RURAL ED CLOSURES - REAL AB Case #2

- Pt in their 40s, witnessed cardiac arrest
- EMS responds and begins resuscitation
- Only mins from nearest Hospital, but the ED is CLOSED
- Adjacent Hospital ED Closed too
- EMS crew NOT aware of ED closures
1/7 - EMS calls hospital staff for help - crew in significant distress because there is nowhere to take this patient
- Local nursing staff tries calling physicians in the community
- One provider is 25 minutes away
- Resuscitation terminated pre-hospital - "no receiving site"
2/7

RURAL ED CLOSURES - REAL AB Case #1
- ABs are not aware of how frequently rural EDs are closed, and the impact on the people in these communities.
- the ever-worsening stats are meaningless
- it's important to put a human face on what's happening.

Anonymized Actual Case #1:
1/7 Before giving example cases...
Here's a refresher of a recent post on the growing issue across AB:


2/7 buff.ly/FIHAlkb

ED RURAL CLOSURES are happening more and more across AB.

Let's look at some of the issues, before talking about some real cases:

- the frequency of rural ED closures is growing - often with little to no warning for the community
- large areas of AB are left uncovered - pts may not be aware and self-present with emergency conditions
- EMS crews are often unaware and show up to closed locations as well
- growing reliance on Virtual ED (VED) which can ONLY care for the less sick (CTAS 3-5), and refuses to provide any care/advice to CTAS 1-2

Let's talk further "refocusing" and the new corridors
5 ZONES will be converted to 7 CORRIDORS - with futher dispruption and chaos added
Each of the current zones have medical leaders trying to coordinate care within/between zones... who will do this in new corridors?
1/6
Currently there are no plans for:
- Corridor medical leadership (multiple service providers in each corridor with NO overall operational control)
- coordination between zones
- what this will mean for provincial services that cross corridors
- what it will mean for pts
2/6

Hey Alberta! Get ready for this. The Premier has stated she wants to sell off our hospitals to private operators... and he govt has set up all the legislation so that this WILL happen...Maybe we should be aware of at what cost 🧵 :
1/4buff.ly/XMoqtKl How about the cost of lives: 13% increase in DEATHS!
Why - cuz they want to maximize profits so they cut corners and cut staff numbers.
This Study shows how they do this: 11.6% less staff, and 16-18% less operating funding = substandard care and more people die
2/4

WOW! There appears to be conflicts of interest all over the place... but given that govt refuses a Public Inquiry, will we ever find out?

Do ABs even care how their money is spent while the system degrades?
1/7
buff.ly/y4AL4wG So 2 independent Audits:
First: ASG contract followed "sole source contract" rules... but very narrow focus, so 2nd ordered
2nd: look into potential conflict of interest... while looking into it the govt says: stop everything, also CEO fired, also Board fired
2/7

Let's talk about LWBS = Left Without Being Seen

Look at the graphs - anyone can immediately see the trend.

Post pandemic it just keeps getting worse. Let's break this down as everyone should care as it will impact you or a loved one at some point 🧵 :
1/10
This is public data from HQA - it's two quarters behind, but same trend continues and this fall will be horrendous for ED Access Block (= inability to get safe and timely care in the HC system)


Key points:
2/10buff.ly/Zzme8kn

It's been over 8 months since govt fired the AHS CEO and the entire AHS Board... ostensibly to make things better, and to give govt more direct control over the HC system.

An acting CEO and no Board, and things are demonstably worse on all acute care fronts.
1/6 No oversight.
No arms length from govt - it's all govt all the time...
Endless firings, and basically any of those with HC expertise and clinical experience that are still around are just waiting to get fired (why quit and get no severence for your lifelong service?)
2/6

Let's talk about AB's HC workforce, a 🧵 :
The graph is for all of Canada, but this trend continues and is getting worse in AB.
Many reasons but key ones:
- "refocusing" has eliminated any ability for our province to do workforce planning. NO COORDINATED work being done
1/7 - there are so many orgs now, and all with "acting" appointed temporary leads, that one hand has no idea what the other is doing
- HCWs can work in mulitple orgs in our siloed HC "system", and so the orgs are finding themselves competing against each other for same supply!
2/7

Some concerns from former AHS CEOs sworn affidavit 005 - Some issues re CSFs🧵:
- Let's break down some specific concerns raised by the former AHS CEO around CSFs in AB.
- I will talk about CSFs in general... details about specific CSFs are opaque and hidden
1/12 One important note: there is nothing innately wrong with the idea of doing select surgeries in chartered facilities. The key issue is ensuring proper coordination, oversight, safety reporting, transparency, and accountability.
Ensuring they work for the public!
2/12

Some concerns from former AHS CEOs sworn affidavit 004 - HCW Intimidation and Silencing🧵:
- pg 16
- concerns raised of govt being punitive and silencing "critics"
- this should be very alarming when a former AHS CEO raises this concern.
1/10
- if it proves to be true that actual screen shots of this behaviour exist, and from people still in positions of power over HCWs, all ABs should be very worried.

