Professional Documents
Culture Documents
Took
> 30 minutess of prolonged discussion to divert patient to Vancouver. Consultants
WITHIN UAH completely unaware of how unsafe and overcrowded the ED was.
o Female with query appendicitis accepted at 2200 by General surgery from Edson
without informing anyone in ED, and despite the fact that the patient was completely
stable and likely needed an ultrasound that couldn't be obtained untilthe next morning
- Patient with severe back pain reg at 1322, moved to bed at 1900 for analgesia and assessment.
- Patient with a DW and severe leg pain, > 6hrs to get a bed for analgesia, assessment and
treatment. When finally in a bed the patient was crying and screaming at all health care
providers in frustration of prolonged wait in pain without care.
- Multiple CP patients with prolonged waits for ECG and bed:
o 63yo with CP reg at 14i-0, no bed until 1843
o 69yo with CP reg at 1-701-, no bed to even do an ecg until 2000
- 38yo patient with DKA - Na L18, K=5.7, ++ dehydrated. No acute monitored bed to treat patient
for prolonged period.
- Young female 20 weeks pregnant with contractions and abdominal pain. Was going to leave
without being seen due to prolonged wait. Manual pelvic exam done in triage assessment area
(not considered a private area) at patients request to check cervix and risk of premature delivery
- Known free air under diaphragm and perforation from family docs office, presented at 1615, no
bed for analagesia, assessment and treatment until 1800.
- Patient with RLQ pain registered at1,927, diagnosed with an acute appendicitis in the WR at
2230, straight to the OR from the WR. NEVER got into a proper care area for analgesia or
treatment.
- 23yo female with upper Gl bleed and hematemasis, arrived with EMS at2207, still no bed at
midnight.
- 38yo M with new onset tachycardia arrived at 2245 with heart rate of 150. Still no care space for
assessment or treatment at 0015.
- 26 ElPs, 8 definite to be admitted and > 25 in WR at midnight.
o 22yo male with new onset seizure registered at 1733, admitted by neurology in the WR,
still no bed at 0030.
o Patient with a liver transplant, presented with hypertension and headache at 1818, still
no bed at 0030.
- Midnight shift, 30 ElPs,5 definitive admissions pending, and greaterthan 10 "hold overnights".
Some examples of prolonged delays in decision making due to consultation or radiology:
o Reg at 2139, requiring non-emergent ultrasound which is unattainable at night, still
awaiting ultrasound at 0930.
o Reg at 2226, requiring non-emergent ultrasound which is unattainable at night, still
awaiting ultrasound at 0930.
o Reg at 2322, requiring non-emergent ultrasound which is unattainable at night, still
awaiting ultrasound at 0930.
o Patient registered at 2738 with signs and symptoms of possible cauda equina, informed
MRI not available at night, hold untilAM for MRl.
o Patient with abdominal pain and Gl consulted at2200, Gl staff had still not seen to make
a disoosition decision at 0930 the next dav.
Patientwith a Hipfracture registered at L1.38, no analgesia ortreatment until in a bed at L751.
Patient with urinary retention registered at 7229, still not in bed at 1730.
Patient with acute appendicitis - registered at 1541, work-up all done in WR. CT at 2100 from
WR. Still no bed for analgesia or treatment when admitted in WR at2200.
Elderly patient with a pneumonia, WBC of 28.9, Troponin of 0.2'1., and Glucose of 1.9 registered
atl7O4, not in ED care bed until 2200. Hypoglycemia was missed and not treated by the triage
doctor and nurses as there were >40 other patients in the WR and the environment was
completely out of control and unsafe.
Patient with an acute appendicitis registered at 1534 and went to OR from WR. General surgery
staff was upset because the patient had no orders or antibiotics prior to getting to the OR, but
the patient was never in an ED care area at any point - the patient's care was as optimal as
possible due to the overwhelming overcrowding.
No beds in ED, and multiple consultants still accepting patients from out of region despite
protests by staff:
ED
o Stable patient sent for
CT to rule out PE, never made it to a care space.
o PTtransferred from Ft McMurray for plasma exchange despite no beds in hospital/ED.
Patient presented tachy at 136 and SBP of 69. Reg at 1656, no acute care beds for assessment
and treatment until 1732. Found to have a leaking AAA.
28yo with depression and suicidal, victim of spousal abuse, waited > 5hrs and then attempted to
leave without being seen, persuaded by TLP to await formal assessment.
