Manitoba to fast-track less critical emergency patients

Manitoba has implemented a fast-lane system to keep less critical patients moving through the emergency department more rapidly, making way for more urgent cases.

Figure. Fast-lane system gets the largest group of patients moving. Photo by: Corbis/Magma

The new fast-lane system, which is being piloted at the Health Sciences Centre, Manitoba's largest teaching hospital, will speed up service for the largest group of patients, those assessed as Level III and IV. These patients typically have relatively minor ailments such as lacerations, infections, minor headaches, muscle strains, vomiting and diarrhea.

At HSC and St. Boniface hospitals nurse practitioners will treat most of the fast-tracked patients.

The system was developed by a task force of nurses, physicians and hospital administrators after a year-long review of patient charts and an investigation of cases where patients died while waiting.

Manitoba is also spending about $1.5 million on a new computer system to track patients and plot treatment to ensure they are discharged at the earliest possible opportunity.

However, the Canadian Association of Emergency Physicians (CAEP) says fast-tracking may not address the central cause of emergency department overcrowding.

“Emergency department overcrowding is due to too many inpatients occupying stretchers, it's not due to low-level cases in the waiting rooms,” said CAEP president Dr. Andrew Affleck. “[Inpatients] are the [ones] who are waiting and they are the patients whose care is compromised.”

Jan Currie, vice-president of the Winnipeg Regional Health Authority, said the task force found it wasn't the number of emergency beds per se that creates a backlog in Level II cases. “The length of stay upstairs is the real issue,” said Currie. “If we can lower the length of stay, then we will be more efficient.”

Affleck applauded these measures but warned that they will not speed service to more serious Level II cases, the ones that are typically at most risk of becoming medical incidents. These cases require patients to be admitted to hospital but remain in the emergency department for observation and treatment. Most of Canada's emergency departments simply do not have the capacity to handle the current volume of those requiring inpatient treatment, Affleck added. — Dan Lett, Winnipeg