Calgary’s emergency wards grappling with ‘overcapacity’ during flu season: AHS memo

Calgary’s emergency rooms are “at a state of critical overcapacity” ahead of the expected peak of flu season, according to a memo obtained by CBC News — and to deal with the surge and waiting room congestion, officials are urging doctors to speed up their decisions about admitting patients.

The situation is “expected to only get worse,” according to a note sent Friday to Calgary’s acute care doctors.

“While all sites are mobilizing all available resources, we continue to operate in an environment where all funded ED (emergency department) treatment spaces are occupied by inpatients, causing severe access blockage,” wrote Dr. Katherine Patoka, clinical division chief of emergency medicine for the Calgary region of Alberta Health Services, along with her deputy, Dr. James Andruchow.

Due to staffing shortages and stress, there is an existing order for paramedics to immediately offload patients to emergency rooms to allow those ambulance crews to handle additional calls, the memo said.

“This combination of overwhelmed capacity and the unexpected influx of critically ill patients from EMS results in lengthy delays in care and poses major safety risks to patients waiting for evaluation and treatment.”

Officials had warned about the dangers of overcrowding in hospital emergency wards during respiratory virus season. Hours before this “significant overcapacity” memo was circulated in Calgary hospitals last Friday, Hospital Services Minister Matt Jones said officials expected Alberta’s influenza season to peak on Dec. 21, with hospitalizations continuing to rise for an additional week.

The respiratory disease known as RSV, which can also send patients to hospital, is projected to peak by Jan. 11, according to provincial modelling.

The memo said that to help keep patients safe and improve system flow, they would ask residents and attending physicians to take no more than four hours for a “disposition decision” — whether to admit or discharge patients.

The memo says doctors will receive special alerts regarding that goal, and if a decision takes more than four hours, emergency department administrators can step in to help.

“Although we recognize that no inpatient beds may be available, identifying patients suitable for admission in a timely manner helps identify barriers … and supports safe, system-level decision making and equitable risk management during this period of increased demand,” Patoka and Andruchow wrote their colleagues.

“The situation is really bad right now,” says Dr. Joe Vipond, who works in the emergency department at Rockyview Hospital.

“Sometimes people have to wait for eight-nine hours to get darshan. Some of them are sick and getting sicker – it seems dangerous.”

According to Vipond, it is unusual for emergency room administrators to involve themselves in doctors’ decision making on admission, although sometimes they intervene when there is uncertainty about where to send a patient.

“I think our administration is trying to figure out how to best manage the problem.”

Dr. Eddie Lang, former head of the Rockyview emergency unit, said as people gather for the holidays, “extremely high” levels of flu are circulating, which is landing many elderly Calgarians in hospitals with respiratory problems.

“Across the city, emergency departments are admitting a lot of patients who have been diagnosed, they’ve been treated, they’re on oxygen, but they don’t have a bed to go up because the floors above are full,” he said in an interview.

“And that creates a backlog, which also impacts the paramedics who are trying to get their patients released and back on the street.”

An AHS spokesperson tried to downplay the urgency of the memo.

“This memo has been shared on multiple occasions over the past year, including during last winter’s respiratory season and stampede, when volumes were expected to increase,” Kristen Anderson wrote in an email to CBC News.

The four-hour mark is a typical target for emergency patient flow, he said, and the memo from zone leaders was meant to serve as a reminder.

Province-wide, Alberta Health Services had 130 temporary hospital beds ready for a surge during respiratory virus season. Of those, 123 have been opened across the province, Anderson said in his response to CBC News.

However, there are still beds available at AHS hospitals in Calgary, he said.

According to the province’s respiratory virus dashboard, 1,635 Albertans have been hospitalized with influenza since flu season began in the fall, with 116 of them requiring treatment in intensive care units. Forty-seven people have died from the flu in the province.

With files from Jennifer Lee and Karina Zapata