STATE OF EMERGENCY: Crowded ERs linked to patient deaths, doctor errors

ER doctors point to evidence suggesting hospital congestion increases the rate of physician errors and patient deaths

This is part of a multi-story Special Report on Abbotsford Regional Hospital and its emergency department. For more stories, scroll to the bottom of the story or click here.

Congested emergency rooms lead to increased death rates among patients, according to two ER doctors who have studied overcrowding.

In separate interviews this week, Dr. Eddy Lang, the clinical department head of emergency medicine in Calgary, and Dr. Alan Drummond, the co-chair of public affairs with the Canadian Association of Emergency Physicians, told The News that over-capacity emergency rooms increase the risk of error, complications and mortality rates among patients.

Abbotsford Regional Hospital’s emergency department has come under scrutiny in recent weeks following the deaths of two patients. Three-year-old Nimrat Gill died in hospital Feb. 7 after being sent home the previous day, and 56-year-old Mary Louise Murphy died in her sleep the night of Feb. 1, two days after attending, and being sent home, from the ARH ER.

The News has heard of other cases since, including that of a 68-year-old woman who was taken to hospital in an ambulance in early January suffering from severe bouts of nausea.

After receiving intravenous fluids, she was sent home.

“She could barely walk, she was a mess,” the woman’s friend and next-door neighbour, Bonnilynn Martin, told The News.

Three days later, she went back to the hospital, diagnosed with pneumonia, and was again sent home, this time with antibiotics.

The woman died the next day. Martin said an autopsy found her friend had been suffering full renal failure and that, combined with the pneumonia, had induced a fatal heart attack.

• • • • •

Drummond and Lang both said they couldn’t comment on individual cases and how congestion may or may not have affected the care certain patients received. Gill’s case is the subject of a formal inquiry, while Fraser Health has said it will look at Murphy’s medical charts to see what can be learned. No complaint has yet been filed regarding the death of Martin’s neighbour.

But speaking generally, both doctors referred to research linking crowded emergency rooms to increased death rates among discharged patients.

“Patients who go home under circumstances when emergency is very crowded … are more likely to die,” said Lang, who is also a professor at the University of Calgary and senior researcher with Alberta Health Services.

A study conducted at an Australia hospital found that at a single site there, 13 deaths could be linked to congestion. The exact cause of additional deaths wasn’t established.

In addition to hygiene worries and risks that come with more sick people in a confined area, Drummond said congested emergency rooms also lead to more physician errors.

“It’s a tough job on a good day,” Drummond said. “It’s even tougher when you’re trying to see patients in suboptimal conditions or a rushed manner. We try and fight against that and recognize that the patient in front of us is the most important patient in the room, but it’s human nature.”

There is substantial evidence to suggest Abbotsford’s emergency room is persistently clogged. On Wednesday, the department had 41 admitted patients waiting for placement elsewhere in the hospital, according to the BC Nurses’ Union.

Fraser Health officials note that Abbotsford’s ER has wait times below the provincial average. But multiple other indicators suggest ER overcrowding persists, with those requiring further treatment remaining in the emergency department for much longer than in other jurisdictions.

Congestion is an issue across Canada, but Abbotsford still stands out. Admitted patients spend double the time in the ARH ER than the national average, according to figures from the Canadian Institute for Health Information. The Fraser Health figure is 60 per cent above the Canadian standard.

ARH also regularly fails to speedily admit patients needing more treatment. As of last summer, just 30.7 per cent of ER patients were admitted within 10 hours. That number – which has remained below 40 per cent since first publicly released in 2014 – is among the lowest in Fraser Health and well below the 55 per cent target. The target has been lowered in recent years from the previous 70 per cent.

In material to promote its health care investments, the provincial government has said that congestion is “an overall indicator of patient safety.”

“We know it’s dangerous,” Drummond said. “Most of the politicians won’t say that. They’ll try to suggest it’s inconvenient, but it’s not inconvenient; it’s dangerous.”

Fraser Health says it’s “continuously looking at ways to manage congestion.” Those measures include a steering committee that meets every two weeks, and enhancements to “flow and transition resources” to increase weekend supports. A primary care clinic has also been added to allow for earlier discharge. On Wednesday, Fraser Health said ARH had two fewer admitted patients than it did a year prior.

• • • • •

After having some of the highest mortality rates in Fraser Health in recent years, Abbotsford Regional Hospital has shown improvement, according to Fraser Health CEO Michael Marchbank.

ARH’s hospital standardized mortality ratio (HSMR) was 103 in 2015/16. That was the second highest in Fraser Health, where the average was 92 and the target 90.

The figure isn’t linked solely to issues in the emergency room, but rather compares the number of deaths across a hospital to the number predicted by the type of patients it sees.

The figure dropped to 88 during the most recent reporting period ending last December.

Marchbank credited a focus on quality of care and limiting the spread of sepsis, MRSA and other communicable diseases.

tolsen@abbynews.com