More than 100 emergency room doctors warned Health Minister Dorothy Shepherd and two regional health authorities a year ago about the “significant risk to patient safety” in New Brunswick emergency rooms, a letter obtained by CBC News shows.
Doctors expressed “serious concern” about the “unimaginably long waits and poor outcomes” patients face on a daily basis.
They also accused the health networks Horizon and Vitalité of misleading the public about the “high volume of patients” causing long waits in emergency rooms, when volumes are actually starting to return to pre-pandemic levels.
“The current overwhelming combination of understaffing, blocked access and systemic abuse of EDs by our health system has led to a provincial emergency care crisis the likes of which none of us have seen before,” the Aug. 26, 2021, letter said.
Without emergency intervention, doctors said they fear “the complete failure of emergency services in New Brunswick is imminent.”
The revelation comes after a patient died in the waiting room of Dr. Everett Chalmers Regional Hospital’s emergency department early Tuesday morning while waiting for help.
John Staples said seeing a patient die in the waiting room of Dr. Everett Chalmers Regional Hospital’s emergency room, on the verge of receiving care, was a “harsh and grim realization” that New Brunswick’s health care system is “so sadly broken “. (Joe McDonald/CBC)
Witness John Staples said the man, an adult, waited alone in a wheelchair in visible discomfort for hours when he appeared to have fallen asleep. It was only during a routine check on people in the waiting room that a hospital employee realized the man had stopped breathing, he said.
Some people waited at least eight hours, Staples said, and he saw several people leave without being treated while he was there.
Horizon Health Network confirmed that “an unexpected patient death has occurred” and says a review is underway.
Opposition politicians are calling for the resignation of the Minister of Health and an immediate judicial investigation.
The shortage is ‘intolerable’, says the medical society
In the six-page letter, the 132 emergency department doctors called for an “urgent focus” on the emergency department crisis with clear direction and support for innovative solutions and process improvements within the two health authorities.
They identify four main issues facing emergency services, in order:
- A shortage of nurses, due in part to high turnover, including a 42 percent attrition in one year in one large emergency department.
- Recruitment and retention of board-certified emergency physicians.
- Supporting admitted patients in the emergency department while waiting for a hospital bed.
- Use of emergency departments for non-urgent purposes resulting from poor access to community alternatives for unscheduled care.
The Department of Health, Horizon and Vitalité did not respond to requests for comment, including what, if any, action has been taken to address the concerns and criticisms raised in the letter.
The New Brunswick Medical Society, which was copied on the letter, shares the concerns expressed by emergency room doctors, said president Dr. Mark McMillan.
Dr. Mark McMillan, president of the New Brunswick Medical Society, called for immediate and collaborative action to address the province’s emergency department problems. (New Brunswick Medical Society)
“The shortage of human resources in health has reached an unsustainable point – we must act immediately and in collaboration with all stakeholders and communities in health to address the challenges facing the health system,” he said in an emailed statement .
McMillan also offered his sincere condolences to the family and loved ones of the deceased patient.
“While we cannot speak directly to the circumstances involved, the loss of a patient while waiting for care is tragic and distressing,” he said.
“We trust that health authorities will use their review to learn more about what happened and how to prevent this type of situation from happening again.”
Increase in patients leaving without being seen
According to the letter, a growing number of patients left emergency rooms without being seen or treated last summer.
There were “numerous” days when more than 40 patients left single emergency rooms without being seen. On June 6, for example, 52 patients left Saint John Regional Hospital’s emergency room, and another 32 patients left the next day, according to the letter.
“An increasing number of these patients deteriorate and return with serious complications due to delayed assessment.”
Many of the patients waiting on ambulance stretchers in the hallways for hours have serious medical problems and will need to be admitted, according to the letter written by emergency room doctors. (Paul Chiasson/The Canadian Press)
Although public messages from regional health authorities on social media attributed the emergency room delays to “large patient numbers and staffing challenges”, doctors said the average daily number of attendances was no higher than in 2019.
However, the number of patients requiring emergency care and hospitalization continues to rise, they said.
“Our waiting rooms are full and ambulance stretchers are lined up in our hallways waiting to unload patients, many of whom have serious medical problems and will need to be admitted.” Some patients wait in the hallways for hours, which also ties up paramedics and creates problems for New Brunswick 911 Ambulance, which responds to 911 calls.
“Dangerous Overstretching”
Nursing challenges are a “major problem,” doctors said. Emergency room nurses are highly trained and require years of training, they note, and some emergency patients require individualized nursing care.
“When the number of nurses falls below the required number per shift, emergency assessment beds are forced to close and undifferentiated emergency patients wait longer to be assessed.”
The weekend before the letter was written, the nursing shortage in Moncton’s emergency department reached a crisis point, with only four or five nurses available to cover each shift instead of the usual 15.
Many other emergency rooms had to rely on a “subcritical workforce” of one nurse and one licensed practical nurse while remaining fully open, putting patients and themselves “at grave risk,” the doctors said.
“This situation places enormous pressure on remaining staff, potentially leading to significant adverse events and further loss of our valuable nursing resources,” they warned.
“ED physicians are being dangerously overworked to avoid closures, with many having to work 24- to 36-hour shifts and weekly workloads that are three times our norms.”
A shortage of emergency physicians and nurses has forced some emergency rooms to reduce services or even temporarily close during the summer months, they noted, a situation that has happened again multiple times this summer.
Many emergency beds occupied by admitted patients
Another part of the problem, doctors say, is the number of emergency room beds occupied by patients who have been admitted to hospital but are waiting for a hospital bed.
In St. John’s, for example, there are 24 monitored emergency beds. During the month before the letter was sent there were often more than 20 admitted patients occupying these beds, which are really examination stretchers and are not intended to be occupied for more than a few hours.
Some of the patients stay in the emergency department for more than three days, which leaves only a handful of monitored beds to see about 100 emergency patients per day, of which an average of 22 will be admitted.
Long stays in the emergency room have been shown to increase the risk of poor outcomes, according to the letter. “The fast-paced, noisy, brightly lit environment of the emergency department is not conducive to the care of admitted patients,” it said.
In the emergency department of public hospitals, admitted patients stay for weeks, the letter said.
“Emergency departments are designed and staffed to rapidly screen, evaluate, investigate, and treat patients with undifferentiated serious illness and injury.”
Patients must be discharged in a timely manner to free up resources to deal with subsequent patients.
But emergency departments “over time have become the default waiting area for a broken system, emergency outpatient clinic, discharge lounge, pre- and post-operative care unit, ambulatory overflow and emergency extension, and default access for primary care and community aged care referral centre. ” doctors claim.
The Nova Scotia model is encouraged
They are calling on the government to follow the lead of Nova Scotia, which recently introduced a ministerial directive on patient flow and ambulance offloading.
Admitted patients must be transferred to inpatient units within 12 hours of registration, and ambulance patients must be discharged within 30 minutes of arrival in the emergency department. The president and chief executive officer of the health authority must report on compliance on a monthly basis.
“This directive will ensure that hospital administrators prioritize initiatives that improve patient flow in their emergency departments, which has a direct impact on improving patient outcomes,” the doctors said.
They urged the government to provide adequate resources to ensure its success.
“None of these problems can be solved by emergency medicine leadership alone – so we need the help of our colleagues in primary care, hospital services, hospital administration and government to enable us to provide the emergency services that our society expects and deserves.”
Add Comment