Nova Scotia announces sweeping changes to alleviate pressure on strained ERs

Nova Scotia has announced extra resources to alleviate the pressure on strained emergency departments, following the recent deaths of two women who waited hours for care.

At a news conference Wednesday morning, health officials outlined extra measures to improve ambulance response times, address long wait times and overcrowding in Nova Scotia’s ERs, and offer people more places to receive care.

“The needs of the system have expanded and changed, but the system has not,” said Health Minister Michelle Thompson during the news conference.

“Our government was elected to change that ... after so many years of neglect. The past is not the future.”

EMERGENCY CARE

The province says the following actions will ensure people who have the most urgent needs will receive care first in ERs:

• doctor-led teams will focus on getting patients out of ambulances and into ERs faster
• physician assistants and nurse practitioners will provide care in ERs
• care providers and patient advocates will support patients in waiting rooms
• virtual care will be made available to more patients with less urgent needs
• health-care teams will have access to real-time data on where beds are available across the system and what tests or other actions are needed to get patients well and home more quickly, freeing up beds for others

The doctor-led teams will make immediate care decisions, both in the ER waiting rooms and in ambulance bays.

"To actually lead on the triaging very, very quickly, and getting them out of ambulances and into the ER quickly," said Gail Tomblin Murphy, chief nurse at Nova Scotia Health.

Kevin MacMullin, the business manager of the union representing paramedics, says that's key to reducing ambulance offload times.

"The physican has seen them, they've been reassessed and, you know, it frees up our ambulances to get back on the road," said MacMullin.

The province says it plans to establish waiting room care providers in every ER in Nova Scotia by Saturday. They will reassess and check on patients, while patient advocates will provide food and blankets to keep people comfortable.

"Someone to get them a glass of water, someone to check in on them, see how they're doing," explained Deputy Health Minister Jeannine Lagasse. "Maybe their family member had to leave, so it's someone to be there, even just to talk to them."

Virtual emergency care for non-urgent needs will be expanded next month after being tested in three hospitals -- a move officials say reduced wait times by more than 60 per cent.

Officials say the focus is on ensuring those with urgent needs get care sooner, but also to transform the system long-term.

“We do have the three ingredients for meaningful change: necessary funding, experience around the province and we have political will,” said Karen Oldfield, the president and CEO of Nova Scotia Health, during Wednesday’s news conference.

The province has not said how much it will cost to make the changes, or how many extra front-line workers will need to be recruited and retained -- something officials admit will be a challenge.

"If you're a nurse or a nurse practitioner, or a physician or any other health-care workers who's looking for work, rest assured, I'm looking for you," said Oldfield.

PARAMEDICS

The province announced the following actions to support paramedics:

• paramedic training at more Nova Scotia Community College campuses
• providing a tuition rebate of $11,500 to paramedics who agree to work in the province for at least three years
• adding a second air ambulance to handle routine transfers for tests and treatment between Sydney and Halifax and Yarmouth and Halifax, allowing ground ambulances to stay in communities more often
• more funding to train medical first responders who sometimes arrive at an emergency scene first

MORE CARE OPTIONS

The province announced the following actions to give Nova Scotians more options as to where they can receive care:

• support for new and existing collaborative family medicine practices so they can see more patients
• expanding services in more pharmacies
• adding hours for virtual care appointments and enabling out-of-province doctors who are licensed in Nova Scotia to offer virtual care
• providing more mobile primary care, mobile respiratory care clinics and urgent treatment centres
• making available a new phone app, known as a digital front door, that will help people find the right services for their needs and where they are offered.

‘SENSE OF URGENCY’

Thompson said, while many of the changes have already been in the works for some time, the recent deaths of two women who spent hours waiting for care in Nova Scotia ERs has added to the "sense of urgency" for action.

“As much as we want change to happen overnight, many months of work have gone into what’s happening today,” said Thompson. "Based on recent events in emergency rooms in the province and under the premier's direction, we have accelerated these actions."

The deaths of Allison Holthoff and Charlene Snow have made national headlines this month.

Holthoff arrived at the Cumberland Regional Health Centre in Amherst, N.S., before noon on New Year’s Eve. Her husband said she was in extreme pain, even screaming that she was dying at times, but she waited hours to see a doctor.

By the time she was taken into a room and had a CT scan -- which showed internal bleeding -- it was too late, said her husband.

Roughly 12 hours after she arrived at the hospital, the 37-year-old mother of three was dead.

Snow was suffering from jaw pain and flu-like symptoms when she arrived at the Cape Breton Regional Hospital on Dec. 30, 2022.

She was triaged, but seven hours later, she decided to leave after being told she likely wouldn’t see a doctor until the next morning.

Frustrated, she returned home. Her heart stopped less than an hour later.

Both deaths are under investigation.

CRITICISM

Liberal Leader Zach Churchill criticized the Progressive Conservative government's plan for lacking details on the money and workforce needed to make it happen.

He said it remains to be seen where the workers will come from to staff the province's ERs.

"They are making new positions to deal with the crisis in our ERs -- and where are these people coming from?" he asked. "We did not hear anything about a recruitment plan or even a retention plan."

The 1st vice-president of the Nova Scotia Government and General Employees Union, which represents almost 15,000 people working in the acute health-care sector, expressed the same concern in a news release, pointing out the plan doesn't outline how to retain skilled and experienced nurses.

"The employer must provide incentives that will allow them to effectively keep experienced health-care professionals in areas of high turnover and specialized need, such as the emergency department," said Hugh Gillis.

Gillis says, on Jan. 9, the NSGEU submitted a letter and a list of 59 suggestions from members working at the Halifax Infirmary ER. He says some of the suggestions, such as adding care providers in ER waiting rooms, have been adopted.

"It is clear the government is listening and they are taking some action, but there is much more than could still be done," said Gillis.

Cumberland North MLA Elizabeth Smith-McCrossin, who has been advocating for Holthoff's family, says the measures don't adequately reflect the seriousness of the state of emergency care in Nova Scotia.

"Today's announcement falls well short of the concrete, urgent actions that Nova Scotians are looking for," said Smith-McCrossin, who sits as an independent. "At best, the measures are a rehashing of old ideas with no timelines attached. It's not enough."