Emergency room deaths in Nova Scotia rose 10 per cent over the past year, partly because patients were arriving at hospitals with illnesses more complex and more serious than in previous years.
A total of 558 people died in ERs across the province in 2022, up from 505 in 2021. The Nova Scotia Health Authority released the data this week, in response to a freedom of information request from the provincial NDP. The health authority said in a statement that the deaths represent less than 1 per cent of the total number of patients who attended ERs in the province last year.
The state of the province’s emergency care has been under scrutiny because of the case of Allison Holthoff, a 37-year-old woman who died in an emergency room in Amherst, N.S., in late December after waiting more than six hours to see a doctor.
“You hear about these incredibly tragic cases … and they often receive a lot of publicity, but the reality is the problem is even greater than that,” said Kirk Magee, the chief of emergency departments in the Nova Scotia Health Authority’s central zone, which includes Halifax.
Deaths in ERs – defined by the province as deaths that occur after patients arrive at hospitals and are registered and triaged, but before they are discharged, released or moved to inpatient units – can fall into many categories, Dr. Magee said.
There are cases like Ms. Holthoff’s, where a patient dies after a prolonged wait without seeing a doctor. There are patients who endure long waits and leave before they receive care, get worse at home, then return to ERs and die. This can happen with stroke patients, or with those who have had heart attacks or sepsis.
And then there are patients who are treated in ERs for periods as long as several days, and die before they are moved to inpatient units or long-term care.
In its annual report on emergency departments, which was published in December, the Nova Scotia Health Authority said the average amount of time patients in triage spent waiting to see health care providers was 2.07 hours across the province.
Among individual hospitals, the shortest average wait time was 0.64 hours, at St. Mary’s Regional Hospital in Sherbrooke, N.S. The longest was 6.17 hours, at the Sacred Heart Community Health Centre on Cape Breton Island. About 8 per cent of patients across the province left emergency departments without being seen.
Alyson Lamb, the executive director of health services for the Nova Scotia Health Authority’s western zone, said an increased number of very sick patients came to ERs in 2022, compared with previous years.
When patients arrive at ERs, they are assigned a level of acuity based on the Canadian Triage Acuity Scale. The highest level is for patients whose lives are threatened, such as those who are unresponsive, and the lowest level is for patients with non-urgent symptoms, such as mild abdominal pain. In 2017, 12 per cent of all ER cases were at the second-most-acute level. In 2022, 18 per cent were.
“The sicker you are, unfortunately, there is a higher chance that, no matter how we intervene, there is a risk of death,” Ms. Lamb said.
One contributing factor to that increase in acuity is that the province has seen an increase in its elderly population.
“It’s not just an 85-year-old female with pneumonia, it’s an 85-year-old female with pneumonia who’s now very frail, and not able to be a caregiver to her husband,” Dr. Magee said.
Another factor is that many Nova Scotians do not receive primary care. When they show up in emergency departments, they are sicker than they would be if they had been getting regular checkups, Ms. Lamb said.
At the start of January, almost 130,000 Nova Scotians were on the provincial waiting list for family doctors – an increase of 56 per cent from the previous year.
Challenges like the ones Nova Scotia is facing are being felt across the country.
Michael Howlett, president of the Canadian Association of Emergency Physicians, said long waits for care and increasing numbers of deaths in ERs are signs of major breakdowns in the wider medical system from years of neglect and underspending.
In a letter the association sent this week to provincial ministers of health, it urged provinces to invest more in primary care to ensure millions of Canadians have access to doctors who can help them, and to reduce their reliance on emergency rooms for care. The group also wants to see more focused training of a variety of health care professionals. And it is calling for better care for frail elderly people not living in institutional care.
“We’re in real trouble unless we start prioritizing and focusing our investment in health care on ways that give us the biggest bang for our buck,” Dr. Howlett said.