Bed shortage at LGH impacts emergency ward Martin Millerchip News Reporter anmillerchi: REWS.COME “YOU'RE getting the royal treatment today,” observes Peggy Craven a: she pulls into the sparsely populated Lions Gate Hospital parkade. She normally parks three blocks away and saves $3.75 since the hospital doesn't pro- vide free parking for staff. But this chilly dark Saturday zarly morning she has a passenger. Having got up at 6:15 a.m. after a late Friday night I am not feeling the least bit royal and am quite happy to subside into a chair in the empry emer- gency ward waiting room area while Craven hastens off to “pick up the tools of my trade.” The chairs may be empty bur the beds aren’t. Craven and night nurse Sherry Stackhouse, huddle by a whiteboard covered in a felt pen grid, It represents the status of each bed in emer- gency and, if it’s occupied, the status of each patient. There’s a lot of writing on the board. . Bottom line: the emergency ward will begi Saturday, Jan. &, with three empty beds. “Wish you could have been here last evening,” says Stackhouse cheerfully when she learns I am there to observe a nursing shift in emergency. She looks amazingly fresh for someone who has just pulled an alf-nighter and who has seven paticnes waiting for beds in the hospital and four more “poten- tials” under observation. Craven acknowledges that this might be considered “a bit more than an average load.” It looks like the plaque over by the chairs in the waiting room may be relevant: “We treat all patients as quickly as possible. Those most seriously ill or injured are always treated first. Delays can be expected.” Craven is working “triage” today. A word from the French that, thanks to shows like 44.4.5.H, and E.R, evokes images of medical professionals working fever- ishly in some sort of war or disaster scenario. The reality is distinctly calmer. Next to the double doors that divide the waiting area from the emergency ward itself there’s a tiny desk where new patients present themselves and ambulance drivers deliver patient paperwork. There’s a chair behind it, but J never see Craven sit in it once over the next eight hours. As the keeper of the gate, her job will be to deter- mine who goes first through those double doors to see a doctor and in what order those needing first aid (as opposed to medical diagnosis) will wait in the chairs. . - It’s a responsible position that requires a biend of knowledge and experience. Each patient entering the emergency room must be appropriately assessed to idennff the priority for treatment and the appropiiate treatment area. Craven must balance what's needed with what's available, both in terms of equipment and the skill sets owned by those on duty. At 9 a.m. she will have a Clinical Resource Nurse to back her up, running the emergency floor and coordi- nating ward admissions. Until then Craven is on her own. . I get a hasty tour of the facilities: the “resus” (for resuscitation) or trauma room holding two beds where those needing immediate assessment and procedures are taken; the observation area, the curtained beds grouped from least acute to most acute; and “the famous hallway” where patients occasionally wait for hospital admission or even treatment. At 8:10 am. the first of the day’s walk-ins appears looking for an ultra-sound. There is some confusion as to who ordered the procedure and whether an appointment has been made. ‘Ten minutes later a woman who can barely walk, an ugly pallor to her face, leans on Craven's counter to tell of a night without sicep. She’s had a bone fusion oper- ation in her back and the night-time pain has spread down her leg. Craven phones hospital records to get a copy of the patient chart and then comes back to tell the woman what she has done and that she is not sure when a doc- tor will be able to see her. ({t will only be a 30-minute ruatl “The big hurdle we face is the people who use emergency as a drop-in medical facility. If it’s non life-threatening, non-emer- gent, call your doctor or go to a medical clinic. There you will see a doctor in 30 minutes, here you can wait four hours.” —— Clay Adams, North Shere Heztth Region wait for her.) The woman worries more about how she will be examined since it is more painful to sit or lie down. “Info travels really fast now. We can get patient info from another hospital in five minute if we have to,” says Craven As she is explaining how imporzant it is to keep the waiting reassured that they have not been forgotten, a woman having an asthma attack walks in. -Trzven takes her straight in to a curtain area and 2 doctor is told immediately. She or a clerk will get patient details later. The first of the day’s thi victims arrives. Craven takes his temperature and establishes how long the fever has run and the degree of vomiting. In the next three minutes a woman with a still- swelling eye and a patient in pain that a medical clinic has said might be gallstones walk in. The possible gall- stones goes straight to a curtain area while his wife pro- vides details to a clerk. At 9 am. Craven is called to the phone to discuss staffing levels tor the balance of the day and the next night shitt and who might be best-qualified to be the charge nurse for the night shift. Qualified RNs (registered nurses) require specialist training to work critical care on emergency and inten- sive care wards, Nurses wanting to specialize usually pay for upgrading their own skills but, according to Craven, Lions Gate has been “struggling” with seven or eight such vacancies and is putting new nurses through an accelerated three-month training program at its own expense. At 9:14 