‘We need more resources’: More Nova Scotians leaving emergency rooms without seeing a doctor

Cape Breton-based emergency physician Dr. Margaret Fraser wasn’t surprised to hear that national numbers collected by CTV reveal a big spike in the number of people across the country who come to an emergency department for care, and then leave after growing tired of waiting.

The CTV report found in 2021-22 nearly a million people walked out of EDs, a fivefold increase over almost two decades.

“It's very concerning, because some of those people need to be there,” says Dr. Fraser.

It’s a situation she’s familiar with, just this week there was a serious case of a patient who left the emergency department in Sydney after a long wait.

Dr. Fraser says it’s fortunate the patient decided to come back to the ED the following day.

“When they came back and saw me yesterday, they had a case of something called tension pneumothorax, where one entire lung had deflated and their heart was being pushed by the air that was in their chest cavity,” said Fraser.

Dr. Fraser says without diagnosis and treatment, the condition can lead to cardiac arrest and potential death.

“So fortunately they waited yesterday and they were able to be seen, but that could have been a very adverse outcome,” she adds.

Nova Scotia Health says it has seen more patients leave without being seen, although the numbers aren’t as dramatic as national figures.

According to the health authority, 43,058 people left emergency departments in the 2021 – 2022 fiscal year, amounting to 8.2 per cent of registered patients.

In the 2022-2023 fiscal year, that number was 55, 036, or 10.4 per cent.

“We do see patients leaving typically they are the less acute patients, they traditionally wait longer, they still are seen by a clinician but not a provider,” says Allison Lamb, NS Health’s executive director of health services for the western zone.

That means patients register and are triaged, but then often have to wait.

“We are trialing different models because we know the waits, particularly for the lower acuity, are challenging and we’ve also created other access points to care, so really encouraging the virtual care, the Pharmacy Plus, and some of the other models,” she adds.

For Dr. Fraser, the challenges facing emergency departments come from a number of issues.

“We have few nurses than we need in our system right now,” she explains. “We’re running with casual staff who, for one reason or another, can’t take a fulltime position right now.”

Then there’s the shortage of hospital beds.

“Canada has fewer beds per capita than virtually any other country in the industrialized world,” says Dr. Fraser. “Nova Scotia had a boom in hospital development in the 70s and 80s, and has been at a virtual standstill since then.”

Thursday, the PC government’s Minister of Healthcare Redevelopment, Colton LeBlanc, told reporters construction of a new health care facility to replace the aging Halifax Infirmary remains in the design phase, five years after it was announced by the previous Liberal government.

“Recognizing that this is a very important need for our healthcare system in our province,” he said, “it is very focused on design, this year was based on getting a design solidified on this project and we continue to do so.”

Nova Scotia’s health minister hopes providing more primary and long term care options will make a difference in emergency departments.

“All of the efforts that we are creating really are with a view of taking the strain and stress of the emergency room and making sure people get the right care at the right time with the right provider,” says Michelle Thompson.

Opposition leader Zach Churchill says government needs to do more.

“We need more resources in our emergency rooms, we need to figure out how to get more patients from ambulances into hospitals more quickly,” he says. “We need to open up our rural emergency departments once again, or people will still not have access in some of our most remote regions of the province.”

“Again, this is a government that says they are laser-focused on fixing health care, (but) this is a symptom of the ways in which Nova Scotians do not have access to primary care in a consistent way,” NDP leader Claudia Chender adds.

Lamb says the situation has been exacerbated by a population that is both increasing, and aging with more complex health concerns.

She adds it’s important for anyone waiting in an ED to let healthcare staff know if they start to feel worse.

“There’s always eyes on the waiting room, so if someone is visibly getting worse they can be pulled into the emergency department, and certainly we advocate to go back up to the triage nurse or clinician and indicate you’re feeling more unwell so we can re-triage if needed,” she explains.

Dr. Fraser urges residents to seek out care when they need it.

“If you feel you are really unwell, please do not leave,” she says.

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