Hospital diversions a crisis in Alberta: AMA

By Al Beeber - Lethbridge Herald on July 10, 2024.

Herald photo by Al Beeber Signs mark the entrance to the Chinook Regional Hospital. The Alberta Medical Association says it has concerns about the number of patient diversions in Alberta.

LETHBRIDGE HERALDabeeber@lethbridgeherald.com

Diversion to other hospitals in Alberta due to a lack of general surgeons or support teams is a crisis situation, media heard Monday during a Zoom meeting on the state of general surgery with Alberta Medical Association Paul Parks.

Joining Parks, an Emergency Room doctor in Medicine Hat, was general surgeon Lloyd Mack, president of the general surgery section of the AMA who said diversions to other hospitals have become too commonplace in the province.

Diversions occur when a lack of available services prompts patients to be taken by ambulance to other hospitals for their care. That lack of services could be the unavailability of a general surgeon or support staff for the surgeon.

In May, Parks compared the province’s acute care system to an expanding aneurysm and questioned if it could rupture before being stabilized.

He said clinical and operational channels through which patients flow are severely weakened and it’s increasingly difficult to support and stabilize care that Albertans deserve and need in hospitals.

Parks said Monday many Albertans may not know what general surgeons do, noting they are essential to hospitals which can’t function without them.

He added they are essential to have available in hospitals 24 hours a day, seven days a week.

“From head to toe, they provide an incredible wide range of surgical services” with one of the most common ways people will end up being seen by one is when they come to an ER with an unplanned event and require urgent or emergency surgical care, often in the middle of the night or on a weekend or holiday, with the long weekends in May and August particularly busy for things like trauma and the need for emergency surgical services, said Park.

While patients are stabilized in ER, general surgeons are the ones who come to their aid, said Park.

He noted that patients expect that once they are inside the ER, surgeons will be available to take care of them in a timely manner.

“Unfortunately we can’t always meet those expectations in Alberta anymore. There’s an increasing chance that you might end up being seen and stabilized in one emergency department and then unfortunately have to be packaged up and put back in an ambulance and transferred to another hospital where they have the adequate surgical and support services available so that you can actually get that general surgery in a timely manner that you require, Parks added.

AHS in a response Monday stated it has not decreased surgical volumes.

“In fact, as of today we are currently at 108 per cent of our targeted volume, and are on track to complete our target of 310,000 surgeries this year. Surgical diversions are only activated when all available resources have been utilized and all other mitigations have been exhausted. During a temporary surgical diversion, all patients are triaged and treated, and our medical teams evaluate all patients who may require surgery as they always do,” said AHS in an email statement to The Herald.

Park said diversion is happening more and can result in serious complications.

AHS told The Herald “when diversion is required, our teams work closely with clinicians and sites to ensure we can continue to provide high quality care where the resources are best able to meet the patient needs. Surgical emergencies are always cared for appropriately, and each urban site has a general surgeon on call and there are staff surgeons available at all sites. Emergency surgeries continue to be performed as required during times of temporary service disruptions, and all patients needing emergency surgery will receive it.”

Mack said general surgeons are a large group of sub-specialty surgeons who perform many different types of surgery. All go through a five-year residency training program after medical school, Mack said. And almost all have done additional sub-specialty training beyond that.

General surgeons do most of the trauma and emergency surgery, Mack said.

“Hospitals just can’t run without general surgery care,” he said, calling diversions a crisis in Alberta.

Even with a surgeon and open waiting room available, people can be sent to a different hospital if the first doesn’t have available staff who work with the surgeon as a support team.

Tier 1 supports could be a resident physician, clinical assistant, physician assistant or a nurse practitioners, he said.

“A whole number of team members need to be there to look after the patient during surgery as well as before and after” and to assess other patients in ER or intensive care units, said Mack, noting that the lack of anesthesia is a separate but also worrying problem causing cancellations of surgery of between 20 and 40 per cent of operating room capacity in Alberta hospital rooms, he said.

The shortage of anesthesiologists in Alberta is prompting not only delays in, but last-minute cancellations of, elective surgeries and creating difficulty in performing emergency surgeries, says the AMA in a news release.

Mack said the chronic shortages of health care professionals “are hitting general surgery patients particularly hard. If those team members aren’t there, I can’t accept the patient from the emergency room. The ER is effectively closed to surgical patients and the patient has to be sent elsewhere, typically to a hospital that is already busy and now risks becoming overwhelmed as diverted patients continue to arrive,” added Mack.

He said the clock is ticking on patients who need emergency surgery with delays meaning probable complications and potentially more severe illness, or in worse case scenarios, death.

“Diverting of patients is happening frequently, it has become common and the rate is increasing,” Mack added.

In Calgary, diversions have become concerning, says the AMA, with them now occurring for the Foothills Hospital trauma program which is responsible for critically injured patents in southern Alberta.

“Quite simply, this is something that should never happen in any hospital, especially large hospitals that offer the most advanced and high-tech specialist care. This is unprecedented in North America as far as we know. Most Albertans don’t understand that if they come to an emergency room in a large hospital in one of the province’s major cities for critical issues like perforations, ruptured appendix, obstructions, bleeding or other trauma, they may not get the timely care they need as they would have done in the past,” says the AMA.

The province’s surgeons are dealing with an “unprecedented shortage” of surgical support house staff, says AMA.

Media heard that the province’s population boom is adding pressure to the Alberta health care system which it says is short on staff and beds. The Edmonton zone, it notes, has been short 500 beds since 2016, a shortage that could increase to 3,000 by 2036.

And province wide shortages of non-medical supports, including staff to clean and disinfect operating rooms, creates longer turnover, the AMA adds.