ER closures worsening

Rarely a week goes by without another announced closure of a Nova Scotia community hospital’s emergency room due to staffing shortages.

That usually means a lack of family doctors or registered nurses in the area available to work ER shifts.

It’s a problem that’s been getting steadily worse in recent years.

That’s based on stats provided by annual emergency department accountability reports first brought in by the previous NDP government in fiscal 2009-10. Under the NDP, overall ER closures — as measured in hours — dropped from 19,116 in 2009-10 to 15,082 in 2012-13.

But ER closure hours have been climbing ever since. In December, the latest figures were released, showing ER closures jumped from 22,934.5 hours in fiscal 2016-17 to 30,493.5 hours in 2017-18, a 33 per cent year-over-year increase.

(The 2016-17 total cited has been adjusted to remove scheduled closure hours wrongly attributed to the Cobequid Community Health Centre.)

The rise in unscheduled — unplanned, temporary shutdowns — closure hours was even more startling. In 2016-17, there were 5,417.5 temporary ER closure hours; a year later, that climbed to 12,567.5 hours — a 132 per cent increase.

Let’s be clear. Closures, which solely affect smaller hospitals around the province, occur primarily due to staffing shortages. The fact closures are increasing suggests those staffing shortfalls have gotten worse. But ER closures have consequences.

Rural and small-town patients who need emergency care must travel farther to access an ER that’s actually open.

Ambulances similarly have to go farther, which takes more time.

Emergency room closures at smaller hospitals also lead to increased demand at regional hospitals. That contributes to overcrowded ERs — which is not good for patients — where paramedics at times must wait hours to offload their emergencies.

The result? Due to the squeeze on available ambulances or paramedics as a consequence of hours worked, emergency response can, at times, be thin. The union representing the province’s paramedics has been tweeting real-time warnings about a lack of ambulance coverage. Over the holidays, they said there were times no ambulances were available in either HRM or CBRM.

Another factor contributing to ER overcrowding is a frequent lack of sufficient hospital beds to admit emergency department patients who need to be hospitalized.

Those shortfalls in hospital beds are related to the lack of nursing home beds in Nova Scotia. As a result, too many patients needing long-term care get stuck in much-more-expensive hospital beds, waiting for spots to open up in a nursing home. So, in the meantime, they occupy hospital beds that are not, therefore, available for other admissions.

ER closures and overcrowding have been around since the late ’90s, but those problems seem to be intensifying.