Frustrated tales of emergency room standstills are a seasonal tradition in Newfoundland and Labrador, as they are in most jurisdictions — but this summer, it’s different.
Social media are awash with tales of desperate people lined up all day or all night, or lying on stretchers in hallways. Some just leave in frustration.
So, is it worse than in previous years?
“Yes, is the short answer to that,” says Dr. Greg Brown, clinical chief of emergency services with Eastern Health. “And I’ve been an emergency physician with Eastern Health since 2002.”
On the morning of July 26 alone, 16 patients had already been admitted to the Health Sciences Centre from ER, and there were only 23 beds available in total.
“This summer, our volumes are definitely higher than they’ve ever been, actually," Brown said. "And on top of that, of course, we’re dealing with all the normal issues in emergency, the biggest problem being exit block.”
Exit block occurs when patients can’t be moved through the system as fast as they are being seen. They don’t have a bed to go to, even though they’ve been admitted., so they are basically in limbo, taking up ER beds and stretchers needed for new admissions.
An account on Twitter last week of an elderly cancer patient having to leave the hospital after several hours without seeing anyone spurred a flood of empathy and disgust.
“My 96-year-old mom fainted three times there on Monday waiting to be seen just to get antibiotics for a severe throat infection,” one person wrote.
“Our doctors, nurses and hospital staff deserve better and our community and our families deserve better,” wrote another.
Brown says a combination of factors have led to this summer’s perfect storm, the main factor being that so many people delayed getting care at the height of the COVID-19 pandemic.
“When COVID started, people just stopped coming to emergency. They just didn’t show up. The heart attacks, the strokes — all the sick people that we normally see just didn’t come,” he said.
He said some of those people who weren’t attended to then are having further complications now.
“Not only are our volumes up, especially at the Health Sciences, but the acuity of patients is up, as well,” he said.
Another factor is a lack of available beds in long-term care, a situation caused primarily by a shortage of nurses.
In June, Eastern Health had to put a freeze on admissions to Pleasantville Towers and three other facilities because there weren’t enough nurses available.
A trickle of admissions resumed recently after some nurses were reassigned, but the backlog remains.
“We’re backed up largely because there’s a lot of patients who require an alternate level of care, so as they come into emerge, they definitely have issues — they can’t go home, they can’t walk, they need more supports — but it’s not acute, so they don’t need admission to an acute care hospital,” Brown said.
Last week, there were 80 such people in hospital beds in St. John’s waiting for space to open up.
But Brown said people shouldn’t avoid coming to emergency just because they dread the wait.
“That’s something that scares me, actually,” he said. “If people feel like they need to come to emergency, they should absolutely still come.”
Eastern Health acknowledged most of the factors affecting emergency care in a statement to The Telegram July 23.
The health authority said it is taking steps to alleviate the bottleneck, including:
• delaying some planned closures of inpatient beds;
• completing outpatient surgeries, where possible;
• encouraging home-first strategies to assist eligible patients with being discharged in a timely manner; and
• looking at ways to maximize capacity in long-term care facilities with existing resources.
The authority also said it’s working with nurses to address the problem, and admitted part of that is reassigning posts within the system and rescheduling vacation to take place after the summer period.
“Eastern Health recognizes that this is a difficult time for people awaiting health-care services. We apologize for any delays and thank them for their patience and understanding as we work through this situation,” the statement said. “We also extend our sincere appreciation to all Eastern Health staff who have contributed to improving this situation.”
Peter Jackson, Local Journalism Initiative Reporter, The Telegram