Patient with hypokalemia of 2.8 waited >2hrs for a bed for assessment and treatment
2 patients with Febrile Neutropenia (+++ High riskfor infections, requiring isolation) in WR for
prolonged waits.
Patientfrom Fort McMurray with cardiaccontusion accepted directto Cardiology, in ED > 48hrs
with no admission or service taking responsibility for the patient's care. Never actually admitted
to any service, so never counted as an ElP, or a blocked bed. Multiple hand-overs to numerous
emergency physicians with no reasonable continuity of care for entire stay.
Two different patients with small bowel obstructions who were in ED > 48hrs without admission
orders by general surgery. (Both patients were clear SBO's, requiring NG tubes and lV fluids.)
Due to severe overcrowding two intentional overdoses left the WR without being seen. That
night there were > tO% of registered patients who left without being seen (LWBS). Meanwhile
multiple services continued to accept direct without notifying anyone in the ED - ENT and
Neurosurgery were exa mples.
36yo male with Malignant hypertension (2201150), registered at 1230, asked to leave without
beingseeing numerous times, ultimatelyfound to have a troponin of 0.4! and a creatinine of
199. No bed available until 1510 for treatment of his hypertensive emergency. Patient would
have left without treatment if the TLP hadn't persuaded him to stay - this patient had clear
evidence of end organ failure and without treatment would have been at significant risk of
imminent myocardial infarction, stroke, or renal failure as examples.
Only 15 ElPs - we actually had flow and the department almost worked like a real ED.
- BAD - 22 ElPs, 10 awaiting to be admitted, absolutely no flow, > 40 patients in WR
o Patient with dehydration and a sodium of 72O, reg at 2105, no bed until 0230.
- 32 EIPS, only 1 available patient care space. Absolutely no movement. Executive on call
contacted who was unable to provide any relief.
o Patient in Hinton with an aortic dissection - NO beds in entire region to accept the
patient.
o Patient with K of 6.5 in WR for prolonged time with NO bed for assessment/treatment.
- 25 ElPs with 5 more definite to be admitted, numerous with prolonged workups and no
movement pending. Discussed with multiple executives on call with no impact. The operating
rooms went on with full slate of scheduled surgeries despite no discharges pending and the ED
being completely non-functional due to overcrowding.
o Meanwhile a patient was in CHEMS HALLWAY with absolutely no privacy, urinating in
full public view.
- Patient with an acute cholecystitis transferred from Drayton Valley, arrived at 1043, no bed until
1600. >5hs in ED WR with 10/10 severe RUQ pain with no analgesia, assessment or treatment.
Hotmail Windows Live Page 1 of3
trc,
To: Deb.Gsrdcn@capitaihealtlr.ce,
D!,la n.Tayl * rQ ca p it-r I hee ltlr.ca,
Biii.Johnston@capitalhealth.ca
Date: Thursday, October 9, 2AAB,2:09:35 PM
Subjecr: Follow-up on: Patient Relations Prisnr #
TXXXXX
= c ri g i n a I messa g e
i;,11'=== ;====;= ;==-
Dear Debbie Gordon, Dylan Taylor and Bill Johnston,
http://snl06w.snt106.mail.live.com/mail/Inboxlight.aspx?n:1798802884 06/03/2011
Hotmail Windows Live Page 2 of 3
Specifically:
- Is there a formal process for senior executive to be
involved in
complaints that are clearly related to system
overcrowding issues?
- Is the forrral policy for disclosure of adverse events
being
reassessed to account for systemic overcrowding
issues? Is it really
fair or appropriate to have individual ERF's
addressing systemic
overcrowding issues based soiely on drawing the
short straw of being
on shift when tlre place is out of control?
(UrTfortunately, the ED is
nearly ALWAYS out of control lately.)
- What are the medical legal ranrifications for myself
and my
colleagues in regards to cdntinued practice in an
unsafe and
dangerously cvercrowded ED?
- What is Capital Health doing to actively publicly
disclose how
overcrowded and unsafe our ED's are?
http:i/snl06w.sntl06.mail.live.com/mail/Inboxlight.aspx?n:1798802884 06/03120r1
Hotmail Windows Live Page 3 of3
http://sn106w.snt106.mail.live.com/mail/Inboxlight.aspx?n:1798802884 06t$Darl
Message body Page 1 of2
Il
007 - I think I may have stopped sending cc's to the Minister at this point as I was receiving NO replies from
them..
