Further measures taken to address emergency, urgent care wait times

Winnipeg Regional Health Authority
Published Thursday, May 26, 2022

Winnipeg emergency departments and urgent care centres continue to implement new and expanded initiatives designed to improve patient flow as Manitoba's health system responds to long wait times for many patients seeking care, Shared Health and the Winnipeg Regional Health Authority reported today.

"Current wait times are largely caused by patient flow challenges in hospital inpatient units, as the daily number of patients in need of admission has exceeded discharges for several months. This is due in large part to slower or limited supports for continued recovery at home or in the community due to a variety of factors," said Dr. Shawn Young, chief operating officer at HSC Winnipeg. "While these challenges will not be solved overnight, the steps we are taking to improve patient flow out of hospital are showing some promising early results in freeing up space for newly admitted patients."

Across Winnipeg facilities, new initiatives launched this month include the:

• Expedited placement of ALC patients (alternate level of care) from hospital to long-term care, freeing up space in inpatient units for admissions from emergency and urgent care. ALC patients are frequently long-stay inpatients that could be appropriately cared for in other settings with appropriate supports. There were 112 ALC patients in Winnipeg hospitals on Wednesday, down considerably from April, when the daily average was 151;
• Repatriation of stable patients who live outside of Winnipeg to continue their care, when clinically appropriate, to sites in their "home" health region. As of Thursday morning, 162 patients had been repatriated to sites in their home health region this month, freeing up space at Winnipeg inpatient units for others while allowing patients to continue their recovery at sites closer to home and their support network. There were 139 patients repatriated in all of April; and
• Improved collaboration between community and facility-based teams. As staff that support community and home care are returning to their normal work following COVID-related reassignment or redeployment, teams have prioritized the arrangement of supports at home or in the community for inpatients, allowing them to be safely discharged more quickly and opening up space in medicine units for others.

Preliminary data suggests the implementation of these and other initiatives have started to positively effect patient flow at Winnipeg sites, decreasing various wait time metrics over the past 12 days. The health system has also benefited from reduced sick rates over the past month, which has bolstered inpatient capacity, as well as the return of redeployed staff to community and home care duties – which is crucial in providing hospital inpatients with the necessary supports to continue their care at home.

"While our efforts over the past number of weeks are showing early indications that we are headed in the right direction, we know that it is likely to take some time to see significant improvement," said WRHA CEO Mike Nader. "We thank our staff for their continued dedication and professionalism as well as their direct feedback during recent meetings and tours throughout Winnipeg facilities. We continue to seek out measures and initiatives that will have a positive impact on patient care and welcome the input of our teams during this process."

New data released for April 2022 shows wait times at emergency departments and urgent care centres held steady, with median times for patients waiting to be seen at Winnipeg sites of 2.87 hours, an increase of approximately four minutes over the previous month. Ninetieth percentile waits increased by about two minutes from the previous month, to 7.62 hours.

"Wait times continue to be minimal for the sickest and most injured patients, but we acknowledge the ongoing pressure on emergency departments and urgent care centres is causing patients with less significant concerns to wait longer," said Nader. "We are cautiously optimistic that the measures we implemented in late April and early May are slowly easing that pressure, resulting in improved patient access that will be reflected in future reporting periods."

Much of the April reporting period had already occurred prior to the launch of various patient flow reduction initiatives. These measures, when combined with initiatives implemented this month, are helping to improve patient flow and include the:

• Leveling of ambulance transport arrivals across facilities. This change to ambulance transport protocols is shifting appropriate lower-acuity patient arrivals to urgent care centres rather than emergency departments, easing patient flow challenges at acute care facilities while improving patient safety; and
• Use of the Physician-in-Triage (PIT) model of care, which places a physician in the triage area to manage and provide care for those waiting to be seen - with a particular focus on higher-acuity patients. The PIT model began in late April as staffing has allowed at HSC Winnipeg. Discussions are ongoing on expanding the pilot program to St. Boniface and Grace hospitals.

System leaders from both Shared Health and the WRHA continue to meet with staff, physicians and site leaders to discuss their concerns and share ideas on how to further improve patient flow and reduce wait times. Work also continues to recruit and retain health-care workers, including nursing staff, at all sites.

"Higher wait times in emergency and urgent care are a concern to everyone and particularly for all of us who work in the health-care system," said Young. "No stone is being left unturned in our efforts to address patient flow challenges and improve the timeliness and quality of care for patients arriving in urgent care and emergency."

Patients are reminded to continue seeking help in an emergency, either by calling 911 or going to an emergency department or urgent care centre. All patients are assessed and triaged upon arrival and care will be provided, with the sickest and most injured patients prioritized.

Monthly ED wait time data, as well as an FAQ, is available here.