Alberta doctors raise alarm about surgical and trauma diversions

Calling it a "crisis," Alberta doctors say more and more patients in need of emergency surgery are being diverted from one hospital to another, sparking concerns about patient safety.

According to the Alberta Medical Association (AMA), general surgery diversions are occurring with increasing frequency due to staffing shortages, and the group is warning that trauma care is being impacted now, too.

Emergency room patients are often treated by general surgeons for problems such as a ruptured appendix or bowel obstruction.

But the AMA says a shortage of surgical support staff, including medical residents and clinical surgical assistants, means patients often have to be sent to another hospital for that care.

"It's really a crisis situation and the timing is imperative," said Dr. Lloyd Mack, a Calgary-based surgeon and president of the Alberta Medical Association's general surgery section.

Dr. Lloyd Mack is president of the section of general surgery with the Alberta Medical Association.
Dr. Lloyd Mack is the president of the section of general surgery with the Alberta Medical Association. (Alberta Medical Association)

"These patients should not be waiting. When patients present for emergency surgery, I think of the clock as ticking. Delay means probable complications. It may mean more severe illness, very quickly, and in the worst-case scenario a patient can die."

Mack said he's aware of 20 situations in the first three months of this year when general surgery diversions were put in place in Calgary hospitals.

According to the AMA, Alberta has been struggling to attract and retain surgical residents.

"The difficulty we have now is the volume of emergency-type patients and less people to look after them," said Mack.

The situation is complicated by other factors, such as the family doctor shortage, which means more patients are ending up in emergency rooms with more advanced health-care problems, often requiring urgent care, the group said.

"We're all very, very concerned that this is having very negative and significant impacts on Albertans," said Dr. Paul Parks, AMA president.

Trauma care

The AMA is also warning the problem has expanded and is now impacting the trauma program at Calgary's Foothills Medical Centre, which is the only Level 1 trauma facility — treating the most critically injured patients — in southern Alberta.

"I can think of a couple of examples where people went to the Peter Lougheed, for example. But that's not a trauma centre," said Mack.

"So it's quite scary. This is unprecedented."

However, an Alberta Health Services spokesperson told CBC News there haven't been any trauma diversions out of the Foothills Medical Centre this year.

Mack said the trauma department is impacted by the same staffing shortages.

"So there is a trauma surgeon available. Typically there is an operating room available at short notice for trauma patients. But we often are not having the supports."

He said because the staff are "somewhat interchangeable," a hospital will often divert general surgery patients in an effort to preserve the ability to provide trauma care.

"It's very worrisome, said Parks, adding it's becoming more difficult for staff to avoid trauma diversions.

"These are the patients that need timely life-saving care. And any delay for their care or any need to package them up and move them to another centre, when they could be quite unstable.… It's very concerning that it happens, ever."

According to Mack, Calgary hospitals appear to be the hardest hit by the diversions.

Dr. Paul Parks is president of the Alberta Medical Association
Dr. Paul Parks is president of the Alberta Medical Association. He says it's becoming more difficult for staff to avoid trauma diversions. (CBC)

The doctors are calling on Alberta Health Services and the provincial government to take swift action, including workforce investment with the aim of recruiting key surgical support staff such as clinical assistants, physician assistants and nurse practitioners.

"We simply can't do surgeries — or  our jobs — without them." said Mack.

"When we're scrambling to try to do our jobs and the morale becomes down, this province does not look very attractive to young resident physicians training in general surgery. They're the workforce of the future."

According to Parks, the AMA provided some solutions in a hospital stabilization plan it presented to the provincial government in December, including pay changes he said could help with recruitment.

"Unfortunately, we haven't moved forward on a lot of those solutions," he said.

The AMA is also calling on Alberta to make data on surgical diversion available to the public.

The Alberta government said it's working to boost surgical capacity but did not answer questions about staff recruitment, which is the doctors' key concern.

"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," Andrea Smith, press secretary to Alberta's health minister, said in a statement emailed to CBC News.

"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."

Private surgical facilities are not used for emergency surgeries.

Meanwhile, Alberta Health Services said each urban hospital has a general surgeon on call, with staff surgeons on-site, and people needing emergency surgery will receive it.

"During a temporary surgical diversion, all patients are triaged and treated, and our medical teams evaluate all patients who may require surgery," a spokesperson said in an email.

"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."

The health authority said it is on track to meet its surgical volume target of 310,000 surgeries this year.

It did not respond to questions about staff recruitment nor did it say whether it would publicize diversion data.

The Alberta Medical Association is speaking out about the situation as part of an ongoing health-care advocacy campaign.

"Ideally, we need to get ahead of this problem," said Mack.

"It's not safe. It's clearly a poor use of resources, shipping patients around the cities."