St. Boniface could divert some incoming patients to other hospitals in light of long wait times: memo

Winnipeg's St. Boniface Hospital says it could soon be redirecting some of the sickest patients coming to its emergency room by ambulance to other hospitals for the time being, in response to its exceptionally long wait times.

That move could free up space for cardiac patients at the hospital, a paramedic told CBC News.

Hospital staff have recently spoken out about an overflowing ER and dire shortage of capacity at St. Boniface. In one incident Tuesday, a man went into cardiac arrest after waiting four hours for care. 

A memo from Martine Bouchard, the hospital's CEO, sent to staff Friday says St. Boniface has agreed to implement "a modified EMS red redirect status" as a result of this incident and other concerns.

The "modified" status means decisions would likely be made on case-by-case basis, says paramedic Rebecca Clifton, but would likely mean the hospital would enter a state in which the sickest patients could be redirected to ensure there is space for cardiac patients.

If a patient is arriving by ambulance for emergency care that is a St. Boniface specialty, like cardiac care, the hospital may accept them, she said.

"But [if] it's not a St. Boniface specialty — maybe it's more of a trauma … that might be redirected to another hospital which would be better suited for that patient," said Clifton, who is the administrative director for the Paramedic Association of Manitoba. 

Bouchard did not say in her memo when the redirect status will come into effect, but said it will happen "in the very near future" and "EMS will communicate this out shortly."

'Very challenging circumstances': CEO

In a statement sent to CBC News Saturday, a spokesperson for the Winnipeg Regional Health Authority, which oversees St. Boniface, said some sites are responsible for specialized services — cardiac services at St. Boniface and trauma and stroke at Health Sciences Centre, for example.

"Modified [redirect] protocols are designed to preserve capacity for these specialized services. A modified redirect protocol currently exists for services that are only available at HSC, for example," the spokesperson said. 

"A similar protocol is being developed for those patients most appropriately cared for at St. Boniface, but that protocol is not yet in place."

Redirects and diversions are common in both Winnipeg and in rural Manitoba, Clifton said, but they're often for a short duration — possibly just for an hour or two — to ease capacity.

"But it does sound like, based on the memo provided by St. Boniface hospital, that this will be more of an ongoing and reoccurring thing," she said.

That could make things more difficult for paramedics.

"It is hard to be in that situation where … you're already dealing with a very sick patient and now you have to decide the best-suited place to take them," she said.

In the memo, Bouchard also said she has met with hospital staff to talk about their concerns and the hospital's administration is investigating the cardiac arrest incident.

She acknowledged hospital staff are doing their best "to provide the care our patients require under what can only be described as very challenging circumstances."

Poor track record for overcrowding: doctor

Emergency room staff at St. Boniface previously told CBC News that in recent weeks, patients have been waiting up to 16 hours before getting assessed by a doctor.

The man who went into cardiac arrest on Tuesday went there by ambulance. Staff had to resuscitate him in the middle of the hallway in front of other patients, employees who spoke to CBC said.

The St. Boniface redirect status should not dissuade anyone from calling 911 if they are experiencing a medical emergency, Clifton emphasized, as paramedics will be there to help them. 

"Those paramedics are going to provide great care, stabilize the patients and then be able to take them to the best facility for them to be seen in an appropriate manner."

But Dr. Alan Drummond, a Perth, Ont., doctor and co-chair of the Canadian Association of Emergency Physicians' public affairs committee, says diversions can be unsafe for patients, especially those with complex issues who need to be assessed immediately. 

"That simply can't be done, it can't be achieved in the back of an ambulance waiting on an offload ramp outside the Health Sciences Centre."

The longtime family physician has been studying Canada's health-care system for decades, and says Manitoba has one of the worst track records for emergency department overcrowding in the country. 

Though emergency rooms across the country are contending with overcrowding, caused by years of underfunding of health care, he says Manitoba is particularly bad. 

"Manitoba occupies a fairly unique place in the history of crowding insofar as they have consistently ignored the advice of their professionals, their professional staff, they have largely followed ideology versus the science."

Still dealing with COVID pressures: Manitoba Health

It's frustrating to see these extreme cases come up time and time again in Manitoba, yet see little done about it, Drummond said. 

"They seem to be a magnet for really bad media stories that seem to crop up every five or six years in Manitoba, highlighting their inability to wrestle with the problem," he said.

A spokesperson for Manitoba Health said Winnipeg hospitals are still feeling the pressure of COVID-19 while dealing with a return to normal patient loads, compared to the historical lows experienced during the first wave of the pandemic. 

Because many COVID-19-recovered patients are experiencing long stays in hospital, it is challenging to find space for non-COVID patients in need of immediate care, the spokesperson said in an email. 

Though it's expected the province's declining COVID-19 caseload will relieve some of this pressure, "significant increases in capacity are slow as hospitals continue to deal with ICUs and medicine units that filled up during the third wave," the spokesperson said. 

Winnipeg acute care hospitals are also currently participating in an initiative to immediate and medium term strategies to ensure ongoing safe patient care, they said.