Alberta finalizes triage physician program as ER overcrowding worsens

Alberta says triage liaison physicians will begin working in the province’s busiest emergency departments in the coming weeks, as emergency physician Paul Parks warns overcrowding is delaying care. The announcement comes ahead of an Oct. 19 fatal inquiry into the death of Prashant Sreekumar, who died while waiting for care at Edmonton’s Grey Nuns Hospital.

Edmonton Journal has reported:

Alberta has finalized a program to place triage liaison physicians in its busiest emergency departments, with the roles expected to become operational in the coming weeks. Emergency physician Dr. Paul Parks described conditions in emergency rooms across the province as “unbearable, horrendous and the worst it’s ever been,” warning that overcrowding is making timely care difficult and putting patients at risk.

Parks is president of the section of emergency medicine at the Alberta Medical Association (AMA). He said some patients admitted to hospital have remained in emergency departments for more than 100 hours because there is no room elsewhere. “It’s inhumane to think about leaving a sick person in the emergency department for over seven days,” he said. “The lights don’t go out. It doesn’t ever get quiet. They don’t get the same kind of care that they would get on the ward.”

The province’s announcement follows a nine-month delay after the government promised to introduce triage liaison physicians, or TLPs, across the busiest emergency departments. The program was initially scheduled to begin Feb. 1, but talks between the government and the AMA stalled and pushed the deadline back.

Acute Care Alberta (ACA) said in a statement to Postmedia on Thursday that the program’s details had been finalized and it would be operational in the coming weeks. The agency did not provide a specific start date. Hospital and Surgical Services Minister Adriana LaGrange announced in a Friday news release that the role was ready to be implemented.

TLPs will work directly in the province’s busiest emergency departments to help speed up the process for patients waiting for care. ACA said emergency medicine physicians will be invited to join the program and begin filling TLP shifts in emergency departments across Alberta.

“When you build a brand new program from the ground up, it’s important to take the time to get it right,” LaGrange said. “By working directly with physicians throughout the process, we’ve developed a practical, sustainable program that supports front-line doctors while putting patients first.”

Parks said the program’s effectiveness will depend on having enough nurses and allied health-care workers to support the physician working at the front of the emergency department. Without that staffing, he said, TLPs will not be able to do their jobs properly.

At Calgary’s largest trauma centre, emergency departments are regularly short eight or nine nurses on the night shift, Parks said. Some areas of the emergency department are also closed at times because there are not enough staff to operate them.

“In that environment if you were to have a triage liaison waiting room doctor, when you don’t have the right number of nurses in the back in the emergency (room) - you’re just putting a band-aid in an area that isn’t going to be the most impactful or the best area to put our resources,” Parks said.

Former Hospital and Surgical Services Minister Matt Jones announced the TLP role in January after 44-year-old Prashant Sreekumar died while waiting for care in the emergency room at Grey Nuns Hospital. A fatal inquiry into Sreekumar’s death is scheduled to begin Oct. 19.

Maddison McKee, press secretary to LaGrange, said in a statement to Postmedia that the province welcomes the inquiry and is committed to learning from its findings. She said ACA is working to implement 16 recommendations from a Quality Assurance Review announced in March.

“Four separate reviews and investigations have been undertaken to understand what happened and identify where improvements are needed,” McKee said. “Two internal reviews by Covenant Health and Acute Care Alberta have already been completed, while the Office of the Chief Medical Examiner and the public fatality inquiry provide independent assessments.”

Parks said emergency departments routinely see cases like Sreekumar’s, in which patients die before they can access care. He hopes the fatal inquiry will lead to accountability for delivering and acting on its recommendations. “They need to publicly declare it the crisis it is and appoint a leader that’s going to help us provincially manage this disaster mode that we’re in everyday,” he said.

As flu cases begin to emerge in Alberta, Parks warned that emergency department conditions will worsen. The TLP program is now finalized, but ACA has not set a specific operational date. Its rollout is expected to begin in the coming weeks, while the inquiry into Sreekumar’s death is due to start Oct. 19.