April
29, 2006
No
ER Data
"We
have been unable to find any indication of accelerated
morbidity, mortality as a consequence of conditions in
ERs."
Minister of Health George Abbott, Hansard, April
27, 2006
Abbott
could have shown concern over the letters he has received
from emergency room physicians, but he chose to up the
stakes on his credibility with an assertion about morbidity
and mortality. Consequently, he should be able to produce
the research he has had done on morbidity and mortality
related to emergency room treatment. Abbott told the Legislature
that he and his deputy have been reviewing the allegations,
made by two Royal Columbian Hospital physicians and a
nurse, with respect to increased morbidity and mortality,
"with the Fraser Health Authority, with the Ministry
of Health and with the Canadian Institute for Health Information."
That suggests there might be some data that the Ministry
is using for its review.
The
reduction in autopsies causes a data quality problem for
cause of death but the Ministry should have information
on the number of deaths of patients who were admitted
via emergency rooms. Data do not exist which would allow
a researcher to link emergency room deaths with type of
care received in the ER. Morbidity data are even more
difficult; the Canadian Institute for Health Information
maintains the Hospital Morbidity Database. The most recent
report
on data quality in the database is for 2003-2004;
according to the report, in that year the database captured
discharge data for 388,186 in-patients in British Columbia.
The elements in the database are inadequate for any research
that seeks to determine whether persons treated in an
emergency room are made worse (increased morbidity) as
a result of a lack of resources or delays in being seen.
Of course, the Ministry or Health Authorities (the agents
of the Ministry) might have data that could be of some
use. A Freedom
of Information Request has been submitted to identify
the data elements and methodology of the Ministry's review.
It
is highly likely that the anecdotal evidence from emergency
room physicians, who were widely quoted in the news, is
the best information that is available. It is also highly
likely that the high-sounding statement from Abbott on
morbidity and mortality is nothing but a smoke screen
since the data to do the kind of research he suggests
probably don't exist. It would be a good idea to try to
put some hard data together, but in the meantime the warnings
from emergency room physicians should be taken seriously,
much more seriously than the good humoured Minister of
Health seems to be doing.
April
26, 2006
Emergency
Room Crisis, or Not
George
Abbott, MLA for Shuswap, is quick witted and has thoroughly
studied of his portfolio; however, his apparent inability
to give ordinary people understandable answers may be his
undoing.
Emergency
Room doctors at New Westminster's Royal Columbian Hospital
wrote: "The
current setting of severe bed shortage and lack of resources
means patients will continue to suffer from our inability
to see them safely in a timely fashion." Abbott's
response was to quote headlines from the 1990s before going
on to say: "One of the challenges of debating with
the members opposite, frequently, is that they either live
in some mythical past where these problems didn't exist
- because clearly they did - or else they are debating some
socialist nirvana of the future that never will exist in
this province." Could Abbott really believe that it
is some kind of "socialist nirvana" to want adequate
resources for BC's emergency rooms?
It has
become standard practice for the Campbell Liberals to answer
calls for accountability by citing their versions of events
from the last decade. In response to the Hughes' Report,
Premier Campbell said: "I accept that we took on a
big load. I accept that we took on many challenges. I accept
that we may have demanded too much of the people who were
at work in trying to help us do that." Campbell refused
to offer an apology, and when asked to account for his failures
he simply said that: "I think it is important, as Mr.
Hughes suggested, for us to start looking ahead …"
That's strange for a Premier and government that answers
questions about accountability by looking backwards.
BC's
former Auditor General, George Morfitt, helped create a
framework which had the potential to revolutionize politics
and government accountability if only it were supported
by the political parties, and most importantly, by the public.
He wrote:
"Why
the concern over accountability? Because, I believe, people
no longer judge government simply on the basis of how much
it spends on a problem. Rather, as taxpayers, they wonder
if the promise of better, more efficient government has been
realized. As consumers of government services, they want to
know whether the policies and programs of government are effective,
administratively efficient and of high quality. And as citizens,
they wonder whose interests are being served, and whether
the government has been able to strike the right balance among
competing interests (such as protecting the environment while
encouraging economic development)."
Morfitt went
on to say that that "public reporting must be improved
such that it:
-
focuses
on intentions and results;
-
covers
all key aspects of performance; and
-
is
comprehensive and inclusive of all government organizations."
Those
recommendations resulted in the Budget Transparency and
Accountability Act, which requires a strategic plan,
service plans for each ministry and annual reports which
set out intentions and quantifiable results. Unfortunately,
those reports seem to be considered as a legalistic or academic
exercise; the focus of political parties and the media continues
to concentrate on the daily thrust and jab of the most quotable
one-liner. The second
of three goals in the Ministry of Health's service plan
is that: "Patients receive appropriate, effective,
quality care at the right time in the right setting. Health
services are planned, managed and delivered in concert with
patient needs." One of the performance measurements
for that goal is the: "Proportion of patients admitted
from an emergency department to an inpatient bed within
10 hours of the decision to admit." The goal
for this year is that 80% of patients in emergency departments
be admitted to an inpatient bed within 10 hours, and reduced
to 8 hours next year. Emergency room physicians and the
government are arguing over whether patients are dying in
emergency rooms. Of course, there are always patients who
die in emergency rooms, so the question is how many are
needlessly dying there. No one is going to identify specific
cases since that would call into question the judgment of
the physicians and staff who served, or failed, a particular
patient. Instead of engaging in this no-win debate, the
government should be measured by the standard it set for
itself. If that standard is inadequate, emergency room physicians,
and others with the knowledge to comment, should say so.
If the goal is realistic, but not being met, that should
be the focus of the debate. Don't hold your breath waiting
for that kind of rational debate to start in health care
or any other issue in BC. Debating measurable intentions
and results is not as attention grabbing as headlines over
deaths in emergency wards.
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