Ambulance diversions underway as Royal Columbian Hospital attempts smoother tech transition

British Columbia has spent years planning and implementing a purely digital medical record system for the province's hospitals – and one of the largest is now sending away some patients as it attempts a smoother transition than its peers.

In recent weeks, Royal Columbian Hospital in New Westminster has quietly informed certain health-care workers in Fraser Health that they’d be making certain service adjustments as they convert from pen-and-paper to electronic records, including patient files, test and lab requisitions, and medication orders.

RCH has its “go-live” to Meditech Expanse at 5 a.m. on Saturday.

It was only through memos obtained by CTV News that the public learned some patients were being discharged from hospital to reduce the patient load, and that non-urgent ambulances would be turned away starting Thursday, Sept. 5, which Fraser Health later confirmed. 

“Diverting patients from Royal Columbian is an increased workload for us, especially when you think of surrounding ambulances having to go to other communities for extended periods of time,” said Ian Tait, communications officer for Ambulance Paramedics of B.C.

He said that while the union is aware of planning to mitigate the impacts, the added volume of patients to nearby hospitals “could result in waits at the hospitals and offload delays and then our members being stuck in the hospital for prolonged periods of time,” including waiting with patients lying on stretchers in hallways.

After rollout delayed, administrators now confident

RCH is a Level 1 trauma centre and provides most of the complex medical services for Fraser Health, including stroke, heart attack, brain injury and other specialized care. That means patients with serious injuries or heart attacks are transported there by ambulance, even when hospitals like Surrey Memorial are closer.

Fraser Health had originally planed to roll out the software in April but CTV News has learned that frontline staff felt unprepared and undertrained, and that there was a danger to patients as a result. Workers raised their concerns to senior health authority administrators, pointing to the rocky rollout at Eagle Ridge Hospital and Vancouver General as reason to delay in order to better prepare.

“I feel like we will have questions and we’ll be learning some of it on the fly but the base preparations are there now,” said Dr. Gerald Da Roza, associate medical director for RCH. “There is a large support network, including all the hospitals supporting each other through this process.”

He insisted that patients in New Westminster shouldn’t hesitate to go to the emergency department, which will remain open as usual while staff adjust to the new system.

“There’s an operations centre that meets three times a day for the next two weeks and I think we need to be nimble with these situation,” he added. “We have planned for six weeks of ramp-up and extra staff.”

B.C. hospitals playing catch-up

While British Columbia was an early adopter of certain health-care technologies among the provinces, it has fallen behind in recent years and is considered late to go fully digital with records, which the health minister blamed on the previous BC Liberal government. 

“The reason we’re going through this is for patient safety and patient care,” said Dr. Amyeen Hassanali, Fraser Health’s chief medical information officer and a hospitalist himself. “We are going to be able to deliver high-quality care with real-time clinical decision support and reduced patient safety events with this new system.”

Frontline staff have expressed frustration to CTV News that the neighbouring health authority, Vancouver Coastal, did its own upgrades to a completely unrelated system, CST Cerner, which has seen its own rocky implementation in that health region.

Hassanali said the two platforms are also used in different areas of Ontario, and that practitioners can easily pull information from them – while acknowledging that still isn’t possible in B.C.

“There were a lot of lessons learned that we’re taking from Eagle Ridge Hospital as well as our subsequent go-live sites at Mission and Fraser Canyon,” said Hassanali, when asked about the ambulance diversions and discharge patients. “We will drop efficiency initially and that’s why we try to get our capacity down to a manageable level.”

When CTV News asked if productivity had improved or whether patient outcomes were better at Eagle Ridge, which was the first Fraser Health site to implement Expanse, he said it’s difficult to put numbers to efficiency in medicine.

Ambulances are slated to resume normal operations by Tuesday, Sept. 10 but hospital administrators are watching to see how quickly staff adjust and whether the extra tech support and other measures may need to continue longer-term.

The Doctors of BC supports the upgrades but has questioned the timing, which is seeing reduced capacity in hospitals already struggling to keep the doors open amid a critical staffing shortage.