White Robe Black Art26:30emergencies in crisis
Staying in the ER for hours or even days waiting for a hospital bed should be viewed by Canadians as unacceptable, says an ER doctor.
But Dr. Catherine Varner, who is also deputy editor of the Canadian Medical Association Journal, recently penned an editorial warning that emergency departments across the country are facing record-breaking situations. waiting times and closures this summer.
“There have been times in the last couple of years when I’m standing in our waiting room with so many patients waiting to be seen, many of whom are uncomfortable and ill, that you want to yell to the rooftops and say, ‘This is so. it’s what a collapsed healthcare system looks like,'” Varner said in an interview with his colleague, Dr. Brian Goldman, host of CBC Radio’s White Coat, Black Art.
This week, prime ministers pledged to improve health care as a key priority after their meeting in Winnipeg. This comes as ERs across the country still face overcrowding, record wait times, a lack of hospital beds, closures, and staff burnout. The situation is dire for some patients, with reports across the country of people dying while waiting in hospitals.
Some studies suggest that patients admitted to hospital who have to stay in the emergency room because beds in the units are not available may face a higher risk of dying on longer they stay in the emergency department.
Varner, who works in a Toronto emergency room, said patients start out frustrated. But when people with a broken hip, for example, wait hours to be admitted to hospital, she is told that fear grips her, which is a “deep disappointment.”
Trying to maintain a patient’s privacy in a waiting room is challenging, he said. This has led to what she says is a new field, waiting room medicine, where providers adapt to seeing patients sitting in a chair in the waiting room rather than lying on a table or using unconventional spaces, such as an ambulance parked at the entrance of the hospital.
ER doors should never be locked, daughter says
But wait times aren’t the only problem facing Canadian emergency rooms. Shelley Gosselin’s father, Charles Marsh, died before she could enter an open emergency department.
Gosselin said the 78-year-old Marsh was in good health when he had an asthma attack in February. He drove to the local emergency room in Bonavista, NL, looking for oxygen, but it was unexpectedly closed due to staffing shortages. Marsh called an ambulance the next day and died on the way to another emergency room.
Gosselin, who spent 25 years working as a nurse in the military, said it’s hard to view the degrading healthcare system from both sides, knowing that people are dying because their medical needs are not being met.
“There were nurses in the hospital who could have opened the doors and let him in and give him oxygen,” the Ottawa resident said in The current last week.
“Never, ever, should emergency room doors be locked and people who need the essentials in life kept away.”
At the time, Eastern Health said in a statement to Breaking: that it cannot publicly discuss any details related to an individual patient’s case due to the Personal Health Information Act.
In March, the provincial health minister offered doctors $200,000 signing bonus to work at Bonavista.
‘The safety net’
Dr. Paul Atkinson, deputy editor of the Canadian Journal of Emergency MedicineHe said lockdowns in rural areas across the country shouldn’t be happening.
But Atkinson, who runs the emergency medicine department at Horizon Health Network in Saint John, NB, points out that there is another problem contributing to ER overcrowding: people who go to ERs to access care are not scheduled 24 hours a day, 7 days a week.
ERs weren’t designed for that, he said; they were designed to deal with emergencies such as cardiac arrests, strokes, and limb-threatening injuries.
“But how do you do that when you’re also the safety net, when you’re also the admitting area, the waiting area, when you’re also the primary care area or the area where people go when they have nowhere to sleep? on a cold Canadian afternoon? he said.
Both doctors said there is no easy answer to the ER crisis and called for more resources. These include increasing hospital beds, retaining experienced triage nurses, and adding specialists, diagnostic imaging, and operating rooms.
For example, Canada has one of the lowest rates of acute hospital beds per capita in the world. OECD countrieswith only 2.6 beds per 1,000 inhabitants.
Varner suggested expanding the role of nurse practitioners, dietitians, and counselors so that patients can access comprehensive primary care in a timely manner. That’s important given so many family doctors retire like the country the population also grows and centuriesshe said.
Atkinson hopes that innovation, such as receiving specialist advice virtually for critically ill patients, will also help staff at smaller ERs better cope.
How paramedics can help
As a paramedic in Nova Scotia for over 40 years, Kevin McMullin sees his profession adapt to new challenges as well. McMullin believes he has been called in to help revive patients who have gone into cardiac arrest at a hospital “probably at least half a dozen times in the last few years.”
In June, a cardiac arrest at Soldiers Memorial Hospital in Middleton, NS made headlines when nurses had to summon members of the volunteer Middleton Fire Department to resuscitate a patient who was admitted to one of the floors.
McMullin, business manager for the union that represents paramedics and patient transport operators in Nova Scotia, said it’s now normal for the province’s emergency medical center to send medical first responders from local fire departments, as well as paramedics, to Code Blues for hospitalized patients. patients
“They mutter and sigh at the system,” McMullin said of the paramedics treating cardiac arrest patients at the hospital. “If you’re in a rural area, you used to be able to transport yourself to the nearest hospital [that] it could be only 15 minutes away. Now your transport can be up to an hour. So as a result, it means you have patient care issues for a longer period.”
McMullin’s proposed solutions to the ER crisis include:
The Nova Scotia Health Authority said that on the night in question, the inpatient units at Soldiers Memorial Hospital were fully staffed, including a doctor on call.
Despite the ER crisis, Varner stressed that anyone who needs emergency care should come. As always, patients requiring resuscitation will be seen first.
“Be patient because we will see you, we will provide you with high-quality care, but it may take longer,” he said.