As Sarah McLeod’s asthmatic son struggled to breathe during a recent trip to the Calgary ER, she looked up at the chart to see a 10-hour wait time between her son and the care he was receiving. needed.
When she arrived, her son was stable. But he got worse, so McLeod spoke to a nurse.
“The nurse looked at her system and there were, again, no beds available. She was obviously frustrated. She told me she could tell the system was down,” McLeod said.
The nurse was able to find a bed in another unit and McLeod’s son was finally able to get help. But the whole ordeal lasted about eight hours.
“When I left the room, there were still families there when I started at three in the morning,” McLeod said.
The question of the long wait times plague hospital emergency departments long before the COVID-19 pandemic. In Ontario, emergency room patients struggle with with record waiting times to be admitted to hospital.
Black Art White Coat26:30Emergency crisis and solutions
Healthcare experts say there are a number of solutions that could ease the built-up pressure. Some of these solutions will take some time to implement, but others could be implemented now.
Dr. Lindy Samson, chief of staff at CHEO (formerly the Children’s Hospital of Eastern Ontario), says it’s important for children and their development that the wait issue be resolved now, because the ripple effect of crowded emergency departments is impacting surgeries.
“Inpatient medical wards have been 100% or more busy for the past few weeks. And when that happens, it delays the ability for children in the emergency room who need to be admitted to hospital to be able to leave. the emergency department and go up to their hospital room,” said Samson, who is also a pediatric infectious disease specialist.
Non-emergency mental health care
Samson says CHEO is seeing respiratory viruses circulating and an increase in trauma and broken bones that come with children playing outside in the summer.
On top of that, she says, there are a large number of children and adolescents suffering from acute mental distress. And that’s where CHEO started making a difference.
Samson says CHEO is trying to reduce wait times by removing the need for some children to even go to the emergency department in the first place.
The hospital has established a provincially funded Child and Youth Health Team, which partners with more than 60 organizations and providers who work in children’s health care, such as physicians from family, paediatricians, mental health agencies and home care providers.
This group worked together to create a program called One Call, One Click, which is a mental health service that provides easy access to information and sorting to find who can provide the best help in the shortest possible time. without setting foot in the emergency room.
Samson says it’s about putting “children and their families and their needs at the center and [building] a system around that in an integrated way rather than having people jump through hoops and go to different silos planning separately.”
And Samson says the general approach works.
“There is pre-COVID data that shows it decreases their need for hospital admission and I believe ER visits as well,” Samson said.
Rapid assessment areas
Dr. David Petrie says reducing wait times in emergency departments is complex, but can be done by understanding how a hospital system as a whole works and where the problems lie.
Petrie is an emergency physician in Halifax and has worked in emergency medicine for nearly 30 years.
He says that in Nova Scotia emergency departments, the wait between registration and seeing a doctor averages about four hours, but can be up to eight hours.
Petrie suggests in particular improving the system by making better use of the beds available to hospitals.
“Ten, fifteen years ago, a [emergency department] the bed was a [emergency department] bed and the next patient came in, stayed in that bed until his exam was complete… so there was a delay before a decision could be made, and the patient was either moved upstairs to his inpatient bed, be out,” Petrie said.
But Petrie thinks a rapid assessment zone could change that.
“You bring someone in, do your story and your physical… then get them out of that bed where possible, move them into what you might call an internal waiting room and move the next patient “, Petrie said.
“So rather than occupying a bed for four to five hours with one patient, you could move five, six, seven, eight patients into that single bed.”
Responsibility and coordination
Petrie also suggests improving accountability. He says that often different departments do not work together and that by solving their own problems, they will create problems for others.
For example, an inpatient department with a long queue may leave patients in the emergency room. But Petrie says that can be solved with accountability in health care.
“Specifically…some of the most effective impacts on [keeping people moving through the ER] have to do with holding people accountable to certain flow goals,” Petrie said.
“And it has to do with the length of stay. It has to do with sticking to the scheduled exit time, a host of things that can make a difference.”
And Petrie and Samson agree that greater collaboration and teamwork across health services can also help solve the current problem.
“We all have to be committed to our patients and the system, and we all have to work across those boundaries,” Petrie said. “It’s the only way we can get out of this.”
It’s those kinds of differences that Sarah McLeod said she hopes to see so that if she has to take her son to the ER again, he gets help sooner.
“I think we, as citizens, as parents, deserve to know what hospital wait times are and why they are so bad and what can we do about it?” McLeod said.
“Hopefully in the future I won’t have to go back unless it’s incredibly bad.”
Produced by Colleen Ross, Amina Zafar and Stéphanie Dubois.
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