Dr. John Ross addresses a news conference regarding hospital emergency rooms in Halifax on Oct. 26, 2010.ANDREW VAUGHAN
A doctor asked to examine Nova Scotia's troubled emergency rooms says the province needs to develop more collaborative practices to relieve the pressure on overcrowded and overworked emergency departments.
Dr. John Ross said Tuesday close to 90 per cent of visits to small emergency departments in rural areas involve health problems that can be treated in one-stop clinics, which can see patients through same-day or next-day appointments and handle most medical problems that aren't life-threatening emergencies.
Ross recommended setting up a series of 16 clinics at community hospitals across the province that would be staffed by doctors, nurses, nurse practitioners and paramedics.
And although he made no specific recommendations for closures of any of the province's 38 emergency departments, he suggested there are options besides keeping all of them open 24 hours a day, seven days a week. That would be especially true, he said, for some rural departments that see less than two patients a night.
"Options would be variable hours or different types of on-call systems," said Dr. Ross as he released his final report.
He said they would included the use of video technology and systems such as Health Link 811 where nurses provide advice on minor emergency care.
Dr. Ross said his research indicated people are often simply looking for timely assurance that they will be looked after when they are ill or injured.
"As long as we can give them [patients]a decision maker and provide the emergency care it's not necessarily through a doctor or a building," he said.
That suggestion is bound to be sensitive politically for the province's NDP government, which promised to keep all emergency rooms open around the clock during the 2009 election campaign.
Health Minister Maureen MacDonald said Dr. Ross didn't recommend closures. She said the thrust of his report is about improving access to primary and emergency care.
"Our campaign commitment was to provide good quality health care, shorten wait times and have access to emergency health services ... this report really is the road map to get us to that system," said Ms. MacDonald.
The minister said the government would take time to digest the report's 26 recommendations, but promised it wouldn't gather dust.
"The building of collaborative practices is a big piece of what needs to happen," Ms. MacDonald said.
However, Conservative health critic Chris d'Entremont questioned whether the government would have the political will to implement the changes recommended by Ross.
"The second you talk to a community ... and you tell them, 'Sorry, we weren't able to do it and we are going to close your emergency room,' I would say that you're going to have lots of people protesting against you," said Mr. d'Entremont.
The former health minister also said it would be expensive to implement many of the recommendations, including the use of electronic systems.
Liberal health critic Diana Whalen said Ross isn't advocating a blanket solution for all.
"What I see happening is that it's going to be a question of cost and almost negotiations with communities," said Ms. Whalen.
Other recommendations in the report include the setting of minimum standards to raise the quality and consistency of emergency care in every region and the use of performance-based funding as an incentive for emergency departments and health care providers.
"I hope this report gets a lot of the issues on the table that people can start talking about ... otherwise we are going to end up having crisis after crisis," said Dr. Ross.