‘Access block’ growing problem in Alberta emergency rooms

By Nicholas Allen - for the Lethbridge Herald on May 11, 2022.

Albertans are seeing decreased access to emergency rooms across the province.
The challenges and issues growing within the healthcare system continue to impair timely access to health care in our province according to Dr. Paul Parks, an emergency physician at the Medicine Hat Regional Hospital and president of the Section of Emergency Medicine for the Alberta Medical Association.
Parks, who is also a clinical lecturer at the University of Calgary’s Department of Emergency Medicine & Family Medicine, was speaking before the Southern Alberta Council on Public Affairs on Thursday.
Parks has worked across the province which he said gives him insight into what all the emergency departments and hospitals are looking like across the province.
“I’m not officially representing anybody, although I am speaking on behalf of my specialty,” said Parks.
He said he is sharing the emergency physician’s perspective when it comes to “access block” for patients in the healthcare system. He continued by explaining that workers in the emergency departments are worried the system is broken. Parks said when access is working properly in the health care system, it means you have the right person in the right place at the right time.
“It sounds like we should obviously be doing that all the time. But of course, there’s a whole bunch of challenges… there’s a whole bunch of places in the system that aren’t working that access block occurs,” added Parks. “And what that ends up meaning is that you’ve got a patient, but they’re not able to get the right care in the right place at the right time.
Currently, Parks said the biggest issue is that Albertans need to have access to family doctors and preventative care.
“A lot of times that’s not even necessarily an option,” said Parks. “So, they end up in the emergency departments.”
Parks said that the emergency room is not the right place for primary and preventative care to be happening, but it is the only place a lot of Albertans have access. This is an issue for long term treatments, Parks explained.
“You won’t see [the same doctor] every time you come in and you won’t have that continuity of care,” said Parks.
He said departments across the province are now seeing failures in access to palliative care, specialized care for those with a serious illness. Parks said that patients needing end-of-life care and palliative care often must enter overcrowded and busy emergency departments to get that treatment.
“That’s the last place that families and patients want to receive palliative care. I mean, of course, there’s times where we connect them with palliative care and there’s lots of appropriate steps,” said Parks. “But when things are falling apart and they can’t get connected or access to community resources and palliative care, they end up in the emergency department with long waits and it’s really busy teams that are not designed to do that type of care.”
Parks said post-op surgical care is another area that is seeing issues, with patients unable to get access to their surgeon for days or unable to get access after hours of advice, ending up in the emergency department.
Another area seeing problems in Alberta healthcare according to Parks is access to long term care and the massive bottleneck that ends up happening in parts of the hospital.
“The patients are admitted at a hospital but can’t get into long term care… patients that need to be admitted into the hospital end up staying for hours and days and sometimes weeks in a busy emergency department because they can’t get admitted to a floor,” said Parks.
Parks said why he is talking about this is that until people access the system, they don’t necessarily know how bad it is going to be. Parks likened the emergency room as the “canary in the coal mine that’s telling how the system’s functioning.” He said that many of his colleagues would say the “canary is dead.”
Parks described the situation facing many hospital emergency rooms, with many ambulance crews having to wait in the hallways for a bed to clear up for hours at a time.
“That’s another example of access block where new sick people who call 911 are daily experiencing prolonged delays or absences of response because ambulance crews can’t get out into the community and can’t get their sick patient offloaded,” said Parks.
There are no available spaces in the hospitals, according to Parks. He said that often they will have to add spaces in the hallway to accommodate the patients.
“[Emergency rooms] get to a period where all we can do is take that next sickest patient when one bed becomes available and put that patient in,” said Parks.
He said that none of the staff want to make people wait for care but there are no other options available to them.
“We know that this is suboptimal. We know we need help,” said Parks. “And when you get into our system, I think you get some of the best care in the world. It’s getting into the system [that] is becoming more and more difficult.”
He said the pandemic has helped add to these issues but is not the only thing to blame. But two years of the pandemic has worn hospital workers out, according to Parks. He also said staffing vacancy rates for health care workers and physicians are the highest they have ever been.
“We’ll find often even in these busy drowning emergency departments that I describe, there will be times when there will be some beds in the emergency department that we can’t even use because we don’t have enough nurses on a given shift,” said Parks.
These problems, along with many others, have made it increasingly difficult to access care across Alberta according to Parks.
To learn more or watch the forum visit the Southern Alberta Council on Public Affairs website.

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