Thank you very much for the feedback from the System Overcrowding
meeting' I know that Dr' llhut submitted some suggestions and
comments, and I wanted to take the time to raise my concern regarding
one component of the Workplan: Public Communication'
need.
http:llsnl06w.snt106.mail.live.com/mail/RteFrame.html?v:|5.4.3079.0223epFpf 06103/2011
' Hotmail Windows Live Page I of2
IL
(LWBS).
There were 29 patients (out of 211- who presented) that LWBS,
which
amounts to a staggering 14o/o of the patients presenting to our
ED. One
of the first patients that did finally receive an ED bed was a 70 year
old male who waited in the waiting room over 10 hours with a
large
bowel obstruction.
If multiple
severely ill patients had arrived iri the night - as is a
frequent occasion at our ED - we r,vould have been completely
unable to
provide them wiih care or to intervene on their behalf.
htto://snl06w.snt106.mail.live.com/maililnboxl-isht.aspx?n:1798802884 061031201r
' Message body Page 1 of2
r<
010... not sure if I could have been more pleading in this case... read my last paragraph, i'm begging for help.
To: "Gordon, Deb" < Deb.Gordon @ca pital health.ca >, Dylan.Taylor@capita lhealth.ca
Date: Thursday, January 15, 2009, 3:06:01 AM
Subject: Follow-up regarding prolonged delays in admission due to GIM Overcapacity
I will provide all specifics below, but would like to stress that this
is only a prime example of the ongoing disposition issues occurring at
the UAH in light of the ongoing critically unsafe systemic overcrowding.
- The patient was brought in by EMS and registered at @ 0901 Jan 13th
- The patient went to a CHEMS bed @ 1026 (This is a hallway area
without privary, and is merely an extension of the waiting room,)
- Due to systemic overcrowding, specifically the housing of admitted
inpatients within emergency department care spaces, the patient
languished in the hallway bed until an F-POD bed was available at
2048.
- This deserves repeating: the patient did not get to an ED care
space for almost 12 hours. unfoftunately this is routine for our
center, despite all efforts to mitigate the ongoing crisis of systemic
overcrowding,
- the TLP discussed the case with Internal medicine staff sometime
around 2700-2200 when it was clear the patient couldn't ambulate and
care for herself. Family medicine was already over census, and had
already indicated they could not accept anymore admissions. The ONLY
service available for this patient - as per our admission protocol, and
current ooeratino realities - was internal lvledicine. But Dr. J-
refused ro acjmit, anci also reiuseci to suggest another apprEfimf-
service.
- Tne patient was seen by tne rotationai dury ED oocior lorJ
2225, after the TLP had already attempted to procure an admittihQ
service for the patient.
- at -2330 all three emergency doctors within our department were
involved with an extremely difficult intubation in A-pod, and it
wasn't until 0015 that Dr.],ould again address the fact that
there was no service to admlt the patiepl
- a 0100 call with th" ;"* ;;;i,6;:, and Dr.Jroved
completely unhelpful, and it was left that the executive on call would
personally arrange for an admitting service at 0800 the next morning.
- at 1000. there was still no assistance from administration, so
geriatrics were consulted. The emergency physician at the time had no
idea what else to do - the system had completely failed the patient
thus far.
http://sn106w.sntl06.mail.live.com/mail/RteFrarne.html?v:15.4.3079.0223&pf:pf 0610312011
Message body PageZ of2
service - she was a placement issue - but suggested the patient get an
urgent MRI (which was req'd at 1145, but was slotted for sometime
TOMORROW afternoon).
- at 1900, upon hand-over to a fifth DIFFERENT emergency physician, it
became clear that no one was adequately caring for this patient, and
that a disposition was not being actively worked on. A conference call
with the executive on call resulted in GIM agreeing to admit the
patient as they were again "open for business".
- the patient was admitted by GIM at 2255 Jan 14th.
This all occurred in the background of -30 EIPS, and > 30 patients in
the waiting room all day long. Waits to get to an ED bed were
routinely greater than 12 hours, and the waiting room only decanted
because patients left without being seen.
Wouldn't it make more sense for GIM to admit ALL consults requiring
admission and then have senior physicians decant to other services at
0800 the next morning? I eagerly await guidance regarding a reasonable
consistent poliry to procure admission in our ongoing completely
dysfunctional work environment.
http://snl06w.snt106.mail.live.com/mail/RteFrame.html?v:15.4.3079.0223&pFpf 06103t20rr
' Hotmail - rajsherman@hotmail.com - Windows Live Page 1 of 1
I4
m6...
