Local and national headlines this week have drawn attention to a problem Manitoba’s physicians know all too well: overwhelmed emergency rooms are not only harmful for patients and the providers who serve them, but are a major signal other parts of our health system are under deep stress. 

What’s new: Shared Health declared an over-capacity surge to ensure resuscitation capacity was available at Winnipeg’s Health Sciences Centre this weekend, while at St. Boniface, a record 75 people were waiting for care in one evening several days prior. 

CBC News reports today on the breaking point emergency rooms across Canada are reaching. 

What’s happening: We’re hearing from members that typical seasonal surge from respiratory virus season is being compounded by long-standing systemic stress, such as full inpatient units with no room for admission, along with too few inpatient beds, PCH beds and home care supports, resulting in access block in ERs. 

• “What has changed is not arrival, but movement,” emergency medicine specialist Dr. Alecs Chochinov highlighted alongside fellow authors in a powerful Canadian Journal of Emergency Medicine commentary reported on by the National Post. ​“When patients stop moving, they accumulate,” adding this is a ​“chronic, predictable disaster.” 

Predictable, but not new: Unfortunately, this has been a recurring issue every year for decades, and one that is predictable. Appropriate planning and staffing could help to avoid or mitigate it each year: 

• Over 25 years ago, a seminal study demonstrated that ​“an acute hospital can expect regular bed shortages and periodic bed crises if average bed occupancy rises to 90% or more.” 
• In Winnipeg, the average annual occupancy rate for hospitals is 93%. Some hospitals are actually over 100% on average. This leads to care backing up in ERs and Urgent Care Centres as patients are stuck waiting for admission. 
• The government has opened more hospital beds, which is helping, but it is not enough to keep up with Manitoba’s growing and aging population. 

What we’ve heard: We are continuously engaged with members both within the ER and those providing inpatient coverage who have raised increased spatial capacity and the staffing to match, as a chief concern. 

• As we have pressed with leaders, this is not just an ER problem, but a wider systemic one that involves input from hospitalists, acute medicine and critical care specialists and others throughout the health system to best manage the flow of patients. 

• Physicians have continued to raise concerns that broader PCH and homecare supports are needed for those who are not sick enough to stay in hospital, yet lack the ability to care for themselves independently. 

What we’re doing: We continue to share feedback of rural, northern, and Winnipeg physicians with RHAs, Shared Health, and provincial health leaders, pressing for more support and resources. 

• In our 2023 report, Prescription to Improve Health Care, we called for average annual occupancy targets to ensure appropriate capacity to accommodate routine annual surges, while expanding to handle more extraordinary pressures as well. 
• While the health system explores adding PAs, CAs, or NPs, we’ve been pushing to add more capacity to inpatient units in ways that don’t stretch and overwhelm existing physicians and staff. 
• We are continuing to engage with physicians to seek their feedback, including removing avoidable bottlenecks to care within and outside the ER that can lead to unnecessary delays. 

Let us know what you think: Physicians are invited to share feedback including concerns and ideas with their medical leadership. We encourage you to copy Doctors Manitoba at practiceadvice@​doctorsmanitoba.​ca on any feedback you send to your hospital, RHA or Shared Health. If you aren’t comfortable sharing your concerns internally, you can share them with us in confidence.