Winnipeg Free Press

Winnipeg Free Press (Newspaper) - February 14, 2014, Winnipeg, Manitoba C M Y K PAGE A4 A 4 WINNIPEG FREE PRESS, FRIDAY, FEBRUARY 14, 2014 TOP NEWS winnipegfreepress. com WATERFIGHT VIDEO AT - 40 The whole story... AND MORE Use Blippar. There's more to the story above embedded in this page. A N internal review into the deaths of two men sent home by cab from Grace Hospital has found no deficiencies in how each were treated and assessed before being discharged. " The medical assessments were deemed appropriate," said Arlene Wilgosh, president and CEO of the Winnipeg Regional Health Authority. " These gentlemen were deemed competent and the discharges were deemed appropriate." She said both had underlying medical conditions that caused their sudden deaths. " If you have an underlying condition that could predispose you to sudden death, you can't predict when that is going to happen," Wilgosh said. " Sudden death by its definition is sudden death." A more rigorous emergency department discharge process, at times involving cab drivers, will be developed by health- care officials in the wake of the deaths of the two men discharged from the Grace. The regional emergency department checklist will augment the WRHA's safe patient discharge guidelines. For patients being sent home by taxi, drivers will be given specific instructions if the patients need help getting inside their residence. The measures were outlined Thursday by Wilgosh and Lori Lamont, vice- president of inter- professional practice and chief nursing officer. The changes are in response to the deaths of two men who were discharged from the Grace but died after leaving their taxis. Wayne Miller, 62, was discharged from the Grace at about 8: 25 a. m. Dec. 29 and driven home by taxi. At about 9 a. m., residents in the 100 block of Arlington Street discovered the man lying unresponsive on the sidewalk. He suffered an aneurysm and died. On Dec. 31, David Silver, 78, died after being dropped off at home by a cab at about 1: 30 a. m. while wearing a coat over his pyjamas and bedroom slippers. He had just been discharged from the Grace Hospital emergency room, where he was diagnosed with kidney stones and gallstones and told to see his family doctor. He had a heart attack moments after the cab pulled away. His housekeeper found him later that day lying a short distance from his front door. Wilgosh said Silver, when he left the Grace, was " very much in control" but Miller did require assistance. Wilgosh said the two incidents show the WRHA has to enhance its ER patient discharge process. She said the health authority will pilot a regional emergency department checklist with the purpose of making sure its safe patient discharge guidelines are followed. Those guidelines were brought in following the Jan. 28, 2012, death of Heather Brenan, who was sent home in a taxi from Seven Oaks General Hospital and collapsed at her front door. Brenan's death will be the subject of an upcoming provincial inquest. " The checklist is meant to be a one- page ( form) that says, ' Have you talked to the patient about do they have their keys? Is there somebody at home? Do they wish that person to be contacted?' Wilgosh said. It will also allow the WRHA to monitor whether the discharge guidelines are being followed. " It will become part of the patient record," Wilgosh said. Silver's nephew, Miles Pollock, said he appreciates the WRHA is taking action as quickly as it is. " I love the fact they've done positive things," he said. " Maybe it's my uncle's legacy. I hope so." However, Pollock said the WRHA must give more serious thought to releasing patients in subzero temperatures at night and perhaps allow them to stay in the ER until the morning, when alternate arrangements can be made. " I think you have to think about those environmental factors and they don't seem to cover that," Pollock said. Wilgosh said the health authority, in consultation with the taxicab industry, will also enlist the help of cab drivers to make sure a discharged patients gets home safely. For example, it will see drivers being given instructions the patient needs help to the front door and inside their residence. " The taxi driver will come into the emergency ( department) and there will be that communication, and we will also ensure that the discussion between the cab driver and the health- care provider, that that information is also shared with the patient so that all three parties are actually clear what the plan is for the safe trip home," Lamont said. Wilgosh added for some patients in which warm clothing is an issue, a stretcher service will take them home. In the last fiscal year, the WRHA spent more that $ 84,000 in taxi- transportation costs in sending patients home. bruce. owen@ freepress. mb. ca MANITOBANS have some of the longest waits for service in hospital emergency departments in Canada, a new national study says. The Canadian Institute for Health Information survey measured lengths of stay for persons visiting emergency departments between April 2012 and March 2013 in seven provinces and the Yukon. Whether their health condition was deemed urgent or not, Manitobans had the longest stays in emergency departments among the provinces surveyed. They also faced the longest waits in emergency before being admitted to hospital, when that was required. In urgent or emergency cases, the median time spent in a Manitoba emergency department was 4.7 hours, compared with a national average of 3.1 hours. The next longest stay was in Saskatchewan at 3.8 hours. Those who wound up being admitted to hospital waited a median of 12 hours in Manitoba, compared with a national average of 8.8 hours. The report only backs up what the Winnipeg Regional Health Authority knows, WRHA president and CEO Arlene Wilgosh said. She said what's driving the numbers up are the number of people who wait in an ER for more than 24 hours for a bed to open up or for special diagnostic tests. Last year, Wilgosh announced goals that by 2015, ERs would be in a position to treat and discharge 90 per cent of emergency room patients ( those not admitted to hospital) within four hours and ensure nobody sat in an ER for longer than 24 hours. The WRHA also wants to be able to unload all ambulances at city hospitals within 60 minutes and lower the number of non- emergency patients seeking treatment at ERs. However, she said in a recent interview little progress had been made in achieving those goals. When people arrive at an ER, they are triaged based on the type and severity of their medical signs and symptoms and are categorized from Level 1 ( resuscitation) to Level 5 ( non- urgent). Wilgosh said many patients going to ERs are 4s and 5s who could be treated at a Quick Care Clinic, a walk- in clinic, or a minor injury clinic such as the Pan Am Clinic. Many of them are seeking treatment for lacerations, sprains and strains. " A lot of those people are coming from the north end of the city. Is there something that we need to be doing to address that?" She said officials are exploring a second facility in the city, similar to the Pan Am Clinic, that could diagnose and treat minor broken bones and other injuries rather than these cases ending up in the ER. Provinces participating in the survey included Manitoba, Saskatchewan, Alberta, British Columbia, Ontario, Nova Scotia and Prince Edward Island. The Yukon also participated. Across Canada, nine out of 10 patients were in and out of an emergency department within 7.4 hours or less last year, according to the CIHI survey. Agnita Pal, manager of clinical administrative databases for CIHI, cautioned not all emergency departments in Manitoba were captured in the survey - just those in Winnipeg. She said waits tend to be longer in large tertiary hospitals such as Health Sciences Centre and St. Boniface Hospital. Manitobans wait longest for ER help, study finds Discharge measures ' appropriate' But deaths of two patients spur more rigorous process SCAN PAGE TO WATCH VIDEO OF WRHA ANNOUNCEMENT By Bruce Owen SUBMITTED PHOTO David Silver died outside his home. KEN GIGLIOTTI / WINNIPEG FREE PRESS Arlene Wilgosh ( front), with WRHA chief nursing officer Lori Lamont, says an internal review found no deficiencies in the discharge of two patients who later died before reaching their homes. A_ 06_ Feb- 14- 14_ FP_ 01. indd A4 2/ 13/ 14 9: 21: 32 PM ;