How health-care systems can calm congested ERs, according to an emergency physician

Investing in primary health care is the first step in addressing overrun hospital emergency rooms, according to a Charlottetown-based emergency room physician.

“We need some short-term, medium and long-term solutions now,” said Dr. Trevor Jain in a recent interview with CTV News.

Canadians who have family physicians spend less time in emergency departments, are healthier and can better manage their chronic diseases, he says.

A new payment model for family doctors in British Columbia, which sees physicians paid based on the time they spend with patients, the number of patient visits, the number of patients in their practice and the medical complexity of those patients, instead of a “fee-for-service” model is something Maritime health systems could consider, said Jain.

“[B.C. is] actually compensating physicians appropriately for spending time for patients who have complex medical issues, as opposed to just a through-put factory to see tons of patients per hour,” he said.

Step two in fixing emergency room overcrowding is addressing the “long-term care crisis,” said Jain.

“The highest rates of medical usage rates are for those patients over 65.”

The third step, he says, is providing better mental health care.

“If we can address those three things right off the bat, aggressively, even a one to two per cent improvement in the health-care system would help upstream and downstream in the emergency department greatly.”

Another cause of congested emergency departments is what Jain calls a “triple threat” of respiratory illnesses circulating right now.

Hospitals are seeing a significant increase in cases of flu and respiratory syncytial virus (RSV), while COVID-19 continues to be a problem, he said.

“If you have an outbreak in a hospital, we have no way to admit patients to those floors. Therefore, they have to stay in the emergency department. So it’s all kind of related.”

If hospitals were at a “sweet spot” of 85 per cent capacity, the facilities could deal with the increase of these illnesses, but with many operating at 100 per cent, “things can go south,” said Jain.

Still, Jain recommends if parents have a gut feeling there is something wrong with their child they should not hesitate to take them to the emergency department for an assessment.

“Not every fever has to be seen but I trust parents’ intuition,” said Jain. “The problem is there’s going to be extended waits when you get there.”