Over-capacity Grace ER frustrates daughter of Winnipeg senior

The Winnipeg Regional Health Authority is set to release an update on emergency room wait times across the region, but patients and caregivers worry the numbers don't reflect the actual time patients spend waiting.

On Friday, Karen Schellenberg spent more than eight hours in a packed waiting room at the Grace Hospital emergency department with her 82-year-old mother. Alice Cornelson had been sent by ambulance from her home atthe Deer Lodge Centre with digestion issues,and to have diagnostics to assess whether there was something more serious going on like a blockage.

She was seen first by the triage nurse, then proceeded on her stretcher to the waiting room. She was seen by a doctor three hours in, but there were no beds, so she waited.

"While we were in the waiting room for those eight hours, we were stretcher on stretcher, my mom was one of very many, probably six stretchers that were waiting," said Schellenberg. She added the emergency department was full with 35-40 patients, including people waiting on beds in the halls.

"People were waiting and frustrated and tired and sick and it was a really challenging kind of an environment. And the staff was running as fast as they could, trying their best."

The Winnipeg Regional Health Authority reported that the median wait time at the Grace Hospital on Friday was 1.1 hours, which is the time from registration to time seen by a care provider, like a nurse practitioner or physician.

A few hours after they were triaged at around 3 p.m., Schellenberg said a nurse told them that the emergency department was over capacity; the beds in the emergency were full, and to expect to wait.

At around 6 p.m., she said, the doctor assessed her mother in the waiting room, apologizing for having to do so, and proceeding with a "non-invasive examination."

"Getting your name called in a waiting room, like that feels like winning the lottery. They say your name and it's like, "Yay, something's happening," she said.

Admitted to a room around midnight

"The fact that it happened in the waiting room, in the whole scheme of what's going on there ... it was just one more thing that is not good."

After the assessment, her mom went for some tests, and was finally admitted to a hospital room at around midnight. At around 3 a.m., Schellenberg said, they were discharged, as the tests showed no cause for concern.

Schellenberg said she appreciated the care and updates on the capacity issues from the nurses, as well as the care of all providers, but the wait was "discouraging."

"It's like, is it really like this in Canada? It's just surprising to me. We're a rich country. So things should happen so that peoplearen't made to wait for periods of time in their time of need."

Hospital responds

According to Lori Lamont, chief nursing officer for the Winnipeg health region, limited space in the emergency department is "not new,"as the emergency department has been busier since the closure of the Misericordia Urgent Care Centre and the Victoria Hospital's conversion of its emergency department to an urgent care centre.

"We anticipated an increase in ED traffic at Grace and increased physician and nursing staff accordingly. We anticipated the site needing additional space and look forward to the new, expanded Grace emergency department opening in the spring of 2018," said Lamont.

She added that physician assessments in the wait room are not common, but do happen "from time to time."According to the Lamont, the new emergency department space will allow for more patient confidentiality.

"There will be a need to move into an over capacity protocol from time to time, but it's common for ED volume to hospitals to ebb and flow. ED wait times are improving, something we'll talk about within the context of the CIHI report," she added, referencing a health-care report expected to be released Thursday.

ER nurses concerned

The president of the Manitoba Nurses' Union says emergency department nurses at hospitals across Winnipeg not just the Grace are worried about patient care given the overcrowding in emergency departments and increases in ambulance admissions.

"They're concerned. They're concerned they're not providing optimal care," said Sandi Mowat, president of the Manitoba Nurses' Union.

Nursing union leaders at the Grace Hospital are particularly concerned, she said, as the increase in patient volumes is affecting the nurses' abilities to complete assessments on time. Many of those patients are seniors arriving by ambulance who can no longer be sent to the Misericordia or the Victoria emergency department.

They've been calling Code22smore frequently, they've been having patients being seen and treated in the waiting room, which as a nurse is not optimal treatment.- Sandi Mowat, Manitoba Nurses' Union

"They've been calling Code 22s more frequently, they've been having patients being seen and treated in the waiting room, which as a nurse is not optimal treatment, and certainly not the kind of standard of care that we want to be delivering," she said.

According to Lamont, a Code 22 draws attention to the increased patient load in the emergency and helps focus staff attention to move patients through the hospital.

Mowatsaid she understands Schellenberg's concerns.

"That's not certainly again, optimal care. That's going back to the days of hallway medicine. Certainly she was seen by a physician but then after that there's no privacy, issues about having to use the washroom, all those things are sub-standard care. And it's a concern that overcrowding leads to issues around safe patient care."

Mowat said the experience exemplifies why a marker like wait times isn't necessarily the best measure of a patient's wait, or experience in the emergency department.

"I really wish we would quit concentrating on wait times and actually concentrate on making the care better," she said.

'Workto do': hospital

Fortunately, Schellenberg said her mother doesn't have much recollection of the hospital experience, which at the time she found 'scary,' but Schellenberg has been reflecting on it since.

"Overall it's a discouraging kind of experience to be in the waiting room for that long, it's difficult, it was a tough evening. I wish we could do more to make it better," she said.

The hospital concedes it will.

"There is work to do here and the Grace will continue to improve in-patient length of stay to align with the Canadian average, increasing inpatient capacity," wrote Lamont.

But Schellenberg said the work to improve the emergency department experience isn't just the responsibility of government and hospital administration; it's also incumbent on herself, which is why she spoke out.

"To support the medical staff that I saw working as hard as they could that night, to support the patients, who need all the support our system can give them, and I've been asking myself, what can I do, as a Winnipegger, to help the situation?"

She said she believes community members, possibly as volunteers, couldhelp manage the "disappointment and despair"that can come with a prolonged ER wait.

"That's where music or coffee or water or something ... or just a friendly face, somebody to just sit down and ask you how's it going, something to make people feel like they're being cared for."

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