Daring to dream about emergency rooms that work

Opinion

Hey there, time traveller!
This article was published 07/04/2017 (2777 days ago), so information in it may no longer be current.

It is the health-care system’s impossible dream.

Those who toil in Canada’s publicly funded health-care system have long dreamed of a time when only the most seriously ill patients go to emergency departments, while other, less urgent patients turn to other options for care. In this dream, wait times in emergency rooms fall dramatically, treatment outcomes are better and — because everyone is getting the care they need in the most appropriate setting — the cost of operating the system is moderated.

This dream has been deemed impossible for a number of reasons, chief of which is this: patients go for treatment where they want to go, when they want to go, with little regard to whether it’s the most cost-effective or the best option for quality care. People with earaches, sore throats or vomiting children flood emergency rooms because that is where they want to be and damn those who want to tell them otherwise.

All of this brings us to the fascinating plan unveiled by the Progressive Conservative government on Friday to profoundly reorganize the delivery of emergency medicine in Winnipeg. The changes are the result of years of planning and discussion by medical leadership in Manitoba and an 18-month review of acute-care services by Dr. David Peachey, an independent consultant retained by the former NDP government.

Rather than operating six ERs, Winnipeg will have just three, expanded acute-care emergency departments: Health Sciences Centre, St. Boniface Hospital and Grace Hospital. The ERs at Victoria Hospital and Seven Oaks Hospital will be converted into urgent-care centres that can treat about 85 per cent of all those who currently visit an emergency department but not the most seriously ill and injured.

The theory is that the resources needed to provide emergency treatment are spread too thinly across six ERs. As a result, patients in each ER are forced to wait much longer than necessary to get diagnostic imaging, consultations with medical specialists and specialized surgical procedures. In some instances, patients must be transported between hospital ERs to get the right treatment, adding considerably to the overall time and extending waits for less urgent cases.

Now, all of the resources needed for timely emergency care — diagnostic services, medical specialists, emergency surgical services — can be concentrated in just three ERs. The result, it is hoped, will be that the public will get better treatment outcomes with shorter waiting times. Furthermore, the less ill and injured who are channelled to the urgent-care centres should similarly get treatment much quicker.

Is this a fool-proof plan with guaranteed successful outcomes? Hardly. The history of publicly funded health care in Canada is littered with studies and action plans considered to be the best options on the day they were unveiled. It was only long after the changes were made that some of those plans were revealed to be misguided.

There is risk in this plan, to be sure. The provincial government has, for some time, created additional options for less ill and injured patients to divert them away from hospital ERs. And while these options have been somewhat successful, they have not dramatically reduced wait times in emergency departments.

Will fewer but expanded ERs and more numerous urgent-care options do the trick? Well, that is the multibillion-dollar question.

The NDP and Liberal opposition moved quickly to condemn the changes announced Friday, accusing the Tory government of reducing access to acute medical services. However, given the fact that this plan was drafted by medical leaders, not political leaders, the opposition should not be so quick to condemn, particularly since it was the NDP that commissioned the study by Peachey.

In fact, there is an argument to be made that these changes are merely the natural evolution of the health-care system in Winnipeg. During the past 20 years, successive governments have taken steps to concentrate medical services in specific medical facilities. The theory then was — as it is now — that it is inefficient and costly for every hospital to offer every medical service. We simply don’t have the doctors and nurses to make that a reality.

Many of the officials attending the official announcement of the rationalization of emergency medicine talked about the “barriers” that prevented these changes from being made sooner. Those barriers include powerful community leaders who raise money and advocate for community hospitals, medical professional groups that want to wield influence over how and where their people work, and patients themselves for reasons explained above.

Those barriers have discouraged former provincial governments from moving as quickly or as boldly as they probably should have in modernizing the delivery of health care. Going back decades, there are numerous times when solid ideas for improving service delivery were studied, deliberated on and then shelved rather than being allowed to face the political blowback from the aforementioned barrier groups.

All those affected by the new emergency medicine plan should take note. There is no evidence this is either an ideologically based idea,or one that is primarily about reducing services to save money.

In fact, it is possible the former NDP government would have come to the same conclusions, given that it thought it was a good idea to retain Peachey in the first place. However, insiders from the health-care system found that in the last few years of their tenure, the NDP was extremely risk-averse and may have elected to avoid the political complications that come from closing emergency departments.

For the current Tory government, if the rationalization of emergency departments turns out to be an innovation that increases capacity while lowering wait times and overall costs, then it will deserve full credit for having had the political will to do something that has been recommended for many years, but never acted upon.

dan.lett@freepress.mb.ca