ER spillover into hallways creating patient risk

Staff at Atlantic Canada’s largest hospital has had to perform CPR in elevators and hastily erect brown paper room dividers due to spillover from a crowded emergency department, says a union study.

The Nova Scotia Government and General Employees Union released the report on Monday tracking a rise in so-called code census incidents at the Halifax Infirmary, when the emergency department declares the ward is “unsafe” and starts sending patients to in-patient units.

Last year, the Infirmary had 146 code census incidents, up sharply from the 87 times the rapid transfer system was enacted seven years earlier, though the figures have fluctuated.

In January, there were 23 code census calls – a new high for a single month.

“Code census only moves the problem of overcrowding onto in-patient floors,” said Jason MacLean, the union president, during a news conference in Halifax. “It’s not safe for code census to be called virtually every day in a one-month period.”

MacLean said he couldn’t comment on whether there have been deaths or injuries directly related to the overcrowding.

However, the union report includes several anonymous accounts from senior nursing staff who allege patient safety was harmed as a result of the influx of ER patients, as backlogs emerged between units and patients are left in hallways.

In one account, a nurse told researchers the sudden arrival of emergency patients meant patients in intensive care couldn’t be transferred into regular beds when they were improving.

This in turn led to long waits for acutely ill patients who needed to go into intensive care, leading to heart attacks in elevators when last-minute transfers to the ICU were attempted.

“It can take an hour or up to five hours to get the patient into intensive care units ... and we have had some very critical incidents like doing CPR in the elevator and so on,” the staff person said, referring to incidents in the last two years.