AHS axes position aimed at reducing wait times

Alberta Health Services quietly cut emergency department triage doctor positions at all Edmonton hospitals this summer, a position ER doctors say reduced overcrowding in waiting rooms, CBC News has learned.

'We were saving lives because we had physicians out in the waiting room' Dr. Paul Parks

The doctors worked in Edmonton's emergency department waiting rooms, troubleshooting and assessing the sickest patients. They were paid a set salary, rather than fee-for-service like other emergency doctors.

"You could identify the people that needed to be seen more quickly," said Dr. Brian Rowe, an emergency room doctor at the University of Alberta Hospital who studied how the job helped patients there.

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In the 2007 study, Rowe and a group of university researchers found the overall median length of stay for patients was 36 minutes shorter with a Triage Liaison Position, or TLP, in place.

"They were being seen quicker, they left (before being assessed by a doctor) less frequently," Rowe said.

"They were satisfied, we were satisfied," he said. "The entire process improved flow for patients in the emergency department."

Soon after the study, the University of Alberta Hospital introduced regular TLP shifts, while other hospitals added their own triage doctors.

Until June 30, there were two TLP shifts scheduled each day at the U of A and Royal Alex hospitals. The Misericordia, Sturgeon, Stollery and Grey Nuns hospitals each had one shift per day.

'Definitely a gap left'

"We were saving lives because we had physicians out in the waiting room," said Dr. Paul Parks, who represents the emergency medicine section of the Alberta Medical Association and went public in 2010 with warnings about a crisis of "system-wide overcrowding" in Edmonton emergency rooms.

"There is definitely a gap left in these busy emergency departments, if that TLP position is removed," Parks told CBC News.

But Alberta Health Services said triage doctors have outlived their usefulness.

"With the reduction of people designated as EIP (early intervention patients) throughout the region and the continual efforts to improve patient flow, we no longer feel that this is the right service model to use," medical director Owen Heisler wrote in a August 2012 letter announcing the termination of the positions at the end of June.

University of Alberta Hospital emergency doctors say they weren't consulted and were surprised by the decision. They fired back a letter last November requesting AHS reconsider axing the TLP program.

The role "improves access to bed spaces and results in us making this quality care available to a greater number of patients," the doctors wrote.

"We believe that it is in the best interest of patients, physicians, nurses and other hospital staff, and AHS (should) reinstate funding and support for the TLP position."

Edmonton's emergency department overcrowding and wait time problems continue, doctors said.

"Some of the [wait-time] benchmarks are still at 23 and 26 per cent almost identical to what they were three years ago when the alarm was raised," said Parks.

The problem is better than it was three years ago, but is still not fixed, he said. "The numbers speak for themselves. We are still not progressing in some places."

Rowe said he and his colleagues are also frustrated at the way the decision was made, without consultation with the public or staff on the front line.

"I think most of the clinicians are willing to accept, if today is a different era and there is an alternative that is cheaper, more effective, they're willing to accept that," said Rowe. "But they're not willing to accept a decision that's not based on evidence. And I think that's where that letter came from."

Health Minister Fred Hornedefended the decision Tuesday.

"We actually have done a good job at reducing wait times in the province," he said. "It's not due to any one particular strategy."