Winnipeg ER wait times still among worst in Canada but getting better

Winnipeg hospitals still have the longest emergency department wait times in the country, but recent changes have already brought improvements, a Winnipeg Regional Health Authority official says.

There were four Winnipeg emergency departments in the top five longest wait times at hospital ERs in the country, a report from the Canadian Institute for Health Information says.

CIHI's latest wait-times report, released Thursday, gathered information from 209 hospitals across Canada for the fiscal year 2016-17. Quebec and Newfoundland and Labrador do not submit data to CIHI. Smaller hospitals are sometimes not included due to low ER visit numbers.

The Victoria General Hospital ER, which closed in October and became an urgent care centre, was second worst in the country, at six hours. The Concordia Hospital emergency department, which is also slated to close, had the worst wait time in the country, at 6.1 hours. Emergency departments at St. Boniface and Grace hospitals were fourth and fifth, at 5.4 and 5.2 hours, respectively.

About 10 per cent of patients at Winnipeg hospitals waited 5.1 hours or longer to be assessed by a physician after being registered at the ER. The national average for the same period was 3.1 hours.

In anticipation of the release of the CIHI report, the Winnipeg Regional Health Authority held a briefing meeting with media to provide year-to-date figures since health reforms began. Those health reforms include the closing of three emergency departments at Victoria, Concordia and Seven Oaks General Hospital, which was 17th on the longest wait times list, at 4.3 hours.

While not reporting for a complete year, the Winnipeg Regional Health Authority said since April 1, ER wait times have improved 14.5 per cent, dropping to 4.3 hours.

Total time spent in ER

The total time spent from registration to discharge from the ER increased 7.9 per cent over the previous year in Winnipeg hospitals, the report says, with 10 per cent of patients taking 43.5 hours or longer to be released from hospital or be transferred to another department or facility. The national average, which also worsened year over year, was 32.6 hours.

Lori Lamont, WRHA vice-president of nursing and health professionals, said despite the increase in the report, the recent changes in the health authority have taken that time below the national average.

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"We recognize that we have lots of work to do in that area but again, our data from April 1 of this year until the end of October actually shows we've made tremendous improvement in that area and we're now down to just over 30 hours ... for length of stay for 90 per cent of the admitted patients in the emergency, and that actually puts us below the Canadian average," she said.

Among emergency department patients in Winnipeg, 10-15 per cent are admitted to hospital, she said.

One of the reasons for ER closures in Winnipeg was long emergency department wait times, Lamont said.

"We've struggled with this. We've attempted to implement a number of the process improvement kinds of things that have shown success elsewhere, and what we ultimately came to the conclusion is we are spreading ourselves too thin," she said.

"We recognized in order to have a really efficient, effective emergency department, it needs to be located in an acute care hospital that has all of the resources the specialists, the diagnostic services, all of those things readily available to them. Given the population of Winnipeg and of Manitoba, it didn't justify having all of those resources available in six hospitals."

Improved technology a 'game-changer': Lamont

And it's working, Lamont said, with processes improving in all hospitals, and particularly at the three hospitals that will keep their ERs Grace, St. Boniface and Health Sciences Centre, which was 13th on the wait times list at 4.4 hours.

The improvements include hospital teams assigned specifically to treat less acute patients at ERs, Lamont said.

Health Sciences Centre is set up to treat urgent care patients away from the acute patients, she said. St. Boniface has eight treatment beds for urgent care, and as the Grace gets its expansion in spring 2018, processes and space also will be set up there to accommodate patients who aren't as sick.

"That has proven to be really pretty successful and something we want to build on as we make further changes in our consolidation plan," she said.

There are also changes to unit design and capacity to improve flow, she said.

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Lamont credits technology introduced in spring 2017 particularly a computer program called Oculys, which gives clinicians a snapshot of available beds in a hospital as a "game-changer" that allows better flow of patients through hospitals and back into the community or home. Before, hospital staff relied on notebooks of available beds requiring housekeeping before a new patient could be moved, she said.

Changes have also been made to get people from acute hospital stays back into the community more quickly, such as adding private nursing teams through the new priority home services. That helps free up beds, which allows staff to move patients out of the emergency department, she said.

'Moving in the right direction': Goertzen

Manitoba Health Minister Kelvin Goertzensaid Thursday he hadn't read through the entire report, but has taken a look at the "high-level numbers."

Goertzen said he was happy to see the city's ERs showed an eight per cent improvement in wait times over the reporting period and that Manitoba was named the most-improved province.

"I think it's good we're moving in the right direction, but this is the kind of thing that you can never say you've reached where you want to be. You have to continue to work at it," he said.

"We're happy that we're going in the right direction, but I won't spend five minutes celebrating it we'll continue to make better improvements for next time."

But Manitoba Nurses Union president Sandi Mowat said nurses in emergency departments across the city have concerns about how busy ERs have been since October, when the Victoria emergency department was changed to urgent care and the Misercordia Urgent Care Centre was closed.

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Increased patient volume limits nurses' ability to do their jobs well and impacts care, she said.

"I think we have to be really careful about what we're talking about again. Are the wait times the only measurement of care? Are we paying attention to the overcrowding and are we making sure that Manitobans are getting access to good safe care?" Mowat asked.

But Manitobans need to understand that if it's an emergency such as a heart or stroke, they'll be seen immediately, she said.

Winnipeg hospitals' long wait times happen to patients who aren't suffering from an emergency, she said.

"The wait times that are longer are the people that are less urgent, and so some of those people don't necessarily need to be in an emergency room or an urgent care," she said.

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"Medically, it's probably not serious that they're waiting that long. However, should they be waiting that long? Should they be there? Should we be looking at why they're there?

"There is no magic number. I think the important thing to note is if you're having a heart attack, you will be seen immediately."