---0\
--*at ---=:===uflglnal
----*nri^inat message
text---=======:====
Dear Paddy, Chris, and Debbie,
,\el
tl
Download as zip
Spence,
Acute care nurses are leaving the acute care system"..for what is
probably the most expensive Medicenter Care possi[:le. We
already have Urgent Care Centres within the ED's...tlrey are called
the "fast track" side of the FD. Unfortunately the fast tracks are
plugged with admitted patients.
Is it any wonder that the iCU's and CCU's and the emergerrcy
departments cannot staff their beds. Does Dave know that tl-rese
becls are closino?
R.
Raj,
Anonynrous
-Windowslive
Mike,
Thanks you forthe copy of the report. The section will be meetnig
tomorrow evening to formulate a reply.l hope that Minister
Hancock was able to attend the meetino on Fridav.
Cheers.
Raj
li;offi'n
CC: S MT@ albertadoctors.org
;'";,#i,:Hg?.ffi;'n
The Health Quality Council of Ali:erta (HQCA) today
released the report cited irr the subject lirre. The
report is attached below:
Mike
albertadoctors.org
www.a beft adoctors.o rq
I
http ://sn 1 06w. snt 1 06.mail. live. c orn/matIllnboxl.i ght. aspx?n:282 26619 0610312011
Windows Live Page I ot I
Emergency Issues
Dave/Fred/Neil,
I wish you and your families the Merriest Christmas and a Happy
New Year!
God Bless.
Raj
Due the Summer bed closures, we lost many of the gains that
were made. In a way this has been a success in that we have
made do with less by improving our efficiency.
Edmonton now faces a few challenges as our population has
grown by 36,000 over the past year. In addition we are serving
more people from Northern Alberta. Patients that present to
the ED's are sicker and their care is more complicated. We are
in DIRE need of more emergency beds to treat the untreated
and undifferentiated patients that present for care.
1. Misericordia Hospital:
Raj's story: I have been knocking on doors 4-5 days per week
and hear this regularly from the people at the door that the
waits are up to 6-8 hours again. After door knocking, I visit the
ED every second week and things have gone from bad to
worse.
UAH, a 25 year old man with end stage renal disease, on hemodialysis,
was transferred from a peripheral hospital because he was complaining
of chest pain. He waited in the WR from 1415 to L842. He was known
to have an elevated troponin (of unknown significance). Upon arrival
into the department, he was found to have a potassium of 7.0. A CT of
the chest confirmed a pericardial effusion.
The only reasonable way that patients like this can be seen is improve
the output problem in the ED (admitted patients have to move
upstairs). All the efforts that we have aimed at looking after the input
problem (ambulance diversion, TLP, greeters, paramedics in the WR),
will not help these types of patients get seen soon'
- TLP near misses in the WR
While on TLP, I admitted 2 patients to gen surg with
appendicitis, one mild CVA 3 weeks post-CABG to neurology, and a
bowel obstruction in advanced esophageal cancer, All were admitted
from the waiting room. All were briefly assessed in a triage stretcher
and then sat in chairs for much of the day. One (that I know of) went
from the WR to the OR. That same day a ?meningitis developed her
rash while waiting for a bed and fortunately her mother sought us out
to tell us of that 'minor chanqe' in her condition.
For the most part, we are happy with the deal that Capital
Health has kept on the number of EIP's in the department and
Administration and Reverdi Darda must be
congratulated....BUT.. .
B. EFF'ECTS
2. Emergency care
a. LWOT - Record numbers of patients are leaving without
treatment. The evidence is that when they come back they are
sicker and their death rate is higher.
b. Patient 2nd mos t at Risk (Patients who wait in waiting
room to be assessed and treated)
3. INFECTION RISK
As admitted patients are warehoused in the ED's (sometimes for
days) in close quarters, this is a breeding ground for cross
contamination for infections and resistant bugs (MRSA).
Eventually, these patients are moved to the hospital area where
they will contaminate the hospital.
4. Solutions
a. HOW???
By making it a priority....created a special position for
...emergency & unscheduled visits (Dr. Rob Abernathy)
While we wait for the long term solutions to kick in....we have
worked on decreasing the input into the system and not enough
on the output from the hospital and into the community (long
term care).
