Health system addressing emergency, urgent care wait times

Winnipeg Regional Health Authority
Thursday, April 28, 2022

Winnipeg's emergency departments and urgent care centres are taking initial steps to address patient wait times, implementing some immediate changes while engaging front-line staff and physicians in identifying longer-term solutions to existing patient flow challenges that developed throughout the pandemic, the Winnipeg Health Region and Shared Health reported today.

New data released for March 2022 shows an increase to the overall median wait at all Winnipeg Regional Health Authority and Shared Health sites as facilities navigated increased staff sick calls and worsening delays in accessing inpatient beds that's caused by a variety of factors, including increased patient volumes and severe weather.

"Wait times for our sickest and most injured patients continue to be minimal, with those experiencing emergent and possibly life-threatening illness or trauma prioritized to ensure they receive the care they need without delay," said WRHA CEO Mike Nader. "However, a number of challenges are continuing to place increasing amounts of pressure on our emergency and urgent care departments, causing patients with less significant concerns to wait longer to receive care. We are committed to addressing and overcoming these challenges."

Median waits grew by approximately 37 minutes from the previous month, to 2.8 hours, the data showed. Ninetieth percentile waits also increased, to an overall average of 7.58 hours across all sites.

"While the current wait time challenges did not develop overnight, they have been worsened by our ongoing need to respond to COVID-19 at a time when the infectiousness of the virus has increased our sick calls to levels not seen in a decade," said Dr. Shawn Young, HSC Winnipeg's chief operating officer "High volumes of patients across our inpatient units are impacting patient flow, blocking treatment spaces in the emergency departments and urgent care centres until those patients can be admitted to a unit."

Winnipeg sites have begun to implement measures to improve patient flow. While solving the complex issues that contribute to poor patient flow and long wait times will require many different initiatives, both Young and Nader emphasized the importance of involving clinical teams in efforts to identify and implement solutions.

Leadership from both Shared Health and the WRHA have been meeting with emergency and urgent care physicians and staff in recent weeks. Those meetings, which will continue, have led to the implementation of two proposals so far. They are:

• Leveling of ambulance transport arrivals across facilities. Changes to ambulance transport protocols are shifting appropriate lower acuity patient arrivals to urgent care centres rather than Winnipeg's most acute emergency departments. This change, which is gradually being introduced, will eventually result in the redirection of dozens of patients per day away from the city's three biggest hospitals – HSC Winnipeg, St. Boniface and Grace – and leveling patient volumes – and wait times – across all sites.
• Speeding up COVID-19 test results. HSC Winnipeg has begun a pilot project to provide rapid PCR testing for patients who arrive at its adult emergency department and require admission. This replaces the previous process of lab-generated results which increased the wait for a COVID-19 test result and caused some patients to remain in the care of the emergency department until they could be admitted to an appropriate inpatient unit. Early evidence is this is streamlining the process and allowing for quicker patient flow within the department.

These measures are anticipated to result in patient wait time plateauing, if not improving. Additional work to improve patient flow is required in order for longer-term improvements to be realized. Both the WRHA and Shared Health, Nader added, are committed to making the necessary improvements. This will include:

• Recruitment efforts to fill vacant nursing and other roles across the system;
• Focused efforts by community and long-term care teams to discharge patients ready to move into available personal care home beds or home with the support of home care; and
• Ongoing use of inter-region patient transfers which are anticipated to increase with improved spring weather as well as initiatives suggested by front-line staff.

Manitobans are reminded to continue seeking help in an emergency, either by calling 911 or going to an emergency department or urgent care centre, added Young. Longer emergency and urgent care wait times have also caused a corresponding increase in the number of patients who are leaving without being seen, with an overall average across all Winnipeg sites last month being at 13.6 per cent. Higher-acuity patients who left without being seen comprise approximately seven per cent of all emergency and urgent care visitors, a number that is concerning and prompted regular checks from physicians and clinical staff at multiple sites in emergency waiting rooms to ensure patients are not having escalating health concerns.

"We are concerned with the increase in patients who are leaving without being seen and want to remind Manitobans that our teams continue to provide high-quality care," said Young. "While lower-acuity patients may experience a longer wait while we attend to sicker patients immediately, all patients are assessed and triaged upon arrival and care will be provided."

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