a.m. the B.C. Ambulance Service calls to advise they are attending a Code Three in West Vancouver for.s full cardiac arrest. The trauma room is readied. Meanwhile ovo more patients arrive almost togeth- er: one who was here yesterday with an allergic reaction that's getting worse and a heart patient with a defibril- lator experiencing chest pain. The chest pain gets the only remaining curtain area. The cardiac arrest arrives and while doctors and Sunday, January 30, 2000 - North Shore News - 3 SUNDAY Focus See NEWS photo Paul NceGrath TRIAGE nurse Peggy Craven (right) and Clinical Resource Nurse Eve Dedinsky check avaliable examination space in Lions Gate Hospital's emergency ward during a recent busy Saturday shift. nurses work to stabilize her 1 chat to the first of many ambulance crews I will meet in the next few hours. The care workers and ambulance staff I speak to during the day are extremely conscious of the political atmosphere that surrounds health funding and union/management positions. Most are willing to provide background but are anxious not to “say some- thing they shouldn’t” on the record. Paramedic Darrell Mussatto (yes, the North Vancouver City councillor) is pleased to hear there were three free beds to start the day and hopes it will stay that way. “We’ve had ambulances tied up here for eight hours.” He and others tell me about off-duty paramedics being called in to hospitals to babysit stretchers in the hall so that crews can be freed up to go back on the street. They call the stretcher-sitters “i-Hops” (for in- hospital on-duty paramedics), a term that Bob Pearce, communications manager for the B.C. Ambulance Service says he has not heard. Pearce calls them on-duty patient monitors and acknowledges the scheme was implemented in December to cope with the backlogs of patient admis- sions at the big five regional hospitals: Surrey, Richmond, Burnaby, St. Paul’s and Vancouver General. “We're not taking a crew off the street to do this. We are scheduling our irregularly-shifted personnel so we are not taking extra resources away. We believe it is effective in releasing our crews to go back to the street. It’s not meant to augment nursing crews in any way. They are there solely to monitor patients.” Pearce says Lions Gate “has not been identified as having a serious problems” and was not aware that patient monitors were used at the hospital in December. In the next 30 minutes will arrive: a patient who will wait.a Jong time for a catheter removal and the visit of a specialist; an “appointment” with a doctor who will need scarce examination room; a young woman with a broken foot who was here last night and is back to be admitted for surgery; a small girl with an eraser up her nose; another ambulance crew with a confused old lady; a baby hit by a falling object. Also, the woman with the allergic reaction who arrived 40 minutes ago starts to experience breathing Sec A Matter page 18 Coming in Sunday Focus NEXT week, Sunday Focus and reporter Deana Lancaster will look at the culture clash experienced by Iranian girls who just want to be Canadian. _ To suggest a feature story that deserves to be “in Focus” contact Martin Millerchip by fax at 985-2104 or e-mail . Readers who e-mailed suggestions two weeks ago are asked to re- send the information because a recent server mal- function resulted in the loss of some e-mail messages. HEALTHWISE Handbook Canadian Editivn A Self-Care Slanual For You 4% ver 190 beotd Care Probicon. Prevention. Home Care. ‘When to tat 2 Den tur. Self-care education HOW do you know whether to go to emer- gency or not? The Ministry of Health is currently assessing the results ofa two-year project aimed at testing the effectiveness of self-care education and reduc- ing costs to health services. In) November = 1997, approximately 12,000 ran- domly selected households in the Greater Victoria area received: @ The Healtinvise Handbook, a self-care resource book writ- ten and widely used in the USS. and revised for Canada; B access to a “Health Support Line,” a free and confidential telephone line staffed by registered nurses operated Monday through Friday, 3-10:45 p.m.; and @ 2 quarterly newsletter pro- moting the ongoin,, use of self-care resources and pro- viding tips on seasonal and common health problems. The organizers of the Parmerships for Better Health program are quick to emphasize that self-care is not a substitute for, but an impor- tant complement to, profes- sional care. However, over time, it is hoped that informed decision-making will lead to using professional; medical care more effectively | and efficiendly. Participant questionnaires, telephone interviews, partici- pant self-care diaries, health support line data and Medical Services Plan use data are all: being evaluated to determine. if results of che pilot project can be generalized to apply to other regions. Ministry of Health spokesman Jeff Gaulin says he is confident the program achieved its first three objec- tives of: @ expanding health-care’ knowledge; ® enhancing confidence and ability to make appropriate health-care decisions; and — @ enabling more active dis- cussion on health-care options with care-givers, * But Gaulin says while it appears the Capital Health Region experienced some cost-reduction —_ associated with the program it is hard to provide definitive figures. The program may contin- ue in the Capital Health Region or expand to include either Vancouver Island, the South Coast or the province as a whole. Costs and benefits for all of the options are being examined in the ministry with a funding decision expected within the next month. — Martin Millerchip