Patients and their families are often suffering too long in emergency rooms. As BC’s ER doctors, we feel we have to speak up now. BC’s emergency medical services are in deep trouble because we are not keeping up with the increased needs of patients.

Last year across the province - at 19 of the most important Emergency Rooms - approximately 40,000 more patients needed ER treatment than did in 2010 and there were not enough doctors to care for them in a timely manner.

Almost all of the time, at almost every ER in the Province, access to hospital wards is blocked for patients who need to be admitted for in-patient care. There is not enough patient flow and these people are left waiting on ER stretchers, sometimes for days.

BC’s Emergency Doctors have now declared an emergency and are proposing a BC ER Treatment Plan to the Government of BC to help resolve these two main causes of ER patient distress.

BC’s ER patients and their families are in a dilemma for two reasons.

First, there are not enough doctors at 19 of the most important Emergency Rooms to care for patients - often resulting in long and painful waits to see a doctor.

Second, there is not enough patient flow: because most BC hospitals are all 100% full almost all of the time, access to hospital wards is blocked for patients who need to be admitted for specialized in-patient care, resulting in their suffering on ER stretchers sometimes for days.

Another result of these patients staying in the ER: new, incoming ER patients are deprived of the basic medical need to be adequately examined and treated on a stretcher with privacy and proper monitoring. More and more often patients are being examined and diagnosed while sitting in a crowded waiting room.

One or both of these conditions exist in most BC hospitals much of the time.

A uniform approach and commitment needs to be applied across the Province to relieve hospital ward access block. And BC needs to hire enough ER doctors to treat the increasing number of patients at 19 of the most important Emergency Rooms - in all regions of BC - and that’s just not happening.

BC’s ER doctors have a plan to help resolve both of the emergency conditions. To learn more please see the Plan and you voice your support.

BC’s ER doctors are very worried about the Government’s inadequate response to the growing ER patient needs and what it means to the quality of care for ER patients. Doctors and nurses are doing everything we can in our power to ensure adequate care. But, we need help now.

Last year, at 19 of the most important Emergency Rooms across BC, approximately 40,000 more patients needed ER treatment than did in 2010. Increased patients coming to Emergency is becoming an established annual trend and already far exceeds what we’re equipped to handle.

Government acknowledged the problems of overcrowding & access block but never implemented its own plan to solve it fairly– only occasional efforts have been made in a slap-dash way. Now, Government has begun to abandon its promises altogether while the situation is getting worse.

In the short term some of our proposed solutions in the BC ER Treatment Plan don’t cost anything or very little – they simply require a commitment and enforcement – such as moving ER patients admitted to wards on to ward floors while they wait for a bed. A few BC hospitals are already doing this and it is helping patients significantly.

Hiring enough doctors now to meet the growing needs of the last three years we estimate will cost $10 million of additional annual funding (0.0006 per cent of the total Health Care budget) but will be adjusted both for increases and decreases in need moving forward. In other words, if fewer patients need emergency medical care, doctor numbers will also be reduced.

A smart system called the Workload Model already exits that uses yearly patient numbers to calculate the needed number of doctors at each ER. If used a year ahead it allows government to anticipate patient needs and adjust physician staffing up or down as needed. This is smart planning, particularly as it takes time to recruit new Emergency doctors.

The Workload Model was developed in collaboration between Government and ER doctors. Government has since abandoned it.

Using the planning tool to hire doctors is one of the steps in the Doctors’ 5-point BC ER Treatment Plan.

At some point in the future, more hospitals will need to be built to respond to BC’s demographic pressures. Canada has one of the lowest hospital beds/ population ratios of all developed countries.

In the meantime, however, the BC Emergency Treatment Plan provides a very effective framework to respond to the needs of patients for the next 4 – 6 years. It is based on two joint reports that in 2009 Government worked on with BC ER doctors. Despite being agreed to and signed, the joint reports have been effectively shelved and largely forgotten by Government since.

Modeled on the approaches used by England, New Zealand and Australia to successfully address their hospital overcrowding problems, the methodology can be applied here without breaking the bank.

