Nova Scotia hospitals to add more staff to ER departments in response to health care crisis

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The Nova Scotia government announced a series of changes to its emergency care strategy Wednesday, including how ERs are staffed, after mounting calls from patients and health care workers to rescue a system in crisis.

The province will staff up its emergency departments with more nurses and physician assistants to improve waiting times, create more opportunities for paramedics to receive training and divert less-severe cases to virtual care and pharmacies.

Doctor-led teams may now offer care to critical patients before they’ve even been transported from the ambulance to the ER. Physician assistants and nurses will be able to provide care to patients triaged at a lower level of severity who would otherwise be enduring longer waits to see doctors. Patient advocates will be available to support people in waiting rooms by providing comforts such as blankets and water.

Nova Scotia is grappling with many of the same issues plaguing other provinces and territories across the country: long waiting times in emergency rooms; surgical backlogs; and shortages of doctors and nurses.

“Our health care system has been neglected for years,” said Nova Scotia Health Minister Michelle Thompson at a news conference.

Successive governments, she said, “were warned that our work force would retire en masse. Chronic disease rates were increasing and our proportion of the population that was elderly would grow. And the lack of proper infrastructure and human-resource investments would leave us in the place we find ourselves in today. But nobody listened.”

The government’s announcement follows two high-profile cases in late December where patients waited hours in Nova Scotia emergency rooms. Allison Holthoff, 37, died in an Amherst ER after waiting more than six hours and complaining of excruciating stomach pain. Charlene Snow, 67, spent more than seven hours in a Sydney emergency room with jaw pain and flu-like symptoms before giving up and returning home, where she died.

Last week, the Nova Scotia Health Authority released data that showed a total of 558 people died in ERs across the province in 2022, up 10 per cent from 2021.

Leisha Hawker, president of Doctors Nova Scotia, described the new measures as “an excellent step toward improving the emergency-department system” but said that continued investments in primary care are key.

“The emergency department is a canary in the coal mine in terms of how the entire health system is functioning,” said Dr. Hawker, who is a primary-care physician. “The issue a lot of times lies in the fact that our emergency system is responding to urgent and emergent issues. But also, it’s a catch-all for all the Nova Scotians – about 130,000 – who can’t access primary care any other way.”

Alan Drummond, a spokesperson for the Canadian Association of Emergency Physicians, said it’s encouraging to see Nova Scotia taking the crisis seriously. But the changes likely won’t accomplish much, as emergency-room pressures are just a symptom of a much wider problem facing the health care system, including a lack of nurses and hospital beds.

“A lot of this is fluff around the periphery without actually addressing the core problem,” Dr. Drummond said.

For instance, it is a good idea to utilize physician assistants, but there aren’t enough nurses to carry out their orders, which means backlogs and long waits will remain. Dr. Drummond said provinces need to finally address core system problems and develop real solutions, from a comprehensive health-human-resources plan to more hospital capacity to better access to community care for an aging population.

“None of them want to address the core issue,” Dr. Drummond said. “It’s time for a national discussion about this.”

Pilot projects that Nova Scotia has run to change how it delivers health care – particularly to those without a family doctor – suggest there are ways to effectively divert patients from ERs to more appropriate places, said Nova Scotia Health chief executive Karen Oldfield at Wednesday’s press conference.

At Colchester East Hants Health Centre in Truro, about 1,300 patients who were triaged as lower acuity were given the choice to see a virtual doctor and many of them agreed, which significantly reduced the waiting times for them. It turned out that a large portion of these patients simply needed a prescription refill.

Part of Nova Scotia’s new strategy will introduce more virtual ERs like the one at Colchester, but also add more mobile clinics where people can receive primary care and expand the care that can be delivered at pharmacies.

The province has also announced that it will offer a significant tuition rebate to paramedics who agree to work in the province for at least three years – retention of workers has proved to be a major challenge to Nova Scotia’s health care system.

Earlier this month, the Nova Scotia Government and General Employees Union sent a letter to Ms. Oldfield highlighting “grave concerns about patient safety and their own working conditions” shared by its health care worker members who staff the Halifax Infirmary emergency department.

In the letter, the union said the most pressing issue for the province to tackle was retention of staff and that Nova Scotia would have to offer financial incentives to make this happen, or risk losing nurses to private agencies that pay far more and offer better flexibility.

Editor’s note: (Jan 19, 2023): An earlier version of this article incorrectly said neither Allison Holthoff, nor Charlene Snow, were able to see a doctor before they died. In fact, Ms. Holthoff was seen.