While the zone department of Emergency Medicine (EM) was anticipating and hopeful for a year characterized by stability and rebuilding post-pandemic, 2022 would be characterized as one of the more eventful and tumultuous years in the department’s history. With over 280,000 unique visits across the four adult emergency departments in the Calgary Zone, we finally saw a return to pre-pandemic visit volumes as well as admission burden through the Emergency Department (ED). Unfortunately, two factors would lead to a significant deterioration in operational metrics in tandem with negative impacts both on staff morale and ED safety and quality of care. These included a widespread staffing crisis affecting our nursing colleagues primarily but the changes were also the result of unprecedented levels of ED inpatients threatening the mission of emergency and pre-hospital care in the city. With such high proportions of ED space and resource dedicated to admitted patients, 2022 saw some of the worst wait times both for admitted and discharged patients that the zone has experienced in well over a decade. This also contributed to extensive delays in EMS response as a result of large numbers of EMS crews and patients were held awaiting off-load into emergency departments across the four sites.

Despite the challenges, ED leadership including nursing, physicians and directors came together with resolve and poised to introduce and trigger innovative solutions to address these circumstances. By the end of 2022 with enhanced attention to ED wait times and EMS response times highlighted through the appointment of the Official Administrator, the following efforts were either initiated or well underway. These included:

1. Creation of an Emergency Inpatient Task force to address the access block and flow issues affecting emergency and pre-hospital care.
2. Creation of an ED staffing recruitment and retention task force.
3. Creation and staffing of the ED Park nurse position for EMS to download patients.
4. Launch of the Clinical Emergency Physician Liaison initiative to mitigate the risks of EMS holding and facilitate patient flow through the EDs and onto inpatient units.
5. Concerted province-wide efforts on EIP threshold work and capacity management initiatives.

As 2022 entered its final month, the Calgary Zone Emergency Departments appreciated a turning point in the ED crisis which marked the last several months. With progress in staffing and capacity management, our department remains hopeful that 2023 will see sustained improvements and a return to the kind of timely care that is the pride of our team. 

Other highlights for 2022 included:

1. A return to face to face learning with our department hosting Dr. Anton Helman and his widely subscribed EM Cases featuring a dedicated episode to Calgary talent and accomplishments. https://emergencymedicinecases.com/posterior-stroke-ep-lead-hear-score-ketamine-for-suicidal-ideation-peer-support-highlights-from-calgary-em-hodsman-lecture-day/ 
2. 2022 was an exceptionally strong year for all branches of medical education in Calgary. Under the leadership of the new Deputy for Education, Dr. Fareen Zaver, our department undertook and educational strategic plan to establish a wide range of priorities over the next several years.
3. Our postgraduate residency training programs received full accreditation and the Royal College program was even commended on its efforts to advance EDI within the curriculum.
4. Plans for the Zone Department of Emergency Medicine in 2023 include a strategic re-orientation to how our committee functions with the revamp being led by the four co-chairs, Karen Foudy, Neil Collins, Michael Suddes and Eddy Lang.
5. Ayesha Khory took on the lead as our department’s Mental Health Liaison with our colleagues in Psychiatry, Addiction and Mental Health.
6. Colin Bell was appointed as our point of care Ultrasound Lead.
7. Geriatric Emergency Care continues to receive significant boosts in visibility and impact through our Lead Physician on this portfolio, Dr. Margaret McGillivray.
8. Significant turnover in operational leadership with new Site Chief, Meira Louis, at the PLC with Haley Cochrane as Assistant Site Chief and Carly Hagel coming on board as the Assistant Chief at SHC.
9. Calgary remains a highly attractive place for emergency physicians to work. Our Physician Resource Committee, now with revised terms of reference, aligned with EDI principles has recruited 13 new physicians into the Zone in 2022.
10. A successful launch of Connect Care at both the PLC and FMC during Launches 4 and 5.
11. The launch of the Integrated Operational Centre that has resulted in an increase in UCC EMS transports without the increase in secondary transports.

ED operations have worsened in 2022 by virtue of a high EIP load and prolonged length of stay for admitted patients but it is worth noting that this is a national and even and international phenomenon and Calgary still fares well in comparison to the national average. 

https://yourhealthsystem.cihi.ca/hsp/indepth?lang=en#/theme/f3647a180b929173539c81ef6e4de088e99bdff8/3/N4IgKgFgpgtlDCAXATgGxALlAYwPatQEMAHAZygBNNQAGGgRkxQFcoBfDoA

In summary, 2022 posed significant challenges for our department but also allowed us to transform the crisis into opportunities and innovations that highlight and cement the critical role that our department plays in providing care for all Calgarians with emergency healthcare needs.