With Winnipeg's ER woes in the spotlight, some ask if tech can help make waiting rooms safer

The death of a patient who'd waited hours to be seen at a Winnipeg emergency department has some people considering whether the province could innovate its way out of its health-care woes.

Chad Christopher Giffin's death in the city's Health Sciences Centre earlier this week has been ruled a critical incident. An investigation is still ongoing, but the hospital says it was over capacity in the hours leading to the man's death.

The incident has rekindled concerns from Manitobans worried about the current state of health care in the province, with some saying it's eroded trust in the system.

Laura Tamblyn Watts, CEO of seniors advocacy group CanAge, said Wednesday the province should be using available technology to make emergency rooms safer.

"You shouldn't have better monitoring waiting for your table at a restaurant that you have waiting for a bed in the ER," Tamblyn Watts told Information Radio host Marcy Markusa.

"Our basic [devices] could be doing a better job than one overstressed, overworked nurse in the corner, trying to manage the patient flow."

Giffin was initially triaged as a low acuity patient, which HSC said are typically reassessed every couple hours though that frequency may be affected by the number of patients in the department.

At least one Canadian hospital has seen some success using wearable technology to constantly monitor people's vitals while they wait to see a doctor.

N.S. to expand wearables use

Some patients at the Dartmouth General Hospital emergency department — Nova Scotia's busiest hospital — are given the devices based on their acuity and whether they're experiencing symptoms like chest pains or difficulty breathing.

"Emergency departments everywhere are facing really large volumes of patients," said Rachel Nalepa, the hospital's interim health services director.

"We really wanted to ensure that patients that are in our waiting room … were not going to face any sort of adverse event. We also wanted to make sure that they felt as though that they were being cared for to kind of lessen that anxiety."

The devices — attached to the patient's finger and wrist — wirelessly transmit a patient's oxygen levels, heart rates, and other vitals to a monitor, alerting staff whenever they go below or above normal range. The results are monitored by dedicated staff. 

Nalepa said reassessments tripled during a six-month pilot at Dartmouth General.

"100 per cent, patient safety is our first priority," she said. "We knew that what this would do is it would only make the waiting room safer."

The Richmond General and Vancouver General hospitals in British Columbia are currently running trials on the wearables in waiting rooms.

Dr. Kendall Ho, an emergency medicine professor at the University of British Columbia, said the tech is promising, but hospitals must first figure out how to implement it into their workflow, what kind of medical situations merit their use and whether they're worth the price tag when they could easily be lost.

"There are very few medically-approved wearables and sensors for hospital use," Ho said.

"People talk about watches, people talk about rings, people talk about necklaces. Those are good monitoring techniques, but [they're] not accurate."

'Technology can help'

Ho chairs the Canadian Association of Emergency Physicians' digital emergency medicine committee and has worked to implement new technologies in emergency rooms for almost three decades.

That includes the 811 telehealth system currently in place in most Canadian provinces, which along with other virtual care programs aims to free up ERs by diverting people with non-urgent conditions elsewhere.

Ho said other programs meant to address capacity issues have also been successful, including the province's "Hospital at Home" acute care program.

Eligible patients at seven B.C. hospitals have to option to be monitored by a care team in their own homes, using a virtual call bell to stay connected with the health-care staff. 

"When we look at patient flow in emergency department, we often think about three areas. One is input of patients in emergency. Second is throughput: … How do we support safety and increase ways of helping. And then output," Ho said.

"All three areas, we have evidence to suggest that technology can help."

Ho said he's also excited about the potential of machine learning and artificial intelligence — already in use at some Canadian hospitals for transcription and note-taking purposes — to help triage patients in the future.

But he said that ultimately, these innovations can only do so much.

"Technology can be used to help increase efficiency and increase patient safety. But at the end of the day, that system to increase the flow of patients is vital," he said. 

"Also, because of the combination of decreasing health professionals with COVID … we need to renew and increase emergency personnel. Those are foundational factors that need to be solved."