The Victoria General Hospital's sign has a new bright red strip that says "Urgent Care" on Tuesday morning as Winnipeggers looking for emergency treatment face the first E.R. closure in Manitoba's massive health-care overhaul.

By 8 a.m., there were 15 people in Victoria hospital's newly converted urgent care centre, Winnipeg Regional Health Authority officials said.

On Monday until 2 a.m. Tuesday, the emergency room was visited by 117 people, but the health region could not say how many were looking for emergency or acute care, and how many wanted urgent care.

Overnight, ambulances were already diverting emergency patients to other ERs in the city.

The hospital's Mature Women's Health Centre saw its last patients on Friday, and patients are being shifted to the Health Sciences Centre.

Winnipeggers and some unions representing health-care workers have concerns — and some cautious optimism — about the closure.

Chasity Gentes drove her grandmother to the Victoria ER last week and was visiting on Monday. (CBC) "It doesn't seem right for elderly people," said Chasity Gentes, who drove her grandmother to the Victoria emergency department last week and visited her there on Monday.

She said she's concerned about accessibility for all seniors in Winnipeg in light of the changes.

"It's just worrying about the elderly people. Us young people can walk and bus around, but there's a lot of elders in the city."

Urgent care — which covers injuries, infections and other non-life-threatening ailments — accounts for the majority of emergency room visits, Winnipeg health officials say, and those services will continue at that site.

Misericordia's urgent care sign is gone. (Tyson Koschik/CBC) With the closure of the Misericordia Urgent Care Centre on Monday, Winnipeggers who would go there are being told to visit the Victoria General Hospital for urgent care instead.

"We've seen over the years that people in Winnipeg have made really good choices about when to go to urgent care. Less than one per cent of the people presenting at urgent care should have gone to emergency, so we anticipate that the majority of the public will make the right choices," said Lori Lamont, chief nursing officer and vice-president of the health authority.

She said emergency-trained staff are still on site at Misericordia Health Centre to provide emergency care and redirect patients who may not have gotten the message to go to other facilities. If transportation is an issue, she said, all the emergency departments in the city are equipped to provide urgent care.

Manitoba Nurses' Union president Sandi Mowat said nurses are worried about space. (CBC) But Sandi Mowat, head of the Manitoba Nurses' Union, is worried about space, given the reduction of service at the Misericordia and Victoria hospitals. Many of the emergency nurses are concerned, as waiting rooms in the three main acute centres are already often "packed," she said.

"They're going to continue to deliver the best care possible, but I think that the message we've been saying and nurses are saying is, 'Why are we rushing to do this without the proper infrastructure in place?'" Mowat said.

While eight extra treatment spaces were created at St. Boniface hospital, structural changes to the emergency departments aren't set to occur until next year, health authority officials said.

"There will be some pressure, there is no question," Lamont said, adding that in addition to the extra space at St. Boniface Hospital, staffing levels and emergency wait times will be monitored and adjusted, if necessary, daily.

The transfer of sub-acute patients from the three acute care sites has already begun, she said, which will allow easier flow of patients from the emergency departments to the wards.

"A good example of that is the move of the rehab and geriatrics unit from St B. That's an additional 36 beds that were being used in the acute hospital for what classified as sub-acute care and so that frees up additional acute care space. That's happening in the next couple of weeks," she said.

Paramedics ready for longer rides

The city's paramedics are anticipating some challenges, such as longer ambulance rides, and a change in some protocols as the changes roll out.

Paramedics union president Ryan Woiden said paramedics would like to see more community-based care as the system changes. (CBC) "We're always trying to get the patient to the right destination and if that means sometimes we bypass a hospital, then we do. And we do that now and we're going to continue to do that," said paramedics union president Ryan Woiden.

He said some paramedics are concerned about wait times at the remaining emergency departments and the offload delays at emergency sites, but still, the care still begins when they reach the patient at home.

"If you have a heart attack in Transcona, you're still going to go to the St. Boniface Hospital; that's where they specialize in cardiac events. If you have a trauma on the Perimeter, you're still going to make your way to the HSC because that's where they treat traumas. The doctors and nurses at these facilities know what they're doing, and our job is to get them there, and if that means a longer transport, we'll have the skills to do it," he said.

Woiden would like to see a shift in the city towards community-based paramedics that can provide care at people's homes, something Alberta and Ontario paramedics are beginning to do, to cut down on costs and the need for ambulance rides to hospitals altogether.

'Business as usual'

Provincial government officials have said the consolidation of emergency departments will streamline care in Manitoba, and as outlined in the Peachey report informing the transformation, will mitigate service overlap and improve efficiency of care.

Many of the other changes won't happen until spring 2018, and for people going to Seven Oaks and Concordia hospitals, it's still "business as usual," Lamont said.

Seven Oaks' emergency department will be eventually be converted to an urgent care centre like the one at the Victoria, and Concordia's emergency room will close.

"I don't think the studies have been done in-depth. I don't think they've really looked at what the impact is going to be on people, nursing, health and access," said Louise Hebert-Saindon, a nursing instructor at Université de Saint-Boniface who was picking a friend up from day surgery at the Victoria General Hospital on Monday.

She supports the urgent care centre model and opposes the closure of Misericordia's, which was "always busy" and had become a trusted site for many of the city's most vulnerable people, she said.

As the changes continue to roll out, she hopes for more consultation with health-care workers and more in-depth evaluation of the outcomes.