Resuscitating trauma patients on the floor of emergency rooms and examining sick people on stretchers instead of beds has become an increasingly tough reality for staff, says the head of a group that represents ER physicians across the country.
Dr. Michael Howlett of the Canadian Association of Emergency Physicians (CAEP) said overcrowding in emergency departments has worsened as patients who fear going to hospital during the pandemic are now sicker and many more people no longer have family doctors.
“Seeing patients in hallways, on floors for resuscitation, is a real crisis in health care in a first-world country,” said Howlett, who is also chief of emergency medicine for Lakeridge Health based in Oshawa, Ont.
A series of open letters recently released by doctors at Surrey Memorial Hospital in British Columbia has drawn national attention to overcapacity in ERs and on wards where patients can’t be transferred for further care due to a lack of beds.
Howlett said health-care investments must include more training spots for ER doctors and nurses because recruiting international graduates alone will not meet Canada’s need for a high number of health-care providers, including in those specialty areas.
He said quick fixes without any long-term strategies will continue the cycle of “hallway medicine” that Canadians are becoming accustomed to, and will not solve ongoing problems that are plaguing ERs in various parts of the country.
In a recent letter to BC Health Minister Adrian Dix, the Medical Staff Association at Surrey Memorial says neither the province nor management at Fraser Health has provided “any tangible support” for ER doctors in the region where health-care funding has not kept pace with the booming population.
“Your continued silence and inaction on this issue is placing the health and well-being of Surrey residents in jeopardy,” the association wrote to Dix. In the absence of “immediate action,” patients should be transported to other ERs,” as the only responsible recourse,” the association suggested.
Dix was not available for comment by the deadline.
Howlett said the letter is drawing attention to similar issues elsewhere, even as conditions deteriorated after the pandemic.
“We don’t see people trying to find solutions to overcrowding, and it’s worse now than it was last year.”
Hospitals in parts of Ontario, for example, are making plans to prevent another summer of ER closures after the ER in Minden was shut down permanently last week due to staff shortages. The next closest emergency services are 25 kilometers away.
Niagara Health announced last week that starting July 5, it will permanently close two urgent care centers between 10 am and 10 pm so doctors can be redeployed to ERs, which it said will be short 274 physician shifts between June and August alone.
“Our staffing challenges are so serious that our (emergency department) physician group has warned us about our ability to properly staff EDs with emergency-trained physicians and nurses,” it said in a news release.
The CAEP has long called for the recruitment of more ER doctors and nurses. Last July, it wanted premiers gathered in Victoria to discuss health care to put resources for overstretched ERs on its agenda.
Howlett said provincial and territorial leaders meeting again next month in Winnipeg should prioritize staffing in ERs and work on how they will spend a combined $196 billion in federal funding announced in February by Prime Minister Justin Trudeau. All provinces, except Quebec, have agreed to a deal in principle for the money that will be shelled out over a decade.
Canada is short about 2,500 emergency room doctors so retaining and recruiting them is critical, he said.
“It remains to be seen whether or not the funding that’s been put out there will actually benefit the patients.”
Howlett said CAEP has written a report that is currently being reviewed by members wanting certain priority areas to be addressed by governments and hospital administrators through targeted investments that would keep ER doctors and nurses. He added that their job should not cause them so much “moral distress.”
It may be time for independent boards, not governments, to oversee expenditure of limited public money in health care, to allow for long-term planning that’s not vulnerable to election cycles, he said.
Howlett said the Ontario government’s announcement last week to renew funding for staffing until September in rural and northern ERs is only a short-term fix.
Data from Health Quality Ontario shows that in March, patients waited an average of 1.9 hours to be assessed by a doctor in an ER. But that wait time was 4.4 hours at the campus of the Ottawa Hospital and the Windsor Regional Hospital.
The numbers were bleacher when it came to how long ER patients waited to be admitted to a bed on a ward — 10 hours, compared with the province’s target time of eight hours, which was met for only about a quarter of all patients. However, patients in seven hospitals waited more than 30 hours to get to a ward, while the wait time was nearly 40 hours in one hospital.
Data from the Canadian Institute for Health Information (CIHI) shows 90 per cent of patients in emergency rooms across the country waited over four hours before being seen by a doctor between March 2021 and April 2022. That’s a jump from a wait of over three hours between 2017 and 2018.
For patients who were admitted to hospital, 90 per cent waited almost 41 hours before getting a bed in the period between 2021 and 2022, up from 33 hours in 2017 to 2018. The longest wait time, over 74 hours, was in Prince Edward Island’s ERs in 2021 to 2022. The province did not provide comparative data in the preceding years, CIHI data show.
Jeff Yu, who is on the board of directors for the Emergency Nurses Association British Columbia and works casual shifts in an ER while completing his training as a nurse practitioner, said three patients per shift is supposed to be the norm but he and his colleagues have been caring for up to five patients.
“It’s not uncommon to start off the day with the majority of the beds full of admitted patients,” he said.
That means patients are sometimes placed in supply rooms for intravenous polishes and other equipment “where you may not have safety equipment that is easily available to you. It’s not a space that’s designed for patient care,” he said.
“A lot of my colleagues, because they are burnt out, are worried for their patients. They are unable to provide the care they want to give,” said Yu, adding that the average career of an ER nurse lasts about five years before they move on to other types of nursing or leave the profession.
“It’s a combination of things just kind of boiling over.”
This report by The Canadian Press was first published June 7, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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