You waited all day. Did a doctor ever see you?

What happened to me

I went to VGH urgent care and waited most of the day. I was assessed by a psychiatric nurse. A physician ordered a medication for me based on what she relayed to him, and I was discharged on her assessment. That physician never examined me, and never spoke to me. No physician assistant or nurse practitioner saw me either. I was admitted at a different hospital shortly afterward.

I raised it with patient relations, who directed me to file a critical incident report. The response was that it did not meet the criteria, and that discharge based on a nursing assessment is policy.

I am writing this anonymously. Not because the account is uncertain, but because what follows should stand on the hospital’s own documents rather than on who I am.

That is not a finding that the care was appropriate. A critical incident is a narrow test — death, injury or disability not attributable to the natural course of the illness. A great deal of ordinary care sits below it.

It is also difficult to square with what the hospital publishes. If nursing-assessment discharge is policy, the public description of urgent care is inaccurate, and so is the metric the wait-time board reports.

What VGH publishes

The hospital's own description of urgent care sets out the sequence: a triage nurse establishes acuity, and then —

Patients are then seen by an Urgent Care Physician, Physician Assistant or Nurse Practitioner. vgh.mb.ca — Urgent Care

The regional wait-time board uses the same standard. A patient counts as still waiting until an initial assessment by a physician, physician assistant or nurse practitioner, and the published wait time measures the hours from registration to that moment.

The psychiatric liaison nurses who assess mental health presentations in the department are described publicly as conducting an assessment and making recommendations to the urgent care team on a treatment plan. Recommendations to the team — not the disposition itself.

What I am asking for

1. Publish the policy or medical directive that permits discharge without assessment by a physician, physician assistant or nurse practitioner.
2. State which presentations it covers and which are excluded — in particular, whether it can apply to post-operative patients.
3. Correct the public description of urgent care, or the wait-time definitions, so they match actual practice.
4. Tell patients at registration that a physician may not see them, and publish how to ask for one.