THANK YOU
. Hotmail Windows Live Page 1 of4
r)
Spence,
Cheers
RaJ
Colleagues,
Time Bombs
Raj Sherman 08/12/2007
Tc Neil \,Vi kin5orr, Neil Willi:nson, rijlhafl:ia Re p l),
Neil,
FYI. While the elective surgeries were cancelled, this was the
situation in the ED's. I just thought that I'd keep you in the loop.
Cheers
Raj
Dear Raj,
day on surgery. I was told that none of our 22 EIPs (over the limit
of 12 that you negotiated on our behalf )were appropfiate for
those beds... and that until those beds were full. we couldn't
cancel surgeries. Admittedly some of our EIPs were on isolation/
monitors or a two-person assist. Most otheB were deemed "too
heavy"
for the RNs upstairs because of frequent analgesia/medication
needs,
personal care issues etc... I am all for protecting our RNs so they
don't all quit, but it is obvious the FCP beds at the UAH are not
being utilized. It was felt by our bed coordinator and Exec McD. ,
rThank you.
Best wishes for your family this Christmas and a Happier New
Vear!
Raj
,r
> Thanks very much Raj I
: -, _ -,,.
lrttp://snl06w.snt106.mail.live.com.imaillInboxLight.aspx?n=28226619 06t0312011
' Hotmail - rajsherman@hotmail.com.- Windows Live Page 2 of 5
> - | ne puu L lredny pclLerve dnu e)(PeL! ule Et, tu tul|||r L e ture
> of "safety net". They expect the ED to perform in an efficient
and
> effective manner when they have a health crisis. A failure of the
> emergency system to perform as expected (especially with a
bad
> outcome) will be exceedingly damaging to the system and
those
> accountable for the health system. The current reality is the
> - The rural public expectations are that tertiary care EDs will
> assist with caring for critically & seriously lll rural patients.
> This is a crucial and appropriate role in our provincial health
> system. The reality is that the tertiary care emergency and acute
> care system cannot be guaranteed to provide this support and
> frequently actually is unable to provide that backup. The tertiary
> - The current initiatives to develop urban urgent care centers (as
['-
in his role
aritas who concu rs
wtrn
this and is planning to do same.
Staff Physician
GNH Site, Caritas Healih Group
Ca pital Health Region
From: l:f
To: lfTorne@gov.ab.ca
suDlefi: - tnanKs
Date: Fri, 11 Jan 2008 72:23:04 -0700
Fred,
It was good to meet you thls am. I hope that I was able to give you some useful advice.
I un:uld ask you to keep the Delegate report I by not sharing it with anyone (it is for your eyes only).
I have ues not to shed Ca rn a
Thanks again for taking time from your busy schedule and thanks for breakfast.
Raj
ERIssues-lAgree
Raj Sherman 29/12/2007
C;.Care. (cll,
J() Roply
Ken,
]t's good to lrear that you are able to spend some time with farniry
over the holidays. By the by, you,re not old enough to be a
g randpa I
A bird on the wall said that we may have an election call in early
February, so I may not be in a position to meet regarding these
rssues, howevar, Peter Kwan (president Lethbridge), Chris Evans,
Dan Barer and Paul parks (UofA-ER) will continue to work with you
on this issue.
I wouid personally like to thank you, Susan, Sheila, Neil and the
rest of Capital Health Senior Administrat;on for your help and
understanding. It has been a great experience to be a part of
someihing important. By cooperating, we have accomplished
some great thtngs togeiher.
Raj
Raj,
From: Ra Sherman
Imailto
Sent; 07 II:47
PFI
To; Gardener, Ken; Gardener,
Cc: Paul Park
Subject: ER Issues
Dear Ken,
Sincerely,
Raj Shennan
Past-President
Gentlemen,
l2.IMAGINT:
a. if a BUSLOAD of 50 school children was hit by
a semr-tfactor truck on the Henday/Deerfoot.
Thank you,
u\
!i,lffi'n"*"
ro:l*r
RaJ,
Dave,
Raj
Hey Raj,
I was working at the nuns yesterday. I ar surel-ave you the low down about our situation. I heard it
was stupid crazy everywhere. I had a discussion with an internist about the situation and he suggested
garnering public support for change in the ED.
He had suggested having all pts that are unhappy with the wait times, but NOT WITH THE CARE they are
receiving, sign a letter stating so that would be sent to CEO Caritas, Sheila Weatherall, and the edmonton
iournal.
