A group of Alberta doctors is sounding the alarm over an increase in “diversions” in local hospitals, which physicians say lead to patients not getting the emergency surgeries they need in a timely manner.
The Alberta Medical Association (AMA) said diversions happen when there aren’t enough staff available to help with essential work in surgery, even if surgeons are available. This results in patients being transferred by ambulance to other hospitals due to a lack of available staff.
“This is a situation where you arrive at the emergency department, you need immediate surgery and there is an operating room available and there is a general surgeon, such as myself, available, but you still can’t get your surgery at hospital A at that time,” said Dr. Lloyd Mack, president of the general surgery section of the AMA.
“Instead, you’re put back in an ambulance and sent across town to a different hospital … that can provide the surgical care you need.”
Mack said much of the issue comes down to the availability of Tier 1 support staff who work with the surgical team, such as resident physicians, clinical assistants, physician assistants and nurse practitioners.
“A whole number of team members who need to be there to look after the patient during surgery, but as well before and after, as well as to assess other patients in the emergency room or intensive care unit while surgery is happening,” Mack said.
“If those team members aren’t there, I can’t accept the patient from the emergency room.”
Mack said delaying surgery can lead to complications, more severe illness and in the “worst-case scenario,” death.
“These patients shouldn’t be waiting,” he said.
“I personally think this is a crisis.”
Alberta Health Services said in a statement that surgical diversions are only activated “when all available resources have been utilized and all other mitigations have been exhausted.
“During a temporary surgical diversion, all patients are triaged and treated, and our medical teams evaluate all patients who may require surgery as they always do,” AHS said.
“When diversion is required, our teams work closely with clinicians and sites to ensure we can continue to provide high quality care where the resources are best able to meet the patient needs.”
AMA president Dr. Paul Parks said diversions aren’t a new problem, they’ve been happening for years. But he added that they’re becoming more common.
“What we’re experiencing and see more and more is that this is becoming an occurrence in all of the zones in different ways and growing,” Parks said. “And becoming more difficult and more problematic for patient care.”
The AMA said diversions are happening in part because of a workforce shortage. The group said the province needs to recruit and retain more support staff, including residents and clinical staff.
“Money isn’t going to solve everything, because we still need the human bodies, we still need skilled, trained people to be able to plug into those roles,” Parks said.
“This is a supply-and-demand issue across the country and across the world. Finding these trained human beings is becoming more and more difficult, so we have to be the place that is competitive and the place to come work.”
“We simply can’t do surgery or our jobs without them,” Mack said. “It’s only going to get worse if we don’t start taking action now.”
A statement from the office of Health Minister Adriana LaGrange said the government is making investments to boost capacity so Albertans can get the surgeries they need quicker.
“This includes $618 million to upgrade and improve operating rooms across the province and make sure we stay on pace to perform a record number of surgeries this year,” the statement read.
“We need to use all the tools at our disposal to get as many surgeries done as possible. Thousands of Albertans are now getting their publicly-funded surgeries at chartered surgical facilities. This is freeing up operating rooms in hospitals to handle more complex surgeries.
“We are also refocusing Alberta’s health-care system to ensure that Albertans have access to more effective care and improve health outcomes.”
Parks said the AMA provided the province with a hospital stabilization plan in December 2023, providing examples of ways to help mitigate issues, including increasing the alternate funding for hospitalists and some funding models around clinical assistants and after-hours care.
“Unfortunately, we haven’t moved forward on a lot of those solutions,” Parks said.