Still no triage liaison physicians in Alberta ERs, 4 months after province's pledge

thomas more than 4 months after pledging that exigency physicians would before long start monitoring patients in crowded waiting rooms for health crises, the Alberta government’s promised triage liaison physicians (TLP) aren’t yet on the job.

Matt Jones, Alberta's former minister responsible for hospitals, said in January the province would “immediately” revive the role for emergency doctors after 44-year-old father Prashant Sreekumar died waiting for care in the emergency room (ER) of Edmonton's Grey Nuns Community Hospital. Jones said the TLPs would begin work in six hospitals in Edmonton and Calgary on Feb. 1.

“There is a lot of frustration within the emergency physician group with regards to how long this has taken,” Alberta Medical Association (AMA) president Dr. Brian Wirzba said in an interview this week.

The association negotiates doctors’ pay and working conditions with the government. Wirzba said talks about TLPs are now part of broader negotiations with the government about how alternative relationship plans (ARPs) are structured. ARPs are pay arrangements for physicians outside of the fee-for-service model, and are often salaried contracts.

Wirzba said negotiations to get TLPs working shifts in ERs should have taken a matter of weeks. The role sees the physicians watch for patients whose conditions are deteriorating while they wait to be diagnosed and treated. The doctors would also be able to order tests and get early treatments started.

Wirzba said that at one point, the AMA escalated the issue to Premier Danielle Smith's office, and is hopeful they’ll finalize an arrangement within a month.

“We are really pushing hard to get this across the finish line,” he said.

The AMA has previously said emergency physicians would likely take on the shifts in addition to their regular hours. Wirzba said the government and AMA still disagree on the appropriate pay for the work.

Wirzba said there are some ER physicians still interested in working in the TLP role to help ease the burden on their colleagues. He said the job is a stop-gap measure for a year or two while health authorities make longer-term systemic changes to reduce the pressure on hospitals and ERs.

Her husband died in a hospital waiting room

Maddison McKee, press secretary to Hospital and Surgical Health Services Minister Adriana LaGrange, said in a statement that recruitment and talks are ongoing.

She said only after the government established the TLP positions did the AMA request additional compensation.

“We remain committed to reaching a fair and sustainable agreement, but we cannot allow negotiations to impede timely access to care,” she said.

McKee said registered nurses now have expanded responsibilities in emergency departments, including monitoring and treating patients in waiting rooms.

Reviving the TLP program was one of 16 recommendations in a quality assurance review that Acute Care Alberta conducted after Sreekumar died on Dec. 22 of a cardiovascular problem after seeking help at the Grey Nuns ER.

A timeline of Edmonton ER safety concerns

Dec. 22: Prashant Sreekumar, 44, dies after waiting eight hours at the Grey Nuns emergency room

Jan. 8: Alberta doctors call for the government to declare a state of emergency in hospitals

Jan. 11: ER doctors compile a list of recent deaths and injuries they believe may be linked to long waits

Jan. 15: Then-hospitals minister Matt Jones announces a fatality inquiry and plans to hire triage liaison physicians

Feb. 12: No sign of triage liaison physicians in ERs yet

March 3: Premier Danielle Smith suggests the AMA is delaying triage liaison physicians from getting started

March 12: Acute Care Alberta releases results of a January review into Sreekumar's death

April 1: Hospitalists, who care for many patients on evenings and weekends, can no longer be paid with stipends. Some discontinue work or reduce their hours in hospitals. Doctors say this makes it even slower to move patients into wards and out of ERs

May 8: Travis Smith dies waiting for care at the Royal Alexandra Hospital ER

May 30: Smith's family speaks out about their concerns

Vanderlaan said in a statement that Covenant Health, which runs Grey Nuns and other health facilities, is hiring 27 health-care workers to improve admitting and patient flow. She wouldn’t say if the positions are just at the Grey Nuns or at multiple hospitals. Vanderlaan would not give a timeline or goal for implementing the recommendations.

“All 16 recommendations have progressed and are at various stages of implementation,” she said in her statement.

After Sreekumar died, emergency physicians said they believe his case wasn’t isolated, and released an anonymized list of recent cases where they believe long waits for care may have led to patient deaths or serious harm.

The family of another man, 33-year-old Travis Smith, says he died May 8 in the waiting room at the Royal Alexandra Hospital ER in Edmonton, also while waiting for care.

Alberta Health Services says it has started a quality assurance review into a death at the hospital on the same date.

Wirzba said a former outpatient area at the Grey Nuns is now used for emergency patients, and the hospital plans to create a high-intensity unit for sicker patients. Both initiatives are a result of the 16 recommendations made following Sreekumar’s death.

Vanderlaan would not confirm this information.

Dr. Warren Thirsk, the AMA’s section head for emergency medicine and who works at the Royal Alexandra Hospital, said his colleagues have noticed no tangible action from administrators on the recommendations.

Thirsk said many steps require more funding, and until the government provides that funding, he doubts they’ll proceed.

Dr. Allan Pickard, a Grey Nuns emergency physician, said following the recommendation to stop capping the number of patients who can be admitted to wards is the most important change that could improve emergency patient care.

Since 2023, he said, physicians and care teams have put caps on the number of patients they are willing to manage at once in an effort to improve patient safety.

Pickard said those teams in internal medicine, neurology, cardiology and other specialties lack the staff and space they need to care for more patients. However, he said the practice downloads the problem onto ERs, where doctors caring for diagnosed patients have little capacity to see patients arriving with undiagnosed problems.

“We cannot close the door and say, 'No, we are full,'” he said.

The Grey Nuns has more services capped than other hospitals, Pickard said. He said he sees about 25 patients in a typical shift. Up to 20 of them are waiting for a bed in a ward, which means he can see only five newly arrived patients.

“The argument that capping is a patient safety measure does not hold water,” he said “It's just a way of moving the danger to a different service.”

He said any changes in the works aren’t happening fast enough.

Chris Gallaway, executive director of the advocacy group Friends of Medicare, said some health-care workers say they have been invited to meetings to talk about the quality assurance review recommendations, but haven’t seen any changes.

“If ... [Acute Care Alberta is] serious about those 16 recommendations, don't tell us they're in process. Tell us when they'll be in place and how, and get it done,” he said.

Gallaway said he believes the government’s ongoing administrative restructuring of Alberta’s health-care system may also stymie the pace of improvements.

Thirsk, the Royal Alexandra Hospital emergency doctor, said surviving an ER waiting room is a low bar and a poor measure of health-care quality. 

“We are focused on the deaths and the people who haven't survived. And they're tragic and they're sad and are potentially preventable," he said. "But we're ignoring buckets, reams of suffering."

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