SASKATOON - Summer usually offers a reprieve for emergency departments in cities across the country, especially when compared to the influx in patients that doctors deal with during flu season.
But this year, Canadian emergency physicians say they could not catch their breath.
“Emergency departments continue to feel very busy,” said Dr. Brittany Ellis, a Saskatoon emergency physician and representative of the Canadian Association of Emergency Physicians.
Complex cases and overcrowding are just the tip of the iceberg leading to what seems to be a busier than usual summer for emergency departments, according to Ellis.
An aging population, a short supply of inpatient beds, limited access to long-term-care facilities, and a lack of other health-care supports also contribute to the nationwide problem, she said.
“The challenges we are facing are a result of a system-level crisis,” Ellis told CTV News.
“They are not going away, and we are continuing to have ineffective services to provide patients the best care possible.”
Data shows uptick
Saskatoon experienced a 6.7 per cent increase in the number of patients treated in hospitals this summer compared to the five-year summer average, according to data provided by the Saskatchewan Health Authority (SHA).
Provincewide, there was an 8.4 per cent increase.
“More and more people are accessing emergency care,” said John Ash, vice president of Integrated Saskatoon Health with the SHA.
Throughout the summer months, Ellis witnessed patients boarding in emergency departments while they waited hours or days for an inpatient bed to free up. Others waited “for extremely long periods of time” to see an emergency physician, she said.
“This makes the emergency department environment very chaotic, very stressful and at times very difficult for patients and providers,” Ellis said.
Safe, timely access to patient care is one of the health authority’s “key priorities,” according to Ash.
The SHA has been working to increase capacity in its hospitals for the last several months. Additional inpatient beds have been added to all three of Saskatoon’s hospitals, he said.
The SHA has also added long term beds and transitional care beds in the community.
“All of this is around making sure we have the capacity so patients can get the care they need in the right care environment,” Ash said.
“We want to make sure that patients are getting out of the hospital into the appropriate location so we can free up those inpatient beds for patients that need it.”
‘Overflowing’ waiting rooms
This summer was also “markedly different” for Dr. Kirk Magee, an emergency physician at QEII Health Sciences Centre in Halifax.
“We saw emergency departments with waiting rooms that were overflowing,” he told CTV News.
Throughout the summer, Magee saw patients who had been waiting upwards of 20 hours to see a doctor.
He said he has never seen wait times that long, even in the depths of a bad flu season, which has him worried for what is to come.
“If we are seeing this in July and August, what are we going to be seeing in December and January and February when flu season hits?” Magee said.
Research from the Canadian Institute for Health Information (CIHI) shows patients are spending more time in emergency departments for assessments, tests, treatment and admission.
1 in 10 wait for over 48 hours
One in 10 patients admitted to hospital last year waited more than two days in the emergency department, according to CIHI.
“I think we can all agree that waiting for a couple hours is one thing but waiting for eight, nine, 10 or 15 hours is really a symptom of a system in crisis,” Magee said.
Nora Jacobs waited nine hours in a Saskatoon emergency room last month.
She went in with chest problems, thinking she was having a heart attack.
“The room just kept getting fuller and fuller, but nobody was leaving,” she said.
Jacobs, 71, says she did not have access to water, food or her family during her entire wait. The room was at capacity, which meant loved ones could not sit with patients, she said.
“I felt like leaving,” she told CTV News.
“It was terrible. I said I will never go back, ever.”
Impacts to patient care
Long wait times are more than just inconvenient, Ellis said. They can be linked to longer hospital stays and worse outcomes.
For example, evidence suggests a single overnight stay for an older adult in the emergency department increases their risk of dying during that hospital admission, according to Ellis.
“These are real, potentially preventable, harmful events,” she said.
Staying in overcrowded emergency departments can lead to poor quality sleep, an increased risk of delirium and greater chances of medication errors from overwhelmed care teams, Ellis explained.
“It truly is an honour to be an emergency physician in Canada. I just wish we could do it up to the level that we were trained to do,” she said.
Overcrowding and long wait times also appear to be driving some patients out of the emergency department.
Dr. Ellis says research shows an increasing number of patients are leaving before they see an ED doctor, or prior to their completion of care.
“Those are both big problems,” Ellis said. “We know that these patients have worse outcomes than patients who are seen and managed in our departments.”
Dr. Magee says there is also concern for the patients who decide not to enter the emergency department in the first place.
“You do not want to scare the public, but at the same time you have to acknowledge the reality that things are not good,” he said.
“Everyone is there to do the best job they can for their patients.”
He hopes that when people feel like they need to access an emergency department they still come, despite the challenges within the system.
No easy solution
Magee said it will take long-term commitment and accountability from health-care leaders and government officials to overcome the current challenges.
“They are not going to be quick fixes. They are going to be things that take years to improve the system,” he said.
The solution is multi-faceted, according to Magee.
He says the system needs more inpatient beds, long-term care beds and primary care practices that can treat patients before their conditions worsen and they end up in the emergency department.
The health-care system also needs the staff to operate.
“We have to create an environment that not only people want to work in the system, but that they stay for a long time,” he said.
“I can think of no better job in the world than what I do, but it is a hard job, and I think it is even harder for people that are just starting now.”
