Examining hospital services in Digby

Digby’s site lead places the list of services available in Digby on the table – it’s a long, comprehensive list created as a hospital tour, and includes the continuation of diagnostic imaging and laboratory services.

Nova Scotia Health Authority (NSHA) spokesperson Fraser Mooney states clearly that he knows of no plan that NSHA has to remove further services from the Digby General hospital and says the hospital is to remain open.

“When we’re talking about some surgeries or obstetrics in a smaller rural hospital as opposed to a regional hospital like Yarmouth, there are quality and safety issues that we need to consider when offering those services,” he says. “There is a mix of programs and services that are offered here, as well as visiting consultant clinics available here. Geographically, there is a necessity to maintain a general hospital in this area with a 24/7 emergency department, but of course … there are still sometimes challenges in staffing that all the time.”

Mooney says the province’s health service must undergo a regular, national standard, accreditation service.

“Patient safety and safe patient services are a cornerstone of that,” he says. “And it also comes down to a sustainability piece.”

Hubert D’Entremont, the Digby General Hospital site manager, explains further. In the past, for instance, obstetrics were provided by family physicians who had back-up from a general surgeon. That situation no longer meets national criteria for safety – now there must be an obstetrician available as backup.

Mooney adds that as national standards change, the NSHA has to prove they are meeting them. Mooney also says the province’s investment in a renal dialysis unit points to a significant investment in the hospital and in Digby.

NO BLAME GAME

When it comes to emergency department closures, the language NSHA uses is “physician availability.” Questions have been asked about if that language places the blame on the doctors.

Mooney responds: “That language has evolved quite a bit over the years. At one time, we would just say it was closed without giving a real explanation. I think that wasn’t fair to the providers or to the public either. As opposed to blaming, we really want to thank the physicians and the entire emergency team … I know when there is a closure, Hubert and the other team members are working right up until the last minute to find somebody. We look provincewide to find a locum to come in. Every stone is overturned.”

D’Entremont says one of the outcomes of the emergency department closures has been an increased demand on the 911 system. He has a background in paramedic work and helped set up the current EHS provincewide system. He speaks highly of the fully accredited “high-performance model” pre-hospital system N.S. has.

“The community is very fortunate that we have the type of system that we have. One challenge is, over the past years, the call volume has increased, but the number of vehicles and the number of teams has not.”

EMERGENCY SERVICES

D’Entremont calls that pre-hospital emergency system “a safety net” especially helpful if the emergency department is not open. Soon a piece of that system will be integrated into the Digby hospital emergency department in response to the problem of closures due to a lack of available physicians.

“Paramedics will be added to the staff complement at our hospital,” he says. “We’ve had the interview process and the next step is to do the hire so that paramedics will be in the emergency department. Their role will be to triage but also because the posting was related to advanced care, the paramedics will have a wider scope of practice.”

The job description for those roles was put together by a team of nursing staff and physicians to identify what exactly the scope of that role would be, and d’Entremont is hoping this inclusion will allow the emergency department to remain open. He says it’s a model that has been used successfully by the QEII’s emergency department.

Mooney says the paramedics will work for both EHS and for NSHA. D’Entremont says because of their shift work they have availability on their days off, although the hospital site lead was not clear on a start date.

USE OF SYSTEM

One Digby County resident, who chose not to be identified, has said: “That’s what everyone does now. We just call 911. The paramedics know everything, so they can tell you if you need to go to the hospital or not.”

Mooney says it’s clear that’s not what the system is designed for.

“I’ve not heard that specifically … that’s not the optimal use of the system,” he says.

Mooney, meanwhile, promises communications with the community will be improved, and will include a series of community health-care conversations and possibly a regular newsletter.

“Prior to Christmas, the primary health-care program started a community consultation process. Now in 2018 we’re going to expand that into what we call community conversations, and I know there is one scheduled for Digby,” he says. “We certainly have heard that we’re not doing enough talking with people who are accessing our services and who have a stake in high-quality services so we understand that and we want to do that better.”

Despite the ongoing challenges, both Mooney and d’Entremont remain positive about the future.

“The patient is the centre of the health team and we understand that better now than we ever did, and we have a new breed of healthcare providers now and their eagerness and input is helping us to move that idea forward,” Mooney says.

D’Entremont sentiment.

“We’re not there yet, but at the same time, there are very great advances, and that is very exciting.” adds a similar