, once you can get to the emergency department, there is a lot of resources available to you as a result of the concentration of the delivery of services, and in one location the centralization of services," he said.

"But if it takes you a long time to get there sometimes that can have very serious consequences, and sometimes even fatal consequences."