Small-town Ontario ERs temporarily closing on busy summer weekends

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At least half a dozen hospitals in small-town Ontario have recently been forced to close their emergency departments temporarily because of staffing shortfalls, and several are bracing for more shutdowns this summer as the pandemic-era nursing crunch shows few signs of easing.

Hospitals in Carleton Place and Almonte, both near Ottawa, and in the towns of Mount Forest, Wingham, and Durham, northwest of Toronto, all closed their emergency rooms for at least one night this week or plan to do so this weekend.

Short-term ER closings have “a significant impact on the community,” said Angela Stanley, the president and chief executive officer of North Wellington Health Care, which oversees the Louise Marshall Hospital in Mount Forest, where the ER was closed overnight Thursday. “It creates a level of tension. It’s frightening for them, right? If you have an emergency, you want to know that your local emergency department is there for you.”

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Temporary emergency department closings – especially in the summer, when health workers take much-needed vacations – have long been a concern in other parts of the country, particularly the Atlantic Provinces. But beginning last spring, as pandemic-exhausted nurses left the public hospital system or cut back on their hours, a similar phenomenon has played out in the small towns and rural areas of the country’s most populous province.

Sporadic ER closings have “been happening in other provinces for a long time. It just wasn’t happening as much in Ontario,” said Andrew Williams, president and CEO of the Huron Perth Healthcare Alliance, which oversees hospitals in Seaforth, Clinton, St. Marys and Stratford in Southwestern Ontario.

The Seaforth ER has closed 15 times since January, Mr. Williams said, while the St. Marys ER has closed once and the Clinton ER has closed twice. The Clinton department has been a daytime-only ER for about three years.

In most cases, Ontario’s ER closings have been intermittent and last-minute, usually the result of a hospital being unable to fill a night shift in a department so small it might only be staffed by two registered nurses and a physician. However, some Ontario hospitals have taken a hard look at their human-resources realities and opted for planned weekend closings or indefinite reductions to their hours, just as the summer trauma season sends more patients to their doors.

South Grey Bruce Health Centre, for example, announced overnight emergency department closings on weekends in July at its Durham site. The ER at the network’s hospital in nearby Chesley has been open only from Monday to Friday, from 7 a.m. to 5 p.m., since Dec. 5, when it reopened after a two-month closing caused by a critical shortage of nurses.

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Niagara Health cancelled overnight hours at its urgent care clinics in Fort Erie and Port Colborne beginning Wednesday so the system could shore up staffing at emergency rooms in Niagara Falls, Welland, and St. Catharines. Haliburton Highlands Health Services permanently closed the ER at its Minden site on June 1, prompting fury from locals and visitors who relied on the cottage country department.

Alan Drummond, an emergency physician at Perth and Smith Falls District Hospital and a spokesman for the Canadian Association of Emergency Physicians, added that the intermittent closings, “really are a national mess, and it really does need a national discussion.”

The hospital where Dr. Drummond works, which is about an hour’s drive southwest of Ottawa, closed its ER for three weeks last summer after several veteran nurses left the department. This year, the Perth hospital is relying on travel nurses from a private staffing agency, whom the hospital puts up in hotels to keep the ER open, Dr. Drummond said.

Some other hospitals have eschewed that option, calling it expensive and divisive. “We’re one of the few hospitals in our area that have not engaged agencies, and that’s been intentional,” said Karl Ellis, president and CEO of the Listowel Wingham Hospitals Alliance. “There’s issues with staff morale when agency nurses who are being paid far more than the local nurses are coming in on a temporary basis.”

The ER in Wingham, a town of about 3,000 near Lake Huron, was scheduled to close overnight on Friday and this coming Monday. Mr. Ellis worries the Listowel emergency department may have to close for some shifts later this summer if gaps in its schedule can’t be filled.

Hannah Jensen, a spokeswoman for Ontario Health Minister Sylvia Jones, said in an e-mail that her government is doing all it can to keep small-town emergency departments open 24/7.

She said the Ontario government has enacted rules that allow health workers licensed elsewhere in Canada to practise in Ontario easily, launched an “extern” program that offers jobs in hospitals to medical school and nursing students, reduced barriers for internationally trained health workers and renewed a higher-paying summer temporary placement program for doctors, which helped avert nearly 1,500 emergency room closings last year.