Changes after review into man's death while waiting at Winnipeg ER include having aides check vitals

Having an around-the-clock health-care aide trained to check the vitals of patients waiting in the emergency room is one of the new measures introduced at Manitoba's largest hospital after a man died while waiting in for care earlier this year.

A critical incident review was launched after Chad Christopher Giffin, 49, died following a nearly eight-hour wait for care at Winnipeg's Health Sciences Centre on Jan. 7.

On Thursday, the province released 17 measures it says were put in place immediately after his death and steps taken to respond to recommendations coming out of the critical incident review, in order to prevent future incidents.

"One of the fundamental pieces was improving capacity," Manitoba Health Minister Uzoma said at a Thursday news conference, held to announce a team of front-line workers who will work to cut wait times in hospital ERs.

Fifteen health care aides have been trained to check patients' vitals at the ER, with one position dedicated to that task at all times, the province said in a statement sent to CBC.

Policies for next-of-kin notifications for patients who die while under the care of Manitoba's Public Guardian and Trustee have also been updated to emphasize the importance of notifying their families — something Giffin's sister pushed for.

Giffin, who was under the care of the public guardian due to mental illness and addictions, had said he had no next of kin, his sister Ronalee Reynolds previously told CBC News.

While she and her mother are happy with changes made to the hospital's ER and internal processes, they're still "disappointed" that the public guardian and trustee didn't have their contact information updated, she said Thursday.

Reynolds said her brother had estranged himself from their family for close to a decade. She only learned after his death that her brother was well known by staff at the HSC's ER.

On the night he died, he arrived at the hospital just after midnight and was declared dead in a resuscitation room just before 8 a.m., after staff noticed his condition had worsened.

The emergency room was well over capacity on the night leading up to his death, but staffing was close to a baseline level.

The Globe and Mail reported on Thursday that emails obtained through the Freedom of Information and Protection of Privacy Act show Manitoba deputy health minister Scott Sinclair had asked Shared Health why he and an associate deputy health minister were not notified about Giffin's death sooner.

Sinclair also said that media outlets learned of Giffin's death several hours before he and the associate deputy minister learned about it, according to the Globe.

"There were concerns about the timing of that, which I think is important to reflect on, which is again why work is actively being done at Shared Health to address that," Asagwara said Thursday.

Giffin's death forced the province to look at the shortcomings of its health-care system, they said.

"That particular situation, that tragedy, provided opportunities for us as a system to improve and to learn, and that work continues to be done," Asagwara said.

"We want to make sure that we respect the family that was affected, and that we take the necessary steps collectively to prevent incidents like that from happening again."

Asagwara also cited the province's homelessness strategy and its work to establish a sobering centre, as well as a supervised consumption site, as potential ways to decrease the number of homeless people visiting the ER for warmth in the winter months.

Protocols under scrutiny

The province says an internal waiting room surge protocol was also developed at HSC, in response to the critical incident report around Giffin's death.

Protocols are being reinforced with staff in daily "huddles," and 10 patient records are reviewed every week to ensure protocols are being followed. Community support worker logs are also reviewed to ensure patients are checked on each hour, the province said.

Work schedules were reviewed to make sure emergency departments can meet minimum staffing requirements, and staff members who were working when Giffin died were also trained to use automated external defibrillators, according to the province said.

Staffing in the waiting room and contingency planning during times of high patient volumes are also being reviewed, along with environmental reviews of the waiting room to improve sightlines from triage.

Triage process guidelines were also updated with a focus on the benefits of direct assessments, the province said.

The province said it's also working toward reducing overcrowding in ERs, and may expand support services that are typically part of capacity and flow protocols.