Medicine cap (max of 25 admissions allowed per team) have now given the medicine services a way out so that
they do not have to take any more admissions. This obviously has a direct impact on us in the ED as we are now
responsible for these patients.,some for days. f4y collegue had 23 sign overs yesterday and was able to see only
10 patients. This will invariably lead to a negative outcome in the future if this continues, perhaps even death.
Maybe it will take someone dying for capital health and the province to step in and do something
I won't even go into the fact that we had 5 EMS crews waiting to offload patients for HOURS. Everyone was
getting upset..,EMS, patients, Triage, because nothing can be done.
Thank goodness I am going on a long vacation because working in Emergency in Edmonton SUCKS.
Regards,
> Here is the deal with the ED this evening. Significan y unsafe-at
> about 2230, there were 31 EiPs, 40 people in the waiting room, and at
> least 10 waiting for admission. There were 7 or B ambulances waiting
> and B triage category 2s, Experienced triage nurses stated they have
> Thanks for calling last njght and checking on the depadment!
Everyone,
It is my regret to inform all of you that we have had our first documented death in Capital
Health due to delays
in care. I cannot stress the impoftance of cooperation and understanding through
this very difficult time.
Raj
Less than 2 hours after my completing my email to you all yesterday, we have had
our first death in the ED temporally related to the ED overcrowding rssue.
The case will be reviewed formally in-camera by the GNH ED eA committee next
week, and patient identifiers sent in confidence by separate emair as rriel to or.J to,- hi,
review as ED Director.
The first interim analysis was done today by myself and the charge Nurse on duty yesterday.
Itis based on a review or the Elvls record, the ED chart, interview with both triage nurses on
duty when the patient arrived for the remainder of their shift, and the last EMS irew supervisino
patlent prior to her being placed in an ED room and the nursing staff taking over care formally.-
Initial blood work ordered at this time, as well as orders left for ECG to be
done when patient placed in stretcher and room. The ECG was ordered only
as a precaution in case an issue of potentiai cardiac ischemia develooed while beino
worked up for the suspected GI bleed. not because of any chest pain
Dre-arriva l.
s staf f
j
bv
l::i: ll,:T: i 11 1,1 ", 11Yrry:h ?1 :":yi ::i:l.i : ! :": i:t::"d E'v,
No obvious ongoing bleeding was noted by the EMS crews, and no mention of
either bleeding or chest pain was forwarded to me or the nursing staff.
During her time under EMS care in the hallway, one of the triage nurses was reassigned in the
department to other duties no less than three times due to staffing issues.
At 1750 just prior to my concluding my shift, I reviewed her blood work, and noted
a HB of 96 (l'1CV borderline elevated), but had no clear indication of how acute this anemia was
given her previous medical Hx.
When this patient was finally placed in a room at 2020 hours, the nurse attendinq her noteo ner
complain ing of
severe sharp left-sided chest pain.
The ECG ordered at 1057 was finally done at - 2040 hours, and the ED Doc on duW
attended the patient 2104.
The EcG was markedly different from the 1z lead recorded by the EMS crew pre-arrival,
and compatible with ACS/NSTE|VII ML
Soon after, while investigations and treatment continued, she developed crushing chest
pain, became hypotensive, unresponsive by 2305, and died before 2400 hours.
Itis very difficult in retrospect to say whether seeing the ECG earlier, and having an attending
staff Physician on duty review it, the patient, and the EMS EcG would have madl a difference.
- rl
is clear is that an elderly, vulnerable woman died quickly in the ED after a huge delay before
-*<What
'standard
/l ED manaqement could be undertaken.
What is clear is that she is representative of the people most at risk here (the elderly, infirmed,
ano otsaDte0 ) -
the very people
what is clear is that there is every reason to believe these events will continue to occur until
t!*yerceryqqg lssue is effectively addressed Uy serii6ieEpiiat Heatth Adminjstration.
The same day we had delivered to our site a 56 yr old man in cardiac arrest who had a delayed
EMS response time
of over 12 minutes, due to the fact that there were so many crews attending patients in the ED,
that a unit had to be dispatched
from North Edmonton,
As I stated at the onset of this letter, this case will be reviewed formally next week by the ED QA
As well tomorrow (when I return to the same situation again), the Canadian Medical Protective
Association will be returning
my call to them for advice re this, and future potentially preventable tragedies,
From: raj
To:
Subject: RE: l.4isericordia ER 't\
Date: Wed, 16 Jan 2008 11:16:25 -0700 {'
I
Thank you for your e-mail and for taking the time to chat during a busy time on your shift. I have passed your
e-mail to the section leadership (!t,O
We met with Cgpjle! Hgi]!!._ggliSlexgg late yesterday and are hopeful that we can get some much needed relief
to the emergency departments in Edmonton. The Minister's office has also been briefed of the circumstances.
