Rolling surgical outages point to Alberta’s acute care crisis: AMA

“If Alberta doesn’t act, we might not have anybody to take care of sick Albertans in the hospitals after midnight”

“Using the example of a berry aneurysm, it’s getting big — that artery’s just ready to burst. And that’s what we’re seeing on the acute care side,” said AMA president Dr. Paul Parks.

“Calgary has been having diversion of their surgical services to the point where the major hospitals don’t have a surgeon on call on a weekend. For simple appendicitis, they have to diagnose it in the emergency room and transfer them out of the Foothills (hospital) or out of the Peter Lougheed into another site that has surgeons.”

Rotating diversions has been occurring in Calgary weekly for the last six months, and it’s escalating, Parks said.

“So that if you were to go to the Peter Lougheed with your really bad gallbladder and you’re diagnosed in emergency, they’re going to transfer you to another hospital in Calgary because there’s no surgeon on call,” he said.

“Those are stats that haven’t been very publicly shared. That’s just one example of how this hospital stabilization is growing in importance and the necessity to deal with it. We can’t keep putting it off.”

Parks said all members of the allied health care support teams are affected by strains on the systems — clinical associates, surgical assistants, nurse practitioners, physician assistants, and more.

The Misericordia and the Grey Nuns hospitals in Edmonton have been talking about capping their services in internal medicine, and the Misericordia has done so to a degree, Parks said.

“If those two hospitals aren’t able to admit patients after, say, 7 p.m. on any night, then all of a sudden, the Royal Alex and the U of A (hospitals) end up getting way more patients and way sicker patients and it just becomes an added burden when they’re already overflowing,” he said.

In the midst of an $85-million reorganization

It goes back to a call for acute care stabilization given to the government in November, when there were two concurrent crises.

“Myself and my colleagues are quite concerned about how you take a system that’s struggling and in chaos and then you add more disruption, even if it’s change in management that you’re hoping will go in a way that’s positive — that can be very disruptive,” Parks said.

“If Alberta doesn’t act, we might not have anybody to take care of sick Albertans in the hospitals after midnight. It’s getting that bad, the way things have not been updated in and maintained on that acute care side.”

Under the new organization, AHS is reduced to a department under the as-yet-unnamed acute care umbrella.

One well-documented problem is that up to 30 per cent of the patients admitted in hospital are designated “alternative level of care.” Some 1,900 beds, according to the premier, contain patients who were sick, then treated, and now need to go to continuing care — a long-term care facility or assisted living — because their home isn’t medically safe.

“Half our emergency department is filled up with new sick patients that can’t go to the floor because of those alternative level of care patients,” Parks said.

“Now they’re creating a continuing care organization and a new CEO that’s going to be totally disconnected from anything in the acute care organization, and we’re really worried. How do those two CEOs figure that out? If all the flow through the acute care system is impacted by what’s happening in continuing care, how is that disconnected siloed new organization going to function in an integrated manner that will help us so that when we’re struggling in the emergency departments and our waiting rooms are overflowing?”

Daunting numbers in acute care stabilization

The sheer logistics of growth are swamping acute care.

“In the last year, we’ve added 200,000 Albertans. That’s like adding a Red Deer and a Medicine Hat — without new resources to take care of it,” Parks said.

The AMA’s acute care stabilization proposal, given to the government in November, covers a workforce of more than 163 different groups and almost 4,000 physicians in stipends or alternative funding models — some haven’t been adjusted for more than 15 years.

“We gave the government this proposal in November and said, ‘We’ve got to get working on this, too. And you should use this to inform your budget.’ I don’t know if they did or not because I can’t tell if that money’s in the budget or not. But it’s becoming a big issue,” Parks said.

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