The key to fixing Overcrowding/Access block is to set, monitor and enforce a standard time limit for both (1) waiting to see a doctor and for (2) waiting to go upstairs to a bed for really sick patients needing inpatient care.

This means the pressure is shared equally throughout the hospital. In other words, rather than leave 40 patients warehoused in the ER hallways, let’s keep only 4 in the ER and move 4 patients to each of 9 hospital wards where they will temporarily wait for a bed but in the meantime have access to the right specialized care and treatment. This improves in-patient care and frees up ER access and stretchers for waiting new ER patients.

Doctors understand and sympathize with the concern. We are tax payers too. Money is scarce so health care spending has to be about priorities.

What’s important to remember is that emergency rooms are a safety net for everyone needing emergency care. If it’s hard to breath or the pain is just too much to bear, how much is it worth to get urgent medical help quickly? If you or a loved one has ever been in that situation you may be one of the people who feel that the ER is the best tax payer money ever spent. We all count on an ER at some point in our lives.

What BC’s ER doctors are proposing in the BC ER Treatment Plan represents a tiny portion of the overall health care budget (0.0006 per cent of the total Health Care budget).

Government has abandoned its promise to ensure adequate physicians at all ERs across the province.

In some cases Health Authorities have recognized the urgency of the situation in their jurisdiction and increased physician- staffing as a temporary measure. This is happening only in a very few locations.

If you are lucky enough to live in an area where the Health Authority has found temporary funding, you may have actually seen an improvement in ER service. These hospitals are few and far between, however.

If you are unlucky your ER wait times most likely continue to grow longer. For more information on how your hospital is doing, please go to Your Hospital Report Card.

In BC between 10 – 20% of patients who show up in an ER are sick enough to need admission for in-patient care. However, most hospitals are already operating at over 100% capacity. That means that at any given time there are no beds on the wards available for new patients. All of the beds upstairs on the wards are occupied.

This leads to what is often called ‘ER overcrowding’ in the media or what we ER doctors call ‘access block’. Sick patients who need a bed upstairs spend days in an ER hallway, in the noise, bright lights and confusion, ‘blocked’ from going to the right place: the ward.

Meanwhile new patients are packed into ER waiting rooms where we have trouble examining and treating them quickly and properly. We don’t know how sick they are, and that is not safe. The right place for new sick patients is in an ER stretcher, with an ER monitor, nurse and doctor. These new patients are also ‘blocked’ from the right place for their care: the clean available ER stretcher.

In 2009 in recognition of the growing seriousness of this situation, the Government worked in collaboration with the BC doctors to come up with recommendations. It was called the Overcrowding Solutions Collaboration. It included 9 specific recommendations to address doctor shortages and ER patient access block to hospital ward beds.

Government never committed to solving the problem, never implemented the plan at all hospitals – and has now begun to abandon its promises.

In several hospitals in BC, Hospital administrators or other officials have made a commitment to meet targets on patient flow. Commitment and accountability makes all the difference and produces better health outcomes. For example:

• At St Paul’s Hospital in Vancouver even if there is no bed available on a ward, the ER patient who has been admitted is nevertheless moved to the ward to wait for a room. This short-term adjustment shares the pressure equally throughout the hospital: rather than 40 patients in the ER hallways, St Paul’s has 4 patients in the hallways of 9 wards upstairs: the four left in the ER will soon be joined by new sick patients and then some of those will move upstairs too.

• At BC Children’s Hospital, every time a sick child who has been admitted waits in the ER longer than 4 hours for a bed upstairs, a report goes to the Hospital President – every time.

• At Vancouver General Hospital two administrators come to the ER several times a day, then circulate through all the wards to make sure that there are no delays in getting admitted patients upstairs where they get the best care.

For more information on how your hospital is doing, please go to Your Hospital Report Card.

Indeed, there may be areas in health care where BC is doing well. But the same cannot be said for Emergency Medicine. There is no comprehensive, fair and committed approach by the Government to deal with the increasing patient needs and the overcrowding and access block.

