有声报纸 - 医生对急症的建议
资料来源：vancouversunhttp://www.voiceprintcanada.com/audio/57963.mp3
VICTORIA -- The B.C. government has turned hospital emergency rooms into a "warehouse" for patients, causing lineups and making it difficult to treat the sick in a safe and dignified manner, the province's emergency room doctors say in a document obtained by The Vancouver Sun.
The position paper, which also suggests ways of speeding patients out of crowded emergency rooms, will be handed to provincial government officials at a meeting today aimed at fixing the emergency room crisis.
The doctors say all emergency patients who need to stay in hospital should be transferred out of emergency within two hours of the decision to admit them, and hospitals' observance of this two-hour limit should be strictly monitored.
Today's meeting follows a recent series of public criticisms of conditions in Lower Mainland emergency rooms by ER doctors at Vancouver General, Royal Columbian, Lions Gate and Surrey Memorial hospitals. Their concerns prompted the government to say it would put $7 million into easing the problems.
"The reason for this situation is that the current approach to deal with hospital overcrowding in B.C. involves an excessive, inappropriate, and unsafe use of emergency departments to 'warehouse' already stabilized and admitted patients," says the position paper from the emergency-medicine section of the B.C. Medical Association.
"This has resulted in admitted patients being inappropriately kept in emergency departments for long periods of time, sometimes days. This practice has rendered emergency departments unable to assess and treat new patients in the timely, safe, and dignified manner which they deserve."
The BCMA, which represents the province's 8,000 doctors, has not endorsed the statement by the emergency room doctors.
Nor would it comment on the physicians' demand that Health Minister George Abbott order hospitals to set a two-hour limit on transferring to a bed those patients who have been treated in emergency but aren't well enough to go home.
In calling for the adoption of a system of "continuous flow" -- moving patients to other wards rather than allowing them to languish in an emergency ward's hallways -- the ER doctors say their approach would not cost the province any money.
"All admitted patients should be transferred out of emergency departments to an inpatient area within two hours after a decision to admit has been made," say the doctors.
"Each hospital and health authority must rapidly develop plans to share, in a balanced manner, any excess workload resulting from demand for inpatient beds exceeding capacity."
The doctors want all hospitals to document whether they meet the two-hour rule. They say the province should also require monthly performance reviews in each hospital.
"Achievement of these goals must be continually measured," they say. "Hospital administration should be held accountable if goals are not met."
Abbott welcomed the suggestions as a possible solution to emergency room overcrowding.
"I think it's a very constructive suggestion," he said. "I think it is absolutely a very good thing to be putting on the table."
But that doesn't mean he will fully endorse it, he said, adding there is no quick panacea. For one thing, Abbott said he isn't sure a blanket two-hour rule for clearing patients out of an emergency ward is realistic.
"I don't think there's a lot of good purpose in setting out goals that can't be met realistically today," he said, noting the national standard for such transfers is about eight hours.
Other hospital professionals also have concerns about implementing such a broad policy that might simply burden other areas of a hospital, he said.
"Nurses at times have concerns about that," he said.
The overcrowding of emergency wards became a major political issue in British Columbia after doctors released letters in recent weeks complaining of a crisis in emergency rooms.
The New Democratic Party has also hammered the government on the issue, saying it has created a crisis by cutting the number of acute care and long-term beds since 2001. That cost-cutting measure, they said, created a bed shortage.
"The emergency rooms are being used to warehouse patients, I see that everywhere I go," said NDP leader Carole James, who has drawn attention in the legislature to numerous cases of people not getting quick care in emergency wards.
"It's disappointing that it wouldn't be the government coming forward with a solution. Once again we have to see the doctors trying to get the government to fix the chaos that they created."
Overcrowding in emergency rooms is a direct result of the government cutting one in five of the province's acute care beds in recent years as well as long-term hospital beds, James said.
That means chronically ill patients, often the elderly, are filling the acute care beds that would normally be used for patients coming from the emergency ward.
"The government needs to get those long-term beds open for seniors," she said. "They need to make sure seniors are being moved out of those acute-care beds to make room for people."
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