Halifax doctors worry announced ER improvements won't work due to lack of beds

HALIFAX -

A group of emergency room doctors released an open letter to Nova Scotia's premier Thursday expressing worry that changes announced for the province's stressed emergency departments won't address the problem.

The letter to Tim Houston, signed by 39 doctors in the province's largest and busiest ER, said the real problem is not the "overuse" of emergency departments but a lack of bed space for ER patients.

"While we are enthusiastic about the government's commitment to addressing this issue, we worry the proposed solutions won't address the problem," read the letter by doctors from the Halifax Infirmary.

The doctors said patients wait for hours in the emergency department because there is nowhere to put the next person needing care.

"Care from a nurse, nurse practitioner, physician assistant or doctor all requires an actual, private space for the patient," they said. "Our emergency departments are so filled with admitted patients that these beds are simply not available."

That's led to overcrowded ERs and delays in admitting patients who arrive by ambulance, the doctors said. Patients waiting six to eight hours before being admitted to hospital suffer a death rate that is eight per cent higher than those who don't wait as long, they added, meaning one extra patient death occurs for every three or four days that an emergency department is blocked.

The government measures announced Wednesday included the creation of doctor-led triage teams to focus on admitting patients more quickly to ERs and assigning more physician assistants and nurse practitioners to emergency departments.

Health Minister Michelle Thompson has said the urgency to implement the changes was highlighted by the recent deaths of two patients following lengthy waits for treatment in emergency departments. Allison Holthoff, 37, died Dec. 31 after waiting seven hours for treatment in Amherst, N.S., while Charlene Snow, 67, died Dec. 30 after giving up on seeing a doctor at a Cape Breton ER about flu-like symptoms and jaw pain.

Dr. Lorri Beatty, one of the doctors who signed the letter, said on some days 95 per cent of the Halifax Infirmary emergency department's beds are filled with patients who have already been admitted to hospital, but can't be moved to beds elsewhere.

"That leaves us with only a couple of beds for the 200-plus people coming in through the waiting room and via (ambulance)," Beatty said.

A more than 10-year veteran of ER work, Beatty said she can't remember a time when the movement of patients from ambulances through her department wasn't hindered by delays.

"But it's certainly an issue that I've seen get steadily worse over the last couple of years," she said.

Houston didn't dispute the letter's main assertion when questioned following Thursday's cabinet meeting.

"The issues in health-care are long-standing and complex," the premier said. "There's no question that bed utilization and those types of issues are real issues."

However, he defended the government's plan as part of a number of steps that are needed to improve the situation in hospitals and ERs.

"There's a lot more work to be done on this and people know that."

He said part of the solution is bed management, which the government is addressing through the expansion of a coordination centre that provides real-time data to emergency departments about the availability of beds across the health system, as well as the tests that are needed to discharge patients.

"We will continue to listen and to act and there will be more to come," said Houston.

Gunter Holthoff, Allison's husband, said the government's response to his wife's death is too little, too late.

He said most of the changes that were announced will not have a real impact on the health system for some time.

"What's missing is a sense of urgency," he said in a statement Thursday. "We need more health professionals in our emergency rooms now.

"This is a true emergency, and although this problem may have grown steadily and quietly over the last number of years -- we do not have years to quietly address it."

The Nova Scotia Nurses' Union weighed in Thursday, saying the government's plan failed to address the "staggering" nurse vacancy rate and "urgent and untenable" pressures on nurses in ERs.

"We can get patients to emergency faster, we can get more ambulances on the road, but if we don't have professional staff and beds on the other side of the waiting room, wait times will not be reduced," union president Janet Hazelton said in an emailed statement.

Hazelton also expressed concern the changes could mean even more work for overburdened nurses.

But Thompson said Thursday she doesn't believe that's the case, because the plan includes the addition of more staff in ERs. That includes care providers, such as nurse practitioners, as well as non-medical patient advocates who will work to ensure patients are comfortable while they wait for treatment.

"I would hope that it's not seen as additional work for the nursing staff, it's actually a support to the clinical care environment that they are working in," she said.

Thompson said the government is continuing efforts to address Nova Scotia's nursing shortage, which now stands at about 1,200 nurses.

This report by The Canadian Press was first published Jan. 19, 2023.