AMA says surgical, trauma services stressed by shortages as surgical cancellations extended at Royal Alex

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Shortages in surgical and trauma services are stressing Alberta’s emergency rooms, according to an urgent letter to Alberta Health Services chief Athana Mentzelopoulos.

A document shared with Postmedia said the province is experiencing multiple diversions due to lack of Tier 1 providers for surgical and trauma services, and losing ER doctors because of it.

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“These diversions from the various specialties (surgical, trauma, and orthopedics) cause significant impact on the flow in ER departments,” wrote Dr. Arun Abbi, president of the Section of Emergency Medicine of AMA.

“Currently we are losing ER docs due to the progressive administrative burden that is occurring and morale is decreasing every day. We will have a larger attrition if real solutions are not created by AHS to deal with these service disruptions,” he wrote in July.

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Doctors in ERs large and small are making extraordinary use of the RAAPID provincial call centre to arrange transfer of patients to other sites to find accepting physicians.

“This is untenable,” Abbi wrote, citing ER physicians taken away from seeing sick waiting-room patients, leading to increased wait times.

“An ER doctor can only manage so many patients on their list. If they have patients who should be admitted on their list, they are not seeing new patients. This leads to increased waiting room times which leads to increased patient morbidity and potentially deaths. The undifferentiated patient is the one who is at highest risk,” he wrote.

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Stabilizing patients for transfer can mean a wait of up to 12 hours, and doctors busied with transferring patients from one site to another rather than responding to 911 calls.

“The government has said that reducing ER wait times and reducing EMS response times is a priority. These diversions go directly against reducing wait times in these areas.”

In his letter, Abbi envisions a fix: for AHS to help with Tier 1 supports for clinical services to reduce diversions.

“AHS must come up with a Most Responsible Physician (MRP) to admit these patients and if necessary, arrange transport to another site. If this is not possible, then we need a process to directly admit patients to hospital in a timely fashion so that we can continue to see the next patient who is potentially critically ill,” he wrote.

“There must be triggers to directly admit patients to hospital under an accepting MRP.”

“This cannot be the responsibility of the ER physician. The ER physician would only intervene for life-threatening conditions,” he said.

In a response sent July 18, Mentzelopoulos said discussions are ongoing with the Alberta Medical Associatinon, and that enhancements to Tier 1 clinical coverage arrangements, hospital medicine programs, surgical hospitalist programs, and availability of after hours coverage are “very active priorities.”

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GRIDLOCK, CANCELLATIONS

According to the latest Alberta Medical Association polling, seven in 10 Albertans believe the quality of the health-care system over the past five years has declined, with almost half saying it’s “much worse.”

Cancellations of scheduled hip and knee replacements at the Royal Alexandra Hospital’s Orthopedic Surgery Center have been extended three times, now officially to Sept. 3.

AMA president Dr. Paul Parks said the University of Alberta gave the government ample notice that its orthopedic residents would be pulled back to the University Hospitals as of July 1, the start of the resident year.

“It’s still the issue around the support teams for the preoperative and the post-operative care, they’re just not there,” Parks said.

“Grande Prairie is struggling to get hospitalists to cover and admit any patients in the hospital, not just orthopedic ones, and they’ve been waiting for a (funding) update for years,” Parks said.

“Things are not looking good.”

On Thursday, he received word there were more than 34 admitted in-patients parked in Red Deer’s emergency department. Patient flow was gridlocked — “extremely atypical for August.”

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“The urgency is real and compounding. We need the Physician Comprehensive Care Model approved, formally announced and implemented before fall,” he wrote in a letter to AMA members.

SEEING A PATTERN

University of Alberta professor Dr. Louis Francescutti, who is a medical doctor and practising emergency medicine physician, said he’s concerned about a repeating pattern of diversions that could be solved if enough resources were put into the system.

“You’ve got a population that’s aging, and aging populations have greater disease burden … so that means there’s going to be a greater demand on health care. You’ve got more people moving to Alberta, which means they’re going to have to find their care somewhere, and they’re not able to access primary care,” Francescutti said.

Albertans without access to a primary care, through no fault of their own, have to resort to the emergency department.

“Without accountability, nobody’s really trying to make the improvements that are going to make a difference at the end of the day. And you know, we’re still getting pretty well the same amount of money we’d get in the past, while we have all this extra stuff that we have to deal with. On top of all that, COVID-19 prevented a lot of people from getting regular care, and so now people are showing up with disease at a very advanced stage that normally we don’t see,” he said.

500 MORE DOCS

Asked Friday about shortages in the health care system, Ministry of Health spokeswoman Andrea Smith said multiple initiatives are underway to address specific shortages across the health-care system, and Alberta’s government is working to make sure Albertans can access the care they need, when and where they need it.

“In the second quarter of 2024, Alberta recorded an increase of nearly 500 physicians since the same period in 2023,” Smith said, adding that the increase was a net increase, year over year.

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