Drop in staffed hospital beds driving longer ER waits Overall number of unnecessary visits to emergency departments not up, despite what bureaucrats, politicians would have us believe By: Tom Brodbeck Posted: 7:00 PM CST Tuesday, Nov. 29, 2022 Last Modified: 10:24 AM CST Wednesday, Nov. 30, 2022 Updates

Opinion

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This article was published 29/11/2022 (825 days ago), so information in it may no longer be current.

Emergency room wait times in Winnipeg have doubled since the Progressive Conservative government launched its hospital consolidation plan five years ago. But it’s not because more people are showing up at ERs.

According to recent data released by the Winnipeg Regional Health Authority and Shared Health, the number of emergency department and urgent-care visits in 2021-22 was the second lowest in five years.

What has changed is there are fewer hospital beds in the system.

Health Sciences Centre publishes its hospital data separately from the rest of Winnipeg hospitals. When combined with WRHA facilities, the data shows the total number of ER and urgent-care visits in 2021-22 in Winnipeg was 273,381, well below what they were in each of the years between 2017-18 and 2019-20, prior to the COVID-19 pandemic.

During the same period, median ER wait times in Winnipeg have more than doubled from 1.35 hours in October 2017 (when the first phase of consolidation was launched) to three hours in October 2022. The 90th percentile ER wait time (the longest wait time for nine of 10 patients) also more than doubled from 3.9 hours to 8.2 hours during the five-year period.

What the data shows is that it’s not the volume of patients visiting ERs that’s driving up wait times. It is, for the most part, a shortage of staffed hospital beds.

During the same five-year period, the total number of beds in Winnipeg hospitals dropped from 3,160 to 3,024. Bed numbers are up slightly at some hospitals, including HSC, but down at others, such as St. Boniface and Grace (which have the second- and third-longest ER wait times, respectively, behind HSC).

With fewer beds in the system, admitted patients in ERs are forced to wait longer, sometimes days, to get a spot on a medical ward.

When that happens, it creates a bottleneck in the ER and drives up wait times, as emergency department staff care for multiple patients at a time. Staff shortages in ERs, which have grown in recent years, have made the situation worse.

It’s not that patients are showing up at emergency departments sicker in 2021-22 than in previous years, either. The percentage of ER patients sick or injured enough to be admitted to hospital has hovered between 12 per cent and 13 per cent. It fluctuates between hospitals, but it hasn’t changed much over the past five years.

This is what an underfunded health-care system looks like after years of cuts to hospital budgets.

The ER volume data contradicts what some health bureaucrats and politicians have been saying in recent months: that ER wait times are on the rise because too many low-acuity patients are showing up at emergency departments when they could be getting care elsewhere, including their doctor’s office or a walk-in clinic. If that were true, overall ER visits would be on the rise. They’re not.

At St. Boniface Hospital, for example, ER visits over the past five years peaked in 2018-19 at 48,266. They’ve dropped steadily since. There were 42,333 visits in 2021-22. Grace Hospital ER visits peaked in 2019-20 (the year before the pandemic) at 39,487. The number dropped to 34,364 in 2021-22.

The latest figures are current to March 31, and don’t include the surges in ERs Winnipeg has seen in recent months, especially at Children’s Hospital. However, the long-term trend is there are fewer visits to ERs in Winnipeg, not more.

Studies have shown consistently over the years that long ER wait times are caused primarily by hospital overcrowding, not high volumes of low-acuity patients showing up at ERs. The latter is a myth perpetuated by governments and health-care bureaucrats to provide political cover for themselves.

There are many factors that drive hospital overcrowding, including the use of medical beds to house long-term care patients awaiting placement in nursing homes. However, the drop in the number of staffed hospital beds in recent years has been one of the key drivers.

Long ER wait times not only result in substandard care for admitted patients forced to wait days in emergency departments, it also causes some frustrated patients to leave without being seen by a doctor or nurse practitioner.

The percentage of patients across all Winnipeg hospitals who have left the ER without being seen has jumped from 5.6 per cent in 2017-18 to 10.2 per cent in 2021-22.

This is what an underfunded health-care system looks like after years of cuts to hospital budgets.

tom.brodbeck@freepress.mb.ca