As wait times increase and more patients are walking out of emergency departments without receiving care, some Manitoba doctors say reopening previously closed emergency rooms isn’t necessarily the solution.
The recently elected NDP government ran on a pledge to reopen three emergency rooms that were closed and converted to urgent care centres under the previous Progressive Conservative government.
But some front-line workers say addressing patient flow and the systemwide “access block” needs to be the top priority.
“It’s important to look at the system — not to impose expensive solutions [of reopening ERs] and oversimplify complex problems,” said emergency department physician Dr. Alecs Chochinov.
According to Shared Health data, more than one in three patients who recently sought medical care at Health Sciences Centre’s emergency department in Winnipeg left without seeing a doctor.
That number is an important benchmark that doctors and health officials say shows the state of the health-care system.
“The ‘left without being seen’ rate is a symptom of system dysfunction,” Chochinov said.
While hospitals are dealing with critical staffing shortages, Chochinov said one of the single biggest problems throughout the system remains “access block” — when the right care is potentially available, but people cannot access it.
The ER is the canary in the coal mine, said Chochinov.
“Whenever there is a block anywhere, it manifests in the emergency department.”
In emergency departments, that’s most often due to admitted patients taking up stretchers, blocking people in the waiting room from being able to access care.
But it also comes up with hospital patients “waiting for long-term care options who are stuck,” or for those waiting to see a consultant or get diagnostic work, Chochinov said.
Health Sciences Centre chief operating officer Dr. Shawn Young said it’s a cascading problem throughout the system.
“We still have a lot of patients in our hospital beds that we’re not able to get into … long-term care, home care [or] even getting them out into other jurisdictions, because there’s staffing challenges everywhere,” Young said.
There are not enough beds because there are not enough people to staff them, he said.
As well, hospitals are seeing sicker patients than before, said Young, resulting in longer hospital stays and “much more resource-intensive needs.”
But the solution doesn’t necessarily lie within the emergency departments, said Young — things will not get better until there are more beds and more staff.
“That’s in the acute care beds, it’s in lesser-acute beds, it’s in long-term care, and it’s having staff support people in their own homes and apartments with home care.”
Reopening ERs not the solution
Calling the closure of three Winnipeg ERs “the single biggest mistake in health care that the PCs made,” now Premier Wab Kinew promised during the election campaign to spend $500 million over four years to address health-care recruitment in Manitoba, and then begin reopening the emergency rooms — starting with Victoria Hospital, followed by ERs at Seven Oaks and Concordia.
But some doctors say that plan won’t address the root problem.
In 2016, Chochinov was one of the members of the Wait Times Reduction Task Force established by then premier Brian Pallister’s Progressive Conservative government, tasked with putting together a report on the state of the province’s hospital wait times and recommending actions to reduce them.
The group delivered its final 300-page document to the government in December 2017 — after the government had already begun closing ERs.
The report outlined key recommendations and guidelines for the government as it moved forward with its health-care overhaul, including a recommendation that the ER closures at Seven Oaks and Concordia wait until St. Boniface was ready to safely absorb the patient volume increase.
An expansion and modernization of the St. Boniface ER only got started in April 2022, nearly five years after consolidation began, and isn’t expected to be completed until 2025.
“One of the recommendations [from the task force was] that we hasten wisely … we not move too soon in terms of closing [emergency departments], and the previous government did move too hastily,” said Chochinov.
But “moving in haste the other way would be a huge mistake,” he said.
“It doesn’t matter the number of emergency departments you have.… It’s not the number, it’s how they function.”
Chochinov said he hopes the new government listens to experts in the field and those on the front lines.
No retribution for speaking out: premier
Kinew says his new government has reviewed the wait times report, along with another report from consultant Dr. David Peachey, which formed the basis of the PCs’ ER consolidation plan.
“The lack of management by the managerial oversight by the previous government led to those plans going off the rails,” he said at a Tuesday news conference, along with Health Minister Uzoma Asagwara.
A letter was sent to health-care workers across the province, telling them the new government wants to hear their perspectives, solutions and differing opinions, Kinew said.
While the government has received expert advice, Kinew said he welcomes the opportunity to speak with people who may be skeptical of their plans, “so long as they’re good-faith dissenting opinions in order to build a stronger health-care plan.”
The premier also said health-care workers should feel they can speak out publicly about the needs of the system — something he said many have been afraid to do.
“It was the culture of retribution which stood in the way of that,” Kinew said.
“We are going to focus on addressing the problems instead of what the previous government did time and time again, which was addressing the whistleblower.”