‘Being a boiled frog’: Sask. ERs boarding more patients, space limited

'When you go to work and you go into the waiting room and you see these people who are suffering, who are in pain, who are crying, you think, I could do a much better job,' says Dr. James Stempien.

At a time when hospitals have never been more full, health-care staff in Saskatchewan are increasingly treating patients in the emergency department when they should be getting a room.

Each day has new challenges, according to Dr. James Stempien, but he said emergency staff are helping patients with severe physical pain or feeling suicidal.

There have also been times where patients have experienced heart attacks while waiting for a room, he said, recalling a different incident in which an 85-year-old man was lying on the floor because his abdominal pain was so bad.

“We finally had to move him to a stretcher. But, you know, he was in the waiting room because we have nowhere else to put him,” said Stempien, the provincial head of emergency medicine at the Saskatchewan Health Authority, in an interview this week.

“When you go to work and you go into the waiting room and you see these people who are suffering, who are in pain, who are crying, you think, I could do a much better job,” he continued. “(These patients) should be in a room, have an IV, pain medication, a psychiatric nurse. But all I can say is, ‘I’ll do my best to get to you in a while.’”

It’s a wide-reaching and cascading problem in which patients increasingly go to emergency departments because they don’t have a family doctor. When they get there, beds aren’t available because they are already full, particularly with seniors who need to be moved to a long-term care facility.

It means people who show up in emergency have to wait longer. And, as of recently, doctors say more of these patients are being boarded in the emergency department for treatment because there are no beds.

“There’s a huge amount of boarding,” Stempien said. “At times we have had more boarded patients than there are beds. So every bed in the emergency department, every stretcher, every small little room in that emergency department is full of boarded patients.”

On a per capita basis, Saskatchewan also has fewer acute care beds when compared to other provinces, he added, suggesting more are needed.

Dr. James Stempien, an emergency physician and the provincial head of emergency medicine for the Saskatchewan Health Authority, outside the Royal University Hospital emergency entrance.
Dr. James Stempien, an emergency physician and the provincial head of emergency medicine for the Saskatchewan Health Authority, outside the Royal University Hospital emergency entrance.Photo by Michelle Berg /Saskatoon StarPhoenix

For Dr. Brent Thoma, an emergency and trauma physician in Saskatoon, he’s never seen it this bad before.

He explained it also compounds problems for EMS, because paramedics must wait with their patients in the hallway before they are offloaded. This keeps them from going back out and responding to calls, which causes response times to grow.

“Boarding is a problem in most Canadian emergency departments. And I think it’s fair to say that’s not necessarily new, but what’s new is boarding more patients than we have beds in our department,” Thoma said.

At the root of the problem is staff shortages across the sector.

But what’s lacking, according to Thoma, is a plan to retain current employees.

He agreed more staff are needed, but added the work environment needs to improve. Thoma suggested some patients could be moved to other wards to ease pressures in emergency.

That might mean making other wards more overcapacity, he said, but it would let emergency staff take care of the new patients coming in. Currently, they’re devoting most of their time to patients who are already admitted.

“That’s not what our space is designed to do,” Thoma said.

Thoma explained it is like being in a pot that has slowly come to a boil.

“It kind of feels like being a boiled frog; the temperature just keeps going up a little bit at a time,” he said. “Progressively, things have just gotten more and more difficult.”

Stempien said a variety of solutions are needed, including having more family doctors work in the province.

He said hospital staff also need to be working in the professions they were trained to do.

“I think we need an ability to see our patients in the ER and be able to give the proper care and not just do it all on the side in alcoves in the hallway and in the waiting rooms,” he said. “And I think the more we have our patients being looked after on a primary care level, the better it will be for everyone.”

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