ER congestion: Royal Inland’s ER akin to medical shell game
It’s not quite the same as a shell game, but the pieces — stretchers with patients on them — are getting moved around almost as much some nights at Royal Inland Hospital.
Emergency-room Dr. Anders Ganstal said the ward is so crowded that staff are scrambling for beds and are now using examination areas at the nearby orthopedic clinic in the hospital to hold admitted patients who are waiting to be moved up to wards.
Ganstal, one of two Kamloops ER doctors to post videos on a B.C. Medical Association (BCMA) website advocating the public lobby MLAs for health-care improvements, said when he started at RIH seven years ago, the ER was seeing, on average, about 35,000 people a year.
Now, the number is closer to 58,000, he said, and the number of doctors has increased from 12 to 15.2 — although one is off on sick leave and has not been replaced.
The ward has 12 beds and two trauma bays to accommodate that amount of traffic, Gansal said.
To help with the increased demand for services, the province set aside $5 million late last year to pay for additional doctors at some hospitals; Kamloops was the successful recipient of the money allocated to Interior Health Authority, increasing the doctor complement by 2.5 physicians.
Ganstal said he’s confident the ER could handle the increased volume of patients if there were enough beds.
However, with beds occupied by patients waiting for transfer to wards, the potential for a major incident exists, Ganstal said.
“What if there’s a car accident? We had a bus accident recently we had to deal with,” he said.
“And, Kamloops is the third-busiest ER in B.C. and we’ve already got sick people in the hallways.”
As it is, admitted patients shuffled into the ortho area must again be moved out by morning, when that clinic opens for its own doctors and patients.
If there are no beds available on the wards, patients end up back in the ER or in hallways, Ganstal said.
When patients are moved into ortho, nurses have to be reassigned from other areas to care for them, Ganstal said.
The BCMA and the government agreed on a workload model to help determine the number of doctors an ER needs in each hospital, based on several parameters, said Dr. Don Haughton of the BCMA.
He said the model “captures the tipping point where it is most cost-effective” and is not based on every patient being seen immediately, but rather by moving through the system in a manner that avoids an “exponential increase in confusion.”
While the model was used for some time, the government has withdrawn from it, Haughton said, and is one of the reasons the website was created.
The webite can be found at bcemergencycare.com.