Diversion of emergency surgery patients a growing problem, Alberta doctors warn

Calgary’s Rockyview General Hospital is diverting emergency surgery patients for a second time this week, and while the number of people impacted so far is low, the situation is raising concerns about patient safety.

Staffing shortages prompted a general emergency surgical diversion protocol to be put in place at noon on Thursday. According to the health authority, a lack of physician coverage means patients will be sent to Calgary’s three other adult hospitals until 8 a.m. on Friday.

A similar diversion was implemented overnight on Tuesday, and an  AHS spokesperson told CBC News one patient ended up being transported to South Health Campus for emergency surgery as a result.

“Emergency surgeries can still happen in instances like this where staffing is limited. The diversion simply limits new patients coming to the site to ensure all patients receive the care they need when they need it,” AHS spokesperson Kerry Williamson said in a email statement.

“It is common practice to distribute patient volumes to the most appropriate location to balance system pressures.”

This week’s diversions impact general emergency surgeries which can include treating potentially deadly problems such as a ruptured appendix, bowel obstruction or intestinal perforations.

Increasingly common

But doctors say diverting emergency surgery patients is not a normal practice in Calgary.

They say it’s a symptom of a healthcare system under intensifying pressure and, while it is unusual, it is happening with increasing frequency.

“It’s actually really quite uncommon ,” said Dr. Chris Armstrong, a general surgeon at Rockyview General Hospital, who was not working on Tuesday night when the diversion was in effect.

“It’s been happening more frequently in Calgary. There’s multiple pressures from that.”

Dr. Chris Armstrong, a general surgeon at Rockyview General Hospital, says these types of emergency surgery diversions are happening more often and he’s worried about the impact on patients (Submitted by Chris Armstrong)

And diverting these patients is something, until recently, he hadn’t witnessed in his nearly 10 years working as a surgeon in Calgary.

“Any unnecessary delay with surgical care could potentially impact patient outcomes in a negative way. So I think it’s incredibly important to minimize those unnecessary transfers,” he said.

That’s a dangerous thing– Dr. Christopher Armstrong

“When all of the sudden one of those [Calgary hospitals] is diverted, it puts undue pressure on those three other centres that are already busy. That’s a dangerous thing. And it’s a dangerous direction, that if it continues it needs to be addressed.”

The Red Deer Regional Hospital has been under a surgical diversion of its own since April 29 resulting in the transfer of more than 100 patients to either Calgary or Edmonton so far.

That’s exacerbating the pressures in Calgary as hospitals absorb patients from the central Alberta facility.

Armstrong believes there are a number of factors contributing to the shortage of staff, including burnout after two years of the pandemic, a drop in the number of medical trainees who assist the surgical team, and funding changes.

It takes three people to properly run an emergency surgical service safely, he said, including the surgeon and someone to assist in the operating room as well as another provider to care for patients on the ward.

According to Armstrong, there are upcoming nights where surgical teams are short staffed and he’s concerned this could happen again.

“I’m worried. I don’t foresee this situation getting better quickly. I”m worried that its going to get worse and this might become a more frequent occurrence,” he said.

He said staff find ways to treat the most urgent cases — those that can’t wait to be transferred — when they arise.

Hospital strain

These diversions are another sign of the stress facing the province’s hospitals, according to Dr. Vesta Michelle Warren, president of the Alberta Medical Association.

Health-care facilities, she said, are dealing with a high number of COVID-19 patients, an influx of people who are sicker due to delayed care, a surge in viral illnesses, and ongoing staffing shortages.

And they’ve been forced to move patients around in an effort to cope.

“The solution to that is one that I think is going to be more difficult to solve,” she said.

Dr. Vesta Warren, president of the Alberta Medical Association and a doctor in Sundre, Alta., says these diversions are another sign of the stress facing the province’s hospitals. (Submitted by the Alberta Medical Association)

Warren, who has a family practice in Sundre, receives regular notices about hospital diversions.

“This year we’re getting these diversions for multiple services, not just surgeries. We’re seeing it for other areas as well, and we’re getting it multiple times a week,” she said, adding staff are doing their best to care for patients and urging people to go to the hospital if they need care.

Meanwhile, CBC News asked AHS how often these types of diversions have been put in place since December and which hospitals have been impacted.

The health authority did not respond to those questions.

According to AHS, this is the second time this week that a diversion has been put in place at the Rockyview General Hospital.

“There is no impact to scheduled elective surgeries, and no impact to other already scheduled emergency surgeries in the facility,” said Williamson.

“A general surgery staff surgeon will be on-call during this time and available for advice and assessment of emergent general surgery at Rockyview.”

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