What I can speak to from firsthand knowledge:
- almost daily HCWs tell me they are terrified to advocate
2/10

Regarding "refocusing' - which should be nominated for the euphemism of the year award - ABs should pause and reflect on what is happening w the disintegration of our HC system 🧵:
- first off "disintergration" is used intentionally w respect to what's happening
1/8 - govt is both blowing up the system and breaking down any and all INTEGRATION
- they are creating silos, redundant bureaucratic orgs, and moving clinical HC dollars to support more admin and bureaucrats

But what is really important is the HOW they are doing it:
2/8

Some concerns from former AHS CEOs sworn affidavit 003 - Refocusing🧵:
- pg 19
- Some concerns about the chaos of "refocusing"...
- There really was no plan, Premier said blow-up AHS, so they blew it up and then set consultants and bureaucrats to create "anything"...
1/6
Some key concerns:
- NDAs have been used wantonly by this govt - the right hand can't even talk to the left hand...
- people could be on multiple refocusing committees and not be able to share info between the groups!
- AHS couldn't inform HCWs
- everyone flying BLIND
2/6

Some concerns from former AHS CEOs sworn affidavit 002 - Surgical Coordination🧵:
- from page 12
- It is critical to understand that payments for surgery in AB all come out of the EXACT SAME POT.
1/9
- doing more low acuity surgeries in community, w same or less funding = something has to give
- we know from objective data what gave: life and limb saving surgeries, bowel and transplant surgeries, and cancer surgeries... all wait times went up for them.
2/9

Some concerns from former AHS CEOs sworn affidavit 001🧵:
- from page 23
- Concern: govt did not budget HC for pop growth and inflation
- this is factual, and very important to understand
- the Premier even confirmed this during her budget announcement
1/10 Why is this important:
- our pop is BOOMING, and inflation is making it more expensive to provide HC
- govt isn't even doing its most basic duty = ensuring/insuring HC is adequately funded from yr to yr ("insuring" intentional as they are the health insurance provider!)
2/10

"Kyle Warner, press secretary to Hospital Services Minister Matt Jones, said only two hospitals saw one in five patients leaving the ER early"

Both hospitals are in Edmonton... and this is full on admission of UTTER FAILURE
🧵
1/6
buff.ly/L7rPhAJ At times the RAH LWBS numbers are higher than 1 in every 4 patients seeking care... read that again: they are seeking care and RECEIVE NONE.

Aggregrating the top 16 EDs to dilute the provincial avg is mere distraction... Pts only ever present to ONE ED at a time.
2/6

Let's talk HC "refocusing" and Premier's latest announcement 🧵 :
- no one is able to articulate the actual plan. NO ONE
- the Premier is being advised in backrooms on health, she comes out and makes an announcement... and then the legions of consultants and bureacrats scramble - and all of these people making their living on implementing orders/plans? they know it WILL NOT WORK
- but no one can/will tell the Empress she has no clothes - that her HC destruction and disintegration will NOT work
- the "consulting" is how they feed their kids...

It would be really interesting to learn who is advising the Premier on her HC "restructuring"?🧵

Current state:
1: Four new silos, with NO operational control between them (none, nada... )
buff.ly/ufR6u6j 2: FOUR Ministers who won't want to take on the headaches of the other silos even when connected.
Ex - continuing care doing something about ALC pts to help ACA (mostly seniors stranded in hospitals requiring continuing care for safe discharge)

This is honestly too much. The Premier talking about 135M HC dollars just wasted and acting like she has NOTHING to do with why we are here. Everything she and her govt has done has brought us to this point, a 🧵to recap:

1/10buff.ly/HuESfWk 1- She has actively dismantled Public Health in AB
2- She was directly involved in the firing of our previous CMOH, not once but TWICE - sending a chill in PH to the point where AB cannot recruit expert leadership to the position
3- Blew up and disintegrated HC system
2/10

CIHI Surgery Wait Times 🧵
First note what we track: hip/knee replacement + cataracts (not life threatening) and Hip Fracture Repair (life threatening)
- so the only surrogate for in HOSP life threatening surgery care we report = hip # repair
- and this metric is worsening
1/10
- you might think that for hip # repair going from 87-80% and 91-88% is minor, and that the gains in eye and joint surgery in the community makes up for this
- but this is the only surogate we have for all in-hospital surgeries and they ALL are getting worse
2/10

Albertans voting "conservative", a 🧵 on thinking vrs reality:
Most ABs will state they vote conservative for values like: small govt, less bureaucracy, balanced budgets, and govt spending taxpayer money wisely (fiscally conservative)
But in reality our govt is the opposite
1/15 1 - largest govt in AB hx with the most Ministeries and govt bloat
2 - moves in HC to make it more bureaucratic and bloated - 4-5x the admin now, and w admin being govt bureacrats over health experts or HCWs, and with WORSENING HC ACCESS and OUTCOMES
2/15