Emergency rooms are stretched beyond capacity, with some forced to close, as a result of problems that include a major shortage of health care staff, a resurgence of viruses and a lack of available beds in hospitals and long-term care.
According to estimates online, the wait to see a doctor at Vancouver General Hospital’s emergency department was nearly nine hours on Thursday morning. It was 4½ hours at Calgary’s Peter Lougheed Centre, and nearly eight hours at the Health Sciences Centre in Winnipeg.
The Quebec government announced on Thursday that six emergency rooms in the province would be partly closed this summer due to staff shortages. A number of emergency rooms at rural and remote hospitals in B.C. have closed for short periods in recent months, including one that was shuttered at least five times last month.
Doctors report that most patients who require hospital admission from the emergency department are forced to wait for hours, sometimes days, on a stretcher until a bed opens up, which robs them of their dignity and adds to pressure in the emergency room.
“It’s wild and dangerous,” said Kerstin de Wit, an emergency physician at the Kingston Health Sciences Centre in Ontario. “It’s not how emergency medicine is designed to work.”
Many of these problems are not new. But health professionals say the COVID-19 pandemic inflamed the situation – staff burnout and resignations, more patients lacking a family doctor, fewer available hospital beds – creating crises that can no longer be ignored.
“Just a little bit of added volume and a little bit of less resources can have a really big impact on the system,” said Tara Kiran, a family physician at St. Michael’s Hospital in Toronto who conducts research on health system improvement. “What we’re seeing here is an exacerbation of the hallway medicine that existed already.”
Public health officials have said new Omicron sub-variants BA.4 and BA.5 could drive another wave of infections in the coming months, leading to an uptick in hospitalizations, particularly among the unvaccinated and people with waning immunity who may have higher risk factors.
Dr. de Wit said people are coming to the emergency room seeking prescriptions for routine medications because they have nowhere else to go. Many patients who could be sent home if they had access to support, or to rehabilitation or long-term care facilities, are left in the emergency room because nothing is available, she said.
On top of that, doctors and nurses are leaving the profession because of the unsustainable conditions they were forced to endure during the pandemic. Those who are left are working longer hours and covering for colleagues who fall sick with COVID-19 or one of the other viruses back in circulation, Dr. de Wit said.
“An eight-hour shift is sometimes a 12-hour shift, which just leads to exhaustion,” she said. “And exhausted physicians don’t make good decisions.”
Alan Drummond, co-chair of public affairs with the Canadian Association of Emergency Physicians, said a major problem that needs to be addressed is the lack of sufficient space in long-term care and other health institutions to meet the needs of an aging population. Keeping these patients in the hospital while they wait for a place elsewhere is a big source of long wait times in emergency, he added.
“The principal issue: We have insufficient bed capacity to meet the needs of an aging population,” Dr. Drummond said.
But adding beds to hospitals and other facilities would require skilled, competent health care staff to look after the patients. While recruitment and retention are important strategies to make up for shortages, Leisha Hawker, the president of Doctors Nova Scotia, said governments should rethink how primary care works so it can serve more people and prevent health professionals from burning out. A better primary care model can lead to earlier diagnoses and help patients manage chronic illness day to day, instead of ending up in the emergency department when their health reaches a crisis, Dr. Hawker said.
She cited her team-based clinic, where patients have access to an on-call physician even on Christmas Day, and other in-house professionals, which include an occupational therapist, a dietitian, a mental health counsellor and a nurse practitioner.
“My capacity is incredibly expanded. Instead of me trying to sort out something that a social worker is best at, they see our social worker,” Dr. Hawker said. “Everyone is working to the top of their scope so patients have really good care.”
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