MEDICAL EMERGENCY: ‘We are watching the collapse of our system in real time’

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A Winnipeg emergency room doctor is sounding the alarm over escalating wait times that have seen some patients suffer cardiac arrest in waiting rooms.

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The problem is systemic and complex, but often comes down to the challenge of moving patients from emergency department treatment to post-emergency treatment, said Dr. Noam Katz, noting the problem has worsened over the years due to a lack of innovation from medical system architects who sometimes “throw money” at problems while being afraid of change.

“Many people feel like we are watching the collapse of our system in real time,” said Katz reflecting on patient bottlenecks.

It’s now routine for patients to wait 10 to 15 hours for care, a potentially dangerous situation said Katz, who works at St. Boniface Hospital — noting bottlenecks aren’t in emergency departments, but rather in patient outputs.

“If your sink is clogged, the solution isn’t to build a bigger sink,” he said. “You have to fix the clog.”

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In some cases, patients have gone into cardiac arrest or suffered other severe deteriorations
in ER waiting rooms, said Katz.

“I would make the argument that there are certainly people who have had negative outcomes because of their wait time,” he said. “I’m not throwing anyone under the bus here. This is decades of management decisions.”

According to data provided by Shared Health, ER wait times have steadily increased since the pandemic with minor variations, including an 11-minute improvement in average wait times for Winnipeg in July to 3.42 hours.

“COVID certainly accelerated and unmasked a lot of the issues that we’re currently facing,” said Katz, who has seen 90-year-olds wait 23 hours for hospital admission in sometimes “scary” waiting rooms.

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“That alone can lead to morbidity or further problems,” he said.

One in three patients leaves the Health Sciences Centre (HSC) ER without seeing a doctor, said Shared Health in 2023 media reports.

According to data collected by the University of Manitoba, 44% of people at Winnipeg ER intake are low urgency, like sore throats, 38% are medium urgency, like shortness of breath, while 16% are high urgency, like sudden sharp chest pains and 1% are very high urgency, like not breathing.

The university says it’s a myth that long ER wait times in Winnipeg are due to a high volume of ER patients at any given time. Three-quarters of ER visits result in patients being discharged home — 12% are admitted to hospital.

“The number and type of diagnostic tests performed,” has the largest impact on wait times, says the university.

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More long-term care beds and more high-quality home care are needed to help alleviate the problem, said Katz. Also, there is a need for politicians to think outside the box “as the status quo isn’t working.”

Diverting some patients to the independent Minor Illness and Injury Clinic run by a group of Winnipeg ER doctors is a start, said Katz. The province has announced additional clinics to help relieve ER burdens in Winnipeg and Brandon.

“When you become so jaded and cynical — quite frankly from spinning your wheels in the hospital, I applaud people who are starting to do some of these things on their own,” said Katz of the Minor Illness and Injury Clinic.

“Privately run businesses absolutely can fit within the public system to a degree (but) you have to be cautious about it.”

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The province recently announced it is adding 68 transitional care beds to facilities across Manitoba to address ER wait times.

“A bed can’t open without the staff in place, so we’re moving forward methodically to ensure patients get safe care,” said Health, Seniors and Long-Term Care Minister Uzoma Asagwara. “We’ve made good progress — with almost half of these beds already open and the rest coming by the end of the year.”

Work is underway to add 50 more inpatient beds at the HSC, 36 additional beds at St. Boniface Hospital and 31 new beds at Grace Hospital, said a spokesperson from Shared Health.

The province is also expanding the number of allied health staff and hospital case coordinators at Winnipeg hospitals, as well as Selkirk and Brandon, to allow discharges of patients with complex cases to occur seven days per week, said Shared Health.

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More staff are being hired at the new HSC minor treatment clinic, “which allows low-acuity patients who frequently wait the longest for care to be seen in a more timely manner,” said Shared Health.

Average ER wait times have gone up by almost an hour since the NDP took office, said PC Health Critic Kathleen Cook. Despite campaign promises, there still isn’t a concrete plan from the NDP to address staffing shortages, she said.

“We are 10 months in, and really all we’ve had so far is a listening tour,” she said.

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