Full ER shows Winnipeg hospitals still forced to use emergency ward for overflow, doctor says

Emergency departments are continually being used to hold patients who belong elsewhere, a Winnipeg doctor is repeating after one city ER ran out of beds last weekend.

It's become the norm at St. Boniface Hospital to have 20 to 25 patients stuck in an emergency department bottleneck before they can be admitted into an overflow ward. Those areas of the hospital are full because there's not enough staff.

Only a few months ago 15 to 20 patients waiting in emergency for a bed elsewhere was considered "horrible," an emergency physician at the hospital says.

"The metric is always moving, and you unfortunately come to accept that a worsening of these parameters just becomes normal," said the doctor, whom CBC News is not naming because they're not authorized to speak by their employer.

It "makes it increasingly frustrating and difficult to come [into work] because instead of seeing anything in the way of improvement all you're seeing is sort of this continual decline in these numbers," they added. 

A dozen waited on stretchers at HSC

The shortage of ER beds was the primary reason why 12 patients had to wait on stretchers in the entrance hallway at Winnipeg's Health Sciences Centre last Sunday night.

Patients who are eventually admitted can sometimes expect a lengthy wait, which doctors attribute to widespread staff shortages in the various in-patient wards. One patient at HSC waited as long as 170 hours in the ER — more than a week, CBC News reported Tuesday.

Dr. Shawn Young, HSC's chief operating officer, said the hospital was coping with a spike in acutely ill patients seeking care on the weekend, particularly on Sunday.

At St. Boniface Hospital as well, using the ER as an overflow ward is nothing new and a symptom of a larger problem, ranging from severe staffing shortages to a lack of available beds, the doctor says.

As an example, the physician says the emergency department was limited Thursday in its ability to take in new admissions.

At one time in the morning, the ER had 29 people waiting for beds elsewhere in the hospital, nine people seeking transfer to a low-acuity unit, and nine people waiting to see a specialist. That's nearly all of the ER's 50-plus beds.

At the same time, more than 30 individuals were in the waiting room. 

"When you've got 30 in your waiting room, you know you're walking into a bad day," the doctor said.

These types of numbers fluctuate over the course of a day, but are a persistent cause for concern, the physician said: "This is what I would call par for the course."

Another source at the hospital confirmed a similar number of ER beds at St. Boniface were being used for overflow purposes on Thursday afternoon, but the number of people in the waiting room had grown.

Shared Health and the Winnipeg Regional Health Authority said the availability of hospital beds has generally been "very tight" for months, which causes patients requiring admission to wait awhile.

"When this continues as it has for a prolonged period of time, it creates space and resource issues that further exacerbates wait times and generates additional stress for our staff," the health-care organizations said in a joint statement. 

They said the median length of stay for patients waiting to be admitted at one of Winnipeg's six hospitals is trending above 20 hours for the first part of September.

Improving patient flow a focus: Shared Health

The organizations say they're continually trying to improve patient flow, including a heightened focus on moving patients who no longer need acute care to another setting.

On Thursday, 29 patients at St. Boniface and more than a dozen patients at both HSC and Grace Hospital had spent more than 24 hours occupying an ER bed as they waited to be moved elsewhere, a medical professional reported. One patient at the Grace has been waiting 113 hours and counting — nearly five days, the doctor says.

Dr. Michael Howlett, the head of the Canadian Association of Emergency Physicians, says emergency departments across the country are being stretched beyond their mission of providing urgent and emergent care as quickly as possible.

Heavy burden for ERs

"We see a large proportion of patients who come because they haven't got a place to go for their post-operative care," he said in an interview on Wednesday.

People "come to see us because family doctors' offices in the evenings and weekends are closed and the answering machines almost always say, 'If you have a problem, go to the emergency department.'"

"There are people who need testing, and because they need testing and the waiting times for testing are so long they come to see us instead because they feel they can't wait any longer."

All those issues combine to see beds being filled by patients who aren't among the sickest of admissions, Howlett says.

"It's not the public's fault, it's what they're given for options," he said.

Specific to Manitoba, there remains broad confusion over which health-care facility is the right fit for an individual's needs, after some emergency departments in Winnipeg were turned into urgent care centres in the years before the pandemic.

Last month, Health Minister Audrey Gordon said the province would relaunch its previous advertising campaign that directed patients where they needed to go.