Rai
Hello Raj,
Fufther to our conversation earlier this evening, accept this as a more formal update to the
situation in our emergency department:
- We have not been in a position to safely see patients requiring urgent care for several months
now. On average, 70-100% of our emergency beds are occupied with admitted inpatients, and as
I write this, we have 24 admitted inpatients in out 27 bed department.
- Admitted inpatients routinely wait 3-5 days for an inpatient bed, and we often have patients wait
for over a week to go upstairs.
f' - Wabave had a multitude of issues with inadequate and dangerous care provided in the Fn,
including septic patients treated in the waiting room, a pregnant patient (who was unaware of her
gestational age) who laboured with severe abdominal pain for tvvo hours in the waiting room
before delivering a term infant 5 minutes after being put in a room, and so on. CTAS triage criteria
time limits are virtually never met. The triage nurse routinely has to choose between a large
number of seriously ill patients to decide who goes into limited treatment space. I could provide a
number of examples of poor and/or dangerous care each shift as a result of the extreme
overcrowding the department now faces.
Ihold out little hope of meaningful change from Caritas, Capital Health, or the current
government, but good luck in your effofts. Our site chief has been writing letters to this effect for
months, and the situation continues to deteriorate in an accelerated manner.
From: raj
To:
CC:
Subject: Misericordia Er overcrowding
Date: Wed, 16 Jan 2008 22:33:'13 -0700
I,
Your word is all I need,
Y".terday,lnd I have met with senior exec at capital Heatth and have expressed thg urqent need
to address this issue. We will just have to see what they are going to implement in the next few-dffi:-
r:-r-c-
We continue to encourage all of our emergency colleagues to carry on the best that we can desplte the
resources that we have been given. We have also made the point with exec that the system is being held _
toqether by a first class group of peoble who are goinq above and beyond their ceTfo*idu$-Fd5FlE=[iF;1
yoursetves.
I have attached this response to our section etrEc'to Keep the in the loop. Peter Kwan is section president. Paul
Rai
Raj, do you have a fax no.? I would like to fax you a copy of the EDIS screen from yesterday
showing that we had 25 admitted patients in our 26 bed department (a 100o/o utilization!!).
rccc(rco{{x
Dear Fred,
: you
Message body Page 1 of2
From: raj
To:
Subject: RE: Overcrowding
Date: Thu, 21 Feb 2008 23:46:29 -0700
-,
Thanks for the e-mail. I will forward the contents of your e-mail without your name.
Cheers
Raj
> Raj, please feel free to forward this email and information to Dave Hancock
,L-
> and Premier Stelmach so they are aware of the crisis we face everyday in the -#--
> emergency depaftment.
Dear Sheila,
l wish to tell you about anotlter near miss (near Death) last week
that took place at the u offiTR.
Sincerely yours,
This message and any attachments are for the use of the intended
recipient(s) and are confidential. If you afe not the intended
recipient,
you are hereby notified that any review, retransmission,
converslo n to hard
copy, copying, circulation or any other use of this message and
an'y
attachments is strictly proh'biied. If you are not the intended
reciPient.
CVA
6.73 yo Female with possible GI bleed in WR for 8 hours and still
waiting when
I left at 2400!M!!
From a physician and personal point of view I feel helpless in the
ILP rote
and Emergency Physician as I get the sense of all of my colleageus
getting
extremely frustrated. I also get the feeling the nurses are very
frustrated as
well. Many are looking for jobs outside the region. One nurse is
leaving for
Victoria. Our goal of recruiting nurses but how do we retain the
excellent ED
nurses.
My other concern is the plan to burld an urgent care center.
Where are the
staff going to come from? It will clearly take nursing and other
health care
professionals from local hospitals. lt will no way improve patient
care in the
Capital health Region. If the PC plan is to build urgent care
centers. I am
completley against this policy and will vote for another party. As
Dave
http://snl06w.sntl06.mail.live.com/mail/lnboxlight.aspx?n:1798802884 06103/2011
Hotmail of
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