Emergency doctor and mental health advocate say surgery catch-up coming with cost to ER patients

Emergency rooms are busy in Alberta and one of the reasons behind the backlog of patients is the attempt to clear up the backlog of surgeries that were postponed during the pandemic.

The head of emergency medicine in the Calgary zone says hospitals are operating well above an acceptable and safe threshold of admitted patients.

Dr. Eddy Lang says that is leading to a back-up of admitted patients in emergency departments, which in turn he says leads to EMS workers not being able to offload patients from stretchers.

“The situation is quite difficult in the emergency department, but it’s actually affecting the entire community because when three quarters of the paramedics in the city are tied up in emergency department hallways, unable to offload their patients, that puts the whole population at risk,” said Lang.

Hospital staff are now trying to catch up on surgeries that were delayed during the pandemic.

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But Lang says the entire capacity of the emergency department is being consumed by patients who should actually be in rooms upstairs — the problem is there is no place for them to go.

“Because patients with orthopedic procedures and hernia surgeries, from the government’s desire to catch up on all of these delayed surgeries, is preventing us from getting the admitted patients upstairs, so emergency care is being deprioritized,” Lang said.

Lang said this has been going on for the last three or four months and has been compounded by losing emergency nurses — which is contributing to increased wait times for patients who are seeking emergency care.

Read more: Alberta government to fund more private surgical facilities to reduce hospital wait times

Lang understands patients who are coming into the hospital  for services like orthopedic procedures, hernias and for gallbladder surgery are frustrated with being on waiting lists for more than a year, but emergency rooms are filled with waiting patients, many of them struggling with mental health and addictions issues.

“The biggest portion of patients that are in our emergency department who don’t have beds upstairs have mental health and addiction problems. They don’t have available beds to go to,” Lang said.

“The way the system works now, you are going to have your gallbladder surgery if you’ve been waiting long enough, even though there are an unsafe number of mental health and addiction patients waiting for beds in the emergency department,” Lang said.

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Read more: Canada’s ER crisis: Doctors urge governments to find solutions for ‘dangerous’ wait times

“Now we’re going to get help for one demographic, and then the other demographic is going to slip further behind,” said Rick Lundy, the founder and president of Minds Over Matter Mental Health Society.

Lundy said emergency rooms are not the best place for people struggling with mental health and addictions. He said the government needs to get to the root of the problem by providing more resources for those issues.

“They go to emergency rooms and the chances are they’re not going to get admitted. They are given medication and they leave and in a week… the mental health and addiction patient is back through the door again,” Lundy said.

“I’ve helped many patients that go through there thinking they are going to get the help they need and they are not. It’s very dangerous for someone who is holding on by a string to their lives, and they are thinking ,’this is the relief I need’ and it doesn’t happen and they end up going out the door more frustrated,” Lundy said

The province set up the Alberta Surgical Initiative to help catch up on delayed surgeries but Lang warns it comes with a cost.

“The cost is that it compromises emergency department care and EMS response in the community because it means that our departments are full of patients who we have already diagnosed, we’ve started the treatment, we know what’s wrong with them, but they have no place to go upstairs In the hospital,” Lang said

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He says the problem can’t be fixed overnight because it would mean creating more beds and hiring nurses that don’t exist, but he suggests that some less critical surgeries be delayed.

“When we went into disaster mode at the beginning of the pandemic everybody accepted  that we had to shut down surgeries in case we get flooded with COVID patients, which never happened. Now we are in disaster mode again, and we need to think about whether it’s time to reduce the surgical cases to make room for bringing emergency department patients upstairs, which would make emergency departments much safer and reduce wait times and improve the EMS response time in the community.”

Lang said the number of patients coming into the emergency department has not really changed from before the pandemic.

“We can’t slow down on cancer surgeries or really important surgeries, but if you’ve been waiting a year and a half for your hernia and you wait another few months while we help deal with the problem in the emergency department, I don’t know if that’s such a bad thing” Lang said.

Lundy said more needs to be done to stop what he calls the revolving door syndrome of mental health and addictions patients seeking care in emergency rooms.

Read more: University of Calgary diagnostic hub aims to advance research into fighting infection

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“The key is we need to get mental health and addictions out of the emergency rooms and we need to find another place that we can effectively give them the help they need that’s more effective and more efficient and that’s not happening,” Lundy said.

Alberta Health Services says it continues to work diligently to recover to pre-pandemic surgical status.

Over the past four weeks, the average weekly volume for surgical activity was 97 per cent of pre-pandemic surgical volumes.

The surgical wait list for adults sits at about 70,000, compared with about 68,000 in February 2020, before the pandemic.

AHS says it’s “balancing these surgical efforts with ensuring we have capacity to provide care for Albertans, including emergency department services.”

Hospitals sometimes postpone surgeries on a case-by-case basis to help manage bed and staff capacity on any given day. However, AHS says it’s working hard to avoid significant surgical postponements that “will only add to the burden on patients and our healthcare facilities.”

AHS adds it continues to experience significant pressure on the healthcare system, particularly emergency departments (EDs), due to higher-than-usual volumes of seriously ill patients, and increased staff vacancies and absences caused by illness and fatigue.

Critically ill or injured patients will always be seen immediately, and those with less urgent concerns may wait longer to be seen depending on resources.

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Alberta Health, meanwhile, says the health system needs extra capacity across the board.

Press secretary to Alberta’s minister of health, Steve Buick says the government is “working on a new action plan to do that, including emergency and EMS and the hospital units that primarily support them, continuing care services that are essential to move patients out of hospital when they’re ready and surgery.”

In a statement to Global News, Buick says one aspect of that plan is to add capacity to do more surgeries in hospitals and also in independent clinics (Chartered Surgical Facilities/CSFs), where patients get their surgery with full public funding, but they don’t use beds that could be given to patients waiting in Emergency.

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