Triage con­cept needs a re­think

Cape Breton Post - - Editorial -

Triage is the process of de­ter­min­ing the pri­or­ity of pa­tients’ treat­ments based on the sever­ity of their con­di­tion. This ra­tions pa­tient treat­ment ef­fi­ciently when re­sources are in­suf­fi­cient for all to be treated im­me­di­ately. The term comes from the French verb trier, mean­ing to sep­a­rate, sift or se­lect.

I have al­ways been proud of our Cana­dian health care sys­tem of­fer­ing equal treat­ment op­por­tu­ni­ties for rich and poor alike. But I won­der if we are not able to make some im­prove­ments to what we have come to ac­cept as ‘nor­mal pro­ce­dure’?

In past years, I have of­ten taken my stu­dents in On­tario to emer­gency rooms with ski­ing in­juries or other sports in­juries, wait­ing five-six hours for mi­nor and sim­ple ex­am­i­na­tions and pro­ce­dures. More re­cently, at a lo­cal hospi­tal in Cape Bre­ton, I waited for eight hours to have five su­tures sewed on my thumb af­ter ac­ci­den­tally slic­ing it open.

This has led me to ask my­self if there is any pos­si­bil­ity of im­prov­ing our sys­tem and short­en­ing the wait­ing time. I have the great­est re­spect for our health care per­son­nel and for their in­di­vid­ual best ef­forts to meet all the needs of the pa­tients who come through the emer­gency room doors. But, sys­tem­i­cally, can we not tweak our un­der­stand­ing of triage and maybe ease the bur­den on ev­ery­one in­volved?

My ob­ser­va­tion of triage has been one where peo­ple all wait for the one over-worked doc­tor to see peo­ple in the order in which they ar­rive at emer­gency. It is much like tak­ing a num­ber and wait­ing, re­gard­less of the se­ri­ous­ness of the sit­u­a­tion!

Would it not be help­ful for the triage nurse to be al­lowed to de­ter­mine that sev­eral pa­tients with is­sues of lesser ur­gency (like need­ing a few stitches or hav­ing an X-ray to see if it is a break or a sprain or send­ing peo­ple home if a swab or a spec­i­men sent to the lab turns out to be not so se­ri­ous) could be dealt with by a des­ig­nated nurse, thus leav­ing the more se­ri­ously ill peo­ple to be seen by the doc­tor?

I know that many of th­ese med­i­cal con­cerns are han­dled ef­fec­tively and ef­fi­ciently by qual­i­fied nurses in the North­west Ter­ri­to­ries and other north­ern out­posts reg­u­larly be­cause doc­tors are just not avail­able.

No one minds that there will be de­lays when a doc­tor has to deal with an emer­gency when­ever an am­bu­lance ar­rives in the Emer­gency Depart­ment which ex­tends the wait­ing time for all the oth­ers who have been wait­ing there for hours. Yet it sur­prises me to see that ev­ery­one in the wait­ing room has to wait un­til their name is called in order of ar­rival to see the doc­tor on duty. This de­spite the fact that some are ob­vi­ously more ill than oth­ers!

What I am ask­ing is this: “Can we ques­tion the way our sys­tem is work­ing (or not work­ing so well) in hopes of im­prov­ing it and re­duc­ing wait­ing times and the stress on ev­ery­one con­cerned? Can we ask the gov­ern­ment and health care peo­ple who have the ex­per­tise to take an­other look at our won­der­ful health care sys­tem and pos­si­bly make some ad­just­ments to how we do triage in our emer­gency rooms?

Can we imag­ine a wait­ing room where some peo­ple are de­ter­mined to have lesser med­i­cal con­cerns that might be han­dled by other health care pro­fes­sion­als than med­i­cal doc­tors?

Of course, if some­one were to feel that the wait­ing time was unim­por­tant and that they would pre­fer to be seen by a doc­tor, then, by all means, they should be wel­comed to sit and wait. But, oth­ers might be happy to be seen by a nurse and go home af­ter an hour as op­posed to wait­ing six-to-eight hours to have a sim­ple pro­ce­dure done by the ex­hausted and over-worked med­i­cal doc­tor.

Per­son­ally, I wish I had had that op­tion this past week. I would have gladly taken my su­tures from a nurse and gone home af­ter an hour or so in­stead of wait­ing for eight hours for this pro­ce­dure. Basil Boudreau Lin­gan

In­ac­cu­rate count prompts NSHA apol­ogy

In re­sponse to a re­cent op-ed piece (“Doc­tor re­cruit­ment news full of ‘in­ac­cu­rate and de­cep­tive re­ports’, Cape Bre­ton Post, Aug. 5), I would like to re­spond and apol­o­gize to its au­thor, Dr. Michael MacDon­ald, and your read­ers.

The num­ber of doc­tors we re­ferred to in the re­lease ei­ther started in July, 2017 or will be ar­riv­ing over the next six months.

How­ever, the ar­ti­cle prompted us to look at our list again, and we have a cor­rec­tion to make. We an­nounced 16 doc­tors, when in fact there are 13 doc­tors ar­riv­ing. We counted a doc­tor who has been of­fered a con­tract, but has not yet signed. There­fore it should not have been in­cluded as well as a doc­tor who is start­ing, but is ac­tu­ally go­ing to an­other area, not Sydney. The third name was on the list in er­ror.

Dr. MacDon­ald makes a strong point. Re­cruit­ment takes time and takes the ef­fort of many peo­ple. The Nova Sco­tia Health Author­ity’s provin­cial re­cruit­ment team is just one part of that for­mula. Hav­ing ded­i­cated physi­cian re­cruit­ment con­sul­tants in each of our zones gives us a solid foun­da­tion for re­cruit­ment and we are for­tu­nate to have physi­cians who are pas­sion­ate about their work and their com­mu­ni­ties who can re­late to po­ten­tial re­cruits as peers and share their first­hand knowl­edge and ex­pe­ri­ences with them.

I want to apol­o­gize for any con­fu­sion this may have caused and I want to em­pha­size that this an­nounce­ment was only in­tended as good news – to con­grat­u­late the com­mu­nity, the re­cruiters and the many doc­tors who have par­tic­i­pated in this re­cruit­ment ef­fort with ob­vi­ous suc­cess. Heather Han­son

Chief, Pub­lic En­gage­ment and Com­mu­ni­ca­tions

Nova Sco­tia Health Author­ity

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