What a bizarre week! Dr Sherman, the junior health minister, fired off an incendiary email to his fellow MLAs blasting the Premier and Cabinet for their inept management of the ER wait time crisis—and was kicked out of caucus. Dr Duckett finally pulled together 100 clinical leaders for a brainstorming session aimed at reducing ER wait times. The team produced a set of ER protocols and was just about to unveil them when Dr Duckett side tracked the process by refusing to answer the media’s questions because he was eating a cookie. Dr Duckett offered a public apology but the damage was done, the cookie incident went viral and it’s highly likely that Dr Duckett will be going home very soon.
Meanwhile Minister Zwozdesky has taken a different tack. Apparently tired of the continued attacks on ER wait time targets, he’s promised Albertans a Christmas present. He made this promise in the Legislature—twice. On Nov 15 he said “I have given Alberta Health Services until Christmas to come up with the improvements that we need to see.” On Nov 18 he added “…there are some overcrowding issues in emergency rooms in some cases, and we’re addressing those. There is a plan, and there will be even more progress between now and Christmas.”
The Health Minister even put his wait time targets on the record (which is helpful given how many times they have been revised downward). He told the House: “…for the larger hospitals, including…Edmonton and Calgary…45 per cent of the people should be in and admitted within eight hours by the end of this year. Secondly, they are also to be discharging 70 per cent of the people who do not require an overnight stay within four hours. Both of these targets, it’s important to note, will actually be increases from actual results. (That last part is reassuring given that the definition of a “target” is a goal to shoot for, an improvement over actual results, otherwise all you’re left with is the “status quo”.)
Interestingly, Minister Zwozdesky’s Christmas promise ties into an approach advocated by Dr Sherman who cites the UK experience where the number one accountability measure for the entire health system is a metric based on ER wait times for admitted patients. That’s because every other health service feeds into the wait time for admitted patients in the emergency department. In Dr Sherman’s words, “It’s not an emergency problem; it’s a system problem”. This view is shared to a degree by Dr Taft (Member for Edmonton-Riverview) who says that long wait times in emergency rooms “…are a kind of indicator of how the health system, at least the hospital side of the health system is running generally.”
How will these wait time reductions be achieved? Presumably by implementing the ER protocols unveiled by Dr Duckett’s team of clinical leaders just after the cookie incident. The protocols set out thresholds which, when reached, require immediate action to reduce wait times. Think of it as surge protector. Once the threshold is reached the patient is moved out of ER. However it’s not clear where the patient is going because the success of the protocols is dependent on the addition of 81 new beds—49 in Edmonton and 32 in Calgary. These beds will be opened over the next three months. In other words, unless a miracle happens, Minister Zwozdesky will miss his newly revised ER wait time targets and instead of a present in our Christmas stockings we’re going to find a lump of coal.