Horizon cuts hours again at Sussex ER

Sussex's MLA says a half-hour reduction in ER hours at the Sussex Health Centre could offer a pathway to reopening the emergency department to 24-hour service.

In September 2022, Horizon announced a "temporary change of service" in the Sussex emergency department to 7:30 a.m. to 8:30 p.m., seven days a week. On Friday, Horizon Health Network said in a public service announcement that ER hours at the facility would start at 8 a.m. instead.

"This slight change in hours of service will help ensure consistent physician coverage in the ED – and better accommodating physicians who commute to Sussex from outside the area – as we continue to prioritize the recruitment of additional physician support to this facility," Horizon said in the announcement.

The suspension in 24/7 service was said to be temporary, with CEO Margaret Melanson telling Brunswick News they hoped to restore service in less than a year. On Friday, Sussex Mayor Marc Thorne told Brunswick News that Melanson briefed him on the changes and that Horizon is still working to bring back 24-hour service.

"That's not off the table," Thorne said. "This comes as a result of added stress to give the doctors who work in our ER more quality of life."

The Sussex ER is staffed using a combination of full-time doctors based in Sussex and doctors rotating out of Saint John. Thorne said the new hours are a "compromise" to allow the ER to stay open while cutting down on time that travelling ER doctors have to spend away from home. The request came from physicians in the department, he said, and is aimed at reducing burnout.

"I don't like to see the ER opening up a half hour later than it should, I certainly understand how the physicians feel," Thorne said. "At the same time, it is paramount that we get back to 24/7.

"Some people may feel that this loss of a half-hour may be a confirmation that the long-term plan for our ER is to close it, and I can tell you that it is not."

Sussex-Fundy-St. Martins MLA Tammy Scott-Wallace said that ER service is "critical to this community" and that discussions about the coming summer involved "larger gaps to fill" under the existing schedule.

"That was very concerning to me," Scott-Wallace said, saying the half-hour change is "not perfect, but it's a much better scenario than I first feared."

Scott-Wallace said she was told by Melanson that some of those gaps this summer will be achieved with a "blended scenario" in which health professionals like nurse practitioners, advanced care paramedics, respiratory therapists and more could help staff the emergency department when a doctor is not available.

Scott-Wallace said she "doesn't see it as a step backward," saying that the model is a "pilot" which, if successful, could enable a return to 24-hour service in the emergency department.

"I'm optimistic about this opportunity, it's an opportunity to fill gaps with capable medical professionals, it's a service the Sussex region desperately needs."

Thorne said Horizon "had to be creative" to fill the schedule gaps and that he is "encouraged by the flexibility" shown. He said that more serious cases requiring an ambulance could be sent directly to Saint John in those cases.

"People have said for years that nurse practitioners are capable of taking on more, that advanced care paramedics are very knowledgeable and experienced in true emergency care, and they're now being brought into the scope of practice," Thorne said.

Provincial department of health spokesperson Sean Hatchard said the government is "supportive" of Horizon's efforts and said "of the most important things it can do is help ensure the province has a well-staffed health-care system."

Hatchard said the government is working with health authorities, the New Brunswick Medical Society and others on recruitment efforts, and has hired 118 physicians in the 2023-24 fiscal year, a net increase of 47.

Last July, Horizon added three ER doctors to Zone 2, which spans from St. Stephen to Saint John to Sussex, including one assigned to spend 60 per cent of their time in rural emergency departments.

Approximately six full-time staff are required to provide full-time "safe and continuous care," and Sussex has one full-time doctor with physicians rotating in, Thorne told Brunswick News at the time. Two nurse practitioners for primary care and two new registered nurses for the emergency department were also added in Sussex, Horizon said in July.

"Although there is more work to be done before the organization can fully restore 24/7 operation at the SHC Emergency Department, Horizon remains fully committed to this objective," Horizon said in July.

In Friday's announcement, Horizon said only that it is "committed to providing consistent and timely access to quality emergency medical services to residents of Sussex and the surrounding area, and we continue to work closely with community stakeholders and medical leadership on this objective."

When asked Friday if Horizon was still working towards 24/7 operation, spokesperson Kris McDavid referred to the above quote from the announcement, adding in an email that the hours "will remain in place for the foreseeable future."

Scott-Wallace said she remains optimistic that 24/7 ER service will be restored in Sussex.

"When I have any conversations, those conversations always focus on a commitment," she said. "Nobody has told me no ... so I know it's being worked on."

Thorne said he sees the move as a step towards making sure "the care is there."

"In a perfect world, we would have enough emergency room physicians that are truly dedicated ER physicians with a mix of family physicians that can completely cover off all shifts 24/7, but we're not there yet. But that doesn't mean Horizon isn't trying to get there."

Those with non-urgent medical needs are "encouraged to continue to use other options," including Tele-Care 811, pharmacies, virtual care and after-hours clinics, Horizon said in the release, adding information is available at sowhywait.ca.

Andrew Bates, Local Journalism Initiative Reporter, Telegraph-Journal