Triage concept needs a rethink
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