There are no plans to reopen overnight emergency services at Western Hospital in Alberton any time soon, according to Health P.E.I.
In fact, the future of the collaborative emergency centre at the hospital likely hinges on a review of province-wide emergency services currently underway.
And Health P.E.I. is suggesting ongoing staffing challenges will lead to further changes in the way care is delivered across the province.
The CEC had been staffed by a nurse and a paramedic to offer overnight emergency care in Alberton.
On Aug. 1, after numerous intermittent closures, Health P.E.I. said it was suspending the service until Sept. 15, due to continuing staff shortages.
Then on Sept. 15, the agency said the unit would remain closed until late October, with the possibility the shutdown could last into November.
On Nov. 3, Health P.E.I. announced the CEC would remain closed until at least January 2023.
This week the agency said it has no current plans to reopen the service, and any future decision will hinge on the results of the review, first announced in November.
May not offer 'the most service to the most patients'
Dylana Arsenault, executive director of hospital service and patient flow with Health P.E.I., said it's not that the CEC "didn't provide a service to the area, but it may not have offered the most service to the most patients."
Health P.E.I. has said there were about 200 visits to the centre per year — fewer than one per night.
"We're trying to decide: do we want to reopen that service … or should we use our resources in a different way to offer support?" said Arsenault.
Alberton has an emergency department with physician coverage that operates from 8 a.m. to 8 p.m., with the CEC covering the overnight hours.
The daytime ER has been subject to periodic closures due to a lack of staff, but is otherwise still operating.
Arsenault said it could be another three to six months before the review is complete, and in the meantime Health P.E.I. has neither "the evidence or the staffing to reopen [the CEC] at this point in time."
Arsenault said a rapid-response unit staffed by advanced care paramedics is operating overnight based out of Alberton. While those paramedics can respond to emergencies throughout the region, they are not able to transport patients to the nearest hospital in Summerside — that requires an ambulance.
About access to services, not numbers, says MLA
Local MLA Hal Perry has been a vocal supporter of the CEC, raising the issue numerous times in the P.E.I. Legislature.
"The nearest hospital after Western would be one hour away from where I live in Tignish here, and there's still 15 more minutes of the Island toward North Cape," Perry told CBC.
Perry said it's not a question of how often the service is used, but about providing some level of access to potentially life-saving services to residents of West Prince.
"You ask any person or any family who has a member who needed that CEC open when they had an emergency … it is worth to have open," said Perry.
"It's a safety net for people of West Prince to know they have access to health care whenever it's needed."
Inpatient unit running with 40% of nursing staff
But Arsenault said if Health P.E.I. tried to keep the CEC open it could put other services in the region at risk.
She said the inpatient unit at Western Hospital is currently operating with only 40 per cent of its nursing positions filled. As a result, seven of the hospital's 25 beds have been shut down.
The daytime emergency department at Western is running with less than two-thirds of its nursing complement.
Arsenault said similar situations exist across P.E.I. and across the country, and she doesn't expect things to improve in the short term.
"We are seeing a rise in enrolment within a lot of our programs, so, you know, two to three years down the road we might see some benefit to that."
In the short term, she said three things will be key to maintaining staffing levels to support health-care services.
She said staff need to be fairly compensated for their work, and every effort must be made "to make coming to the Island as attractive as possible" to assist recruitment and retention efforts.
"And I think the third thing is we have to look at our service models. We can't have these reductions [in staffing] and do things the way we did before," said Arsenault.
"We have to be able to change and move, but at the same time, not drop our quality of care."
Arsenault said she couldn't provide specifics around what sorts of changes might be considered by Health P.E.I., but said there would be "lots of public engagement" when the time comes to discuss them.