ERs in Nova Scotia under great pressure, doctors say

Emergency departments in Nova Scotia are under great pressure and as annual visits have climbed since the pandemic, so has the number of deaths in emergency care.

Emergency doctors say capacity issues in the healthcare system mean patients spend more time in emergency care instead of accessing alternative and long-term care options.

Dr. Michael Hollett, president of the Canadian Association of Emergency Physicians, says it's about access to health care and what he calls "bed-blocking."

More and more people are showing up to the emergency room, causing over-capacity issues, which means longer waits for care. Wait times can increase the risk for poorer health outcomes and possibly death.

"The main root of the problem is the inability to get people into the hospital for care who need it," said Hollett.

Figures from Nova Scotia Health show emergency department deaths have increased since the pandemic. In the last year there were 673 deaths compared to 596 in the year prior, despite fewer overall visits.

• 2023-24 – 673 deaths (total ED visits: 524,165)
• 2022-23 – 596 deaths (total ED visits: 530,181)
• 2021-22 – 541 deaths (total ED visits: 527,800)
• 2020-21 – 406 deaths (total ED visits: 491,379)
• 2019-20 – 450 deaths (total ED visits: 576,049)
• 2018-19 – 504 deaths (total ED visits: 583,824)
• 2017-18 – 502 deaths (total ED visits: 587,225)

Nova Scotia Health says more patients are arriving sicker or with more serious illnesses and diseases than in previous years.

"What we are seeing in the past year or two is sicker people coming into the emergency departments," said Tanya Penney, senior executive director with emergency care priorities with Nova Scotia Heath. “From an illness and injury perspective, there is a higher level of acuity coming into our emergency departments over the past year,” said Penney. “Front-line staff are certainly reporting sicker people coming into the emergency department.”

Tackling overcrowding issues in emergency departments requires multiple strategies, says Penney, because there's not just one issue leading to the capacity

"It's a complex issue," said Penney. "And there needs to be a multi-focussed strategy tied to that."

From infrastructure issues to health-care professional shortages to pure demographics, they all play a part.

The population in Nova Scotia continues to grow but the population is getting older, too. Nearly 22 per cent of the population is over the age of 65, which adds to the challenge, as seniors tend to live with more health-care issues.

"We know that (the department of) seniors and long-term care have committed to 2,700 new long-term care beds in the province," said Penney. "But...they won't get built overnight."

There are also 160,000 Nova Scotians without a family doctor and opposition party leaders and politicians suggest that's a major factor in more people showing up at emergency departments sicker.

"I think it's a failure to 160,000 people unattached to primary care," said NDP MLA Susan Leblanc. "People are aging and we have lots of chronic illnesses in our province, but if people had a primary care provider, they could manage those illnesses and their aging."

Liberal leader Zach Churchill says people are unnecessarily dying due to a lack of access to health-care services.

"Pressure will keep mounting on our emergency departments if the number of people who need a family doctor keeps increasing," said Churchill.

Minister of Health and Wellness Michelle Thompson says they are addressing overcrowding in emergency departments and investing in primary care and new collaborative care teams.

The Canadian Association of Emergency Physicians laid out a full plan in March with 30 recommendations to fix the emergency health-care system, which Thompson said they are working on.

"We are moving all of those things forward," said Thompson. "Some of those things take longer than others, but I don't want Nova Scotians to be afraid in any way to go to the emergency room."

To improve patient flow and expand capacity, the province is making changes across the entire health-care system, said Thompson, like creating more long-term care spaces and opening the new transitional care centre in Bedford at Hogan Court, which will open 68 beds for hospital patients transitioning back to their homes.

For more Nova Scotia news visit our dedicated provincial page.