'It's growing and growing': AMA says ER staffing shortages causing worse outcomes for patients

President of the Alberta Medical Association Dr. Paul Parks speaks with Alberta Primetime host Michael Higgins about why the organization is sounding the alarm about emergency room staffing and patient transfers.

Michael Higgins: While nurses say morale has never been lower in Alberta's health system, emergency doctors are warning of a worsening crisis. They say a growing number of patients with urgent surgical needs are turning up in ER’s only to be delayed and eventually diverted to other hospitals. Why is this? What's happening such that emergency surgeries are not only being delayed but ultimately diverted to other hospitals?

Paul Parks: This is an issue that's been growing over the last couple of years. It's related to our workforce challenges. So specifically, not actually the general surgeons that do the operating but the people that helped do the pre-operative care, the intra-operative care and the post-operative care, the teams that do all of those pieces of the surgical care. We're just really struggling to recruit them and retain them and because of that now we're facing scenarios where someone might go to a hospital, like the Foothills Medical Center in Calgary, be diagnosed with acute appendicitis and there's no ability to be able to take care of that patient and do the operation in the Foothills as an example. And then they have to wait for an ambulance that can take hours and then be transported to another hospital like Peter Lougheed to get their surgical care because of the resource challenges on the teams around that help support our surgical care.

Michael Higgins: Okay, so what does that mean for someone who potentially finds themselves in that scenario, what are the potential consequences of being packed up in an ambulance and transferred somewhere else?

Paul Parks: Sadly it means more delays and increased risk. This shouldn't be normal and unfortunately it's happening more and more to the point where now we actually have protocols and policies on how to set up days where we know there's going to be no ability to care in a certain facility in a major urban centre and has to be has to be transferred to another hospital. And what that means then is delays because they'll get seen in the emergency departments, might see myself or a colleague, get diagnosed with a very serious surgical condition that needs a general surgeon and needs an operation and then, because at that site they can't manage them, they have to then wait for an interim hospital and an ambulance has to be pulled off the streets. That is its main job, to respond to new emergencies of the community, we have to get an ambulance and we have to set them up and deliver them to another emerge where they have to see another emergency physician and then ultimately see a surgeon and then ultimately wait for the OR to be available there. So it just means increased delays to safe and timely access to surgical care and we know that that increases morbidity and mortality and can have very serious outcomes for patients.

Michael Higgins: And this is happening in a in a facility as large as the Foothills?

Paul Parks: Correct. It's happening more and more across the province and what's really alarming is it's happening in our major trauma centres in our major urban centres. I should say that, you know, there are times where we're worried that actual trauma care could be impacted. We're doing everything we possibly can so that doesn't happen but I’ve got to say that these are conditions like, you know, appendicitis, your gallbladder, or bowel perforations. Very serious life-threatening regular general surgery that should be able to, it's bread and butter type surgery, that a centre like the Foothills can absolutely deal with. For them to have to transfer them out of the Foothills to another centre shows how stressed and, you know, really broken our system is in many places.

Michael Higgins: Your association is raising the alarm here, how much data do you have to draw on to backup this level of concern?

Paul Parks: That's a good example. So now, to give you specific objective data, we'd very much like AHS, they're tracking this, Ttey know how often they're diverting, they know ahead of time now when facilities can't take care of patients in those facilities because the team isn't available, the supports aren't available. They know how often the diversions are happening and so we need them to start publicly reporting that. The reason we're raising the alarm now though, is that because of the struggles and challenges around the workforce, we're seeing it happen more and more and more. There's also struggles around and anesthesia access and so it's happening in regional centres because there's not anesthesia. It's happening in the Edmonton Zone as well, it's happening more and more in various spaces that it's becoming problematic.

Michael Higgins: What's your view on the government's level of urgency here in response?

Paul Parks: We have a relationship that we're communicating with the government but we need them to share our urgency now. The AMA did give the government a hospital stabilization plan that highlighted, you know, we have to invest in the hospitalists and the team and that tier one supports that help support our highest levels of surgeons and care. We gave them a plan in December of 2023, so last year, and said, here’s some of the investments we have to do right now to address the difficult, unscheduled, unpredictable after hours care that happens in some of our hospitals and unfortunately we haven’t been able to move forward on action on that plan. I think they’re starting to share our concern, we need them to share our urgency and we really need to act now.

Michael Higgins: We spoke with you last back in May and we touched on the overhaul of health care and how that’s creating uncertainty in a system already under a great deal of stress. How much of a window do you have now on that road map forward and what level of confidence do you have in success?

Paul Parks: We have to remain optimistic but I will say that the restructuring has maybe distracted Alberta Health from prioritizing some of the pieces because they’re working so hard on doing the refocusing and restructuring that maybe that’s a component of why they weren’t able to act on the hospital stabilization plan that we provided more than six months ago. We’re starting to raise the alarm more and more because this isn’t just general surgical access in one site in Calgary, say for example. It’s impacting orthopedic care in the Edmonton Zone, delays to cancer care is increasing, we’re seeing internal medicine hospitalists starting to have to cap and not be able to take care of patients that will have to be diverted to other hospitals. It’s growing and growing and we’re really concerned. I use the analogy of an aneurism, a big balloon that’s getting bigger, at some point it’s going to burst open and that’ll affect human beings so we need to act on it as soon as we possibly can.