What this means is that if you live in an area where the Health Authority has found more resources to hire more ER doctors or near a hospital where the administrator has found creative and effective ways to meet the 10-hour wait-time limit for ER patients to be moved to an in-patient ward then you’re lucky. But, you are the exception.

Many BC residents are not that lucky.

In the BC ER Treatment Plan we are proposing these solutions be applied at all hospitals and enforced so that all BC patients can expect the same standards and care.

The Plan is based on a joint-report and recommendations that BC doctors worked on with Government in 2009 Overcrowding Solutions Collaboration. The plan has never been implemented as intended despite Government promises and it has now been effectively abandoned.

If that’s the case, then that’s excellent. For most British Columbians especially those living beyond Metro Vancouver, that is not the case. It means that you likely went to one of the very few hospitals where the Health Authority has found some resources to hire more ER doctors or a hospital where the administrator has found creative and effective ways to meet the 10-hour wait-time limit for ER patients to be moved to an in-patient ward.

Then again, you may have been just lucky for that day– even the busiest ERs have slow periods.
Support the BC ER Plan Now.

ER doctors are already working many extra hours and shifts in some locations as a stop-gap measure because they don’t want to see patients suffer.

However, just as you wouldn’t want to get on a plane being flown by a pilot who is routinely exceeding maximum allowable flight hours, you wouldn’t want to be treated by an ER doctor who is consistently working too many hours or shifts beyond the set limit.

With very good reason, maximum hour limits are in place for the most stressful professions like pilots and ER physicians where many life and death decisions are made quickly and often with limited information.

This is why more doctors need to be hired to meet the growing needs of ER patients just as one would hire more pilots if one suddenly added 40 more flights to an airline’s schedule.

Doctors understand and sympathize with the concern. We are tax payers too. Money is scarce so health care spending has to be about priorities.

What’s important to remember is that emergency rooms are a safety net for everyone needing emergency care. If it’s hard to breath or the pain is just too much to bear, how much is it worth to get urgent medical help quickly? If you or a loved one has ever been in that situation you may be one of the people who feel that the ER is the best tax payer money ever spent. We all count on an ER at some point in our lives.

What BC’s ER doctors are proposing in the BC ER Treatment Plan represents a tiny portion of the overall health care budget.

In fact, it costs tax payers a great deal of health and money NOT to solve the ER crisis:

• Patients who wait a long time for a doctor sometimes leave in frustration, wait at home until they are much sicker, and then return. This can take a long-term toll on their health and quality of life. And, treating these patients often costs more in the long-term because their conditions worsen due to waiting too long for treatment.

• Studies have shown that patients who are in the ER but who need to be admitted for in-patient care often get sicker and for a longer period of time if they are forced to wait in the ER for excessive periods of time to be admitted. Health outcomes are much better when patients are promptly moved to the right ward where they can be treated by the specialist doctors and nurses for their needs.

The BC ER Treatment Plan was largely based on a proven model pioneered by New Zealand, Australia and England. They faced what BC is facing now and they turned things around for patients in less than one year without breaking the bank.

And the systems in Australia and England have been improved and tweaked to address unanticipated consequences; for example, it is an ER doctor who runs the whole “4-hour ER rule” program in England, and he has the authority to change things that are not working.

There is much research that shows that patients with minor problems are not the problem in ERs. Those patients do not add much in cost, complexity, or lost efficiency in the ER. This is accepted as true in the New Zealand, Australia and England overcrowding plans, and even in the BC Overcrowding reports Overcrowding Solutions Collaboration.

This is a good initiative and we support it wholeheartedly, but it will likely have little to no impact on the number of patients who show up at the ER at any given time. It is largely a misconception that patients who do not have a family physician or ‘general practitioner’ are the ones “clogging up” ERs.

A 2008 survey** of patients visiting emergency departments in British Columbia found that 94% reported having a regular family physician. For more information read the Canadian Health Services Research Foundation’s Mythbusters: Using Evidence to Debunk Common Myths in Canadian Healthcare.

Source: ** Murray M. 2008. Patient experiences with emergency departments in British Columbia, 2007. www.health.gov.bc.ca.