Emergency room delays due to medical tests, not bed shortages, report says

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

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

Dismal wait times in Winnipeg emergency rooms could be the result of time-consuming medical scans and tests ordered by caregivers rather than a shortage of hospital beds, a new report by the Manitoba Centre for Health Policy finds.

The report, Factors Affecting Emergency Department Waiting Room Times in Winnipeg, was released Thursday at the University of Manitoba.

Dr. Malcolm Doupe, the report's lead author, said his research contradicts the commonly held belief that bed shortages are responsible for clogging up hospitals and lead to patients lingering for hours in the ER.

"Yes, this is a factor," Doupe said. "But our research shows it's not the most important factor."

Time to look inward, say doctors

Only 12 per cent of emergency room visits end with a patient transferred into a hospital bed, the research found.

Doupe said it's diagnostic tests, like CT scans, X-rays, urinalysis and blood work that have the greatest impact on the length of time patients have to squirm in emergency rooms chairs.

"If we're going to discuss strategies for reducing ED [emergency department] wait times, our recommendation is to not just focus on freeing up hospital beds but rather to also focus on what's happening within the emergency department," he said.

Winnipeg patients often have to wait much longer than patients in other parts of the country. In November, the Canadian Institute for Health Information found Concordia Hospital had the longest emergency room wait times in Canada for the fifth year in a row.

Winnipeg sees about 250,000 emergency department visits a year, or 610 visits per day, Doupe said.

More than half of those visits result in some form of diagnostic test.

"We learned that it can be very time-consuming for patients to undergo tests, for medical professionals to interpret the results, and for staff to take action based on the results," said Doupe.

Dr. Alecs Chochinov, medical director of the Winnipeg Regional Health Authority emergency program, said the report's findings are important.

For too long the focus has been on patients and turnaround, he said, and Doupe's report shows the way an emergency department works has been neglected.

"Nobody's paid attention to it," Chochinov said. "The processes that we employ in the emergency department to look after patients ... have to be looked at."

It could be possible to save time by delaying tests by a day or two in some less urgent cases and still deliver timely care to a patient, said Dr. Ricardo Lobato de Faria, an emergency room doctor and chief medical officer at Seven Oaks Hospital.

"The actual practice of emergency medicine has evolved. It's changed the demands from both patients and their caregivers and we have found a delay in the process," he said.

Doupe says it's up to experts to review emergency room diagnostic tests, but if they do change processes, they should evaluate the data to see if those changes result in reduced wait times. 

Impact of QuickCare clinics

About 40 per cent of emergency department visits are for reasons that are not urgent — like sprains and sore throats — and 10 per cent of patients do not complete the visit, he found.

In 2012, the province began opening QuickCare clinics to try to siphon off some of the less urgent cases and reduce pressure on emergency rooms.

Doupe said his research did not look at the direct impact of QuickCare services. He said opening clinics near hospitals could help reduce wait times for other less urgent cases but would have little effect on patients in critical condition — like those suffering from heart attacks — because they already receive fast care.

The University of Manitoba researchers based their report on data gathered by Emergency Department Information System, which began collecting information from Winnipeg hospitals in 2009.