‘Best care’ im­pos­si­ble in stressed emer­gency

Cape Breton Post - - EDITORIAL - Jim Vib­ert Op-ed Jim Vib­ert con­sulted or worked for five Nova Sco­tia gov­ern­ments. He now keeps a close and crit­i­cal eye on provin­cial and re­gional pow­ers.

The so­cial me­dia post was terse, likely writ­ten in haste, but it cap­tured the frus­tra­tion, des­per­a­tion and anger of a doc­tor strug­gling to do what she trained for, un­der con­di­tions that con­spired against her.

There is “noth­ing short of a cri­sis in our (Cape Bre­ton) re­gional emer­gency depart­ment,” Meg Keat­ing wrote last week. “Sick pa­tients in hall­way beds; staff forced to re­pur­pose random spa­ces, like wash­rooms, to per­form as­sess­ments; 26 ad­mit­ted pa­tients wait­ing for beds; only enough car­diac mon­i­tors for the sick­est.”

Her col­league, Mar­garet Fraser, saw a sep­a­rate call for help from the depart­ment the same day, so she went in for a few hours. She was back at six the next morn­ing. The chaotic con­di­tions per­sisted through­out that day and into the next. Pa­tients were jammed ev­ery­where, am­bu­lances stacked up out­side wait­ing to un­load, and the re­lent­less stream of walk-ins con­tin­ued. Staff stress lev­els kept climb­ing.

“When you know you are not pro­vid­ing the best pos­si­ble care be­cause it is sim­ply phys­i­cally im­pos­si­ble, that cre­ates stress. All that ad­di­tional stress cre­ates burnout and moral in­jury,” says Dr. Fraser, pres­i­dent of the Cape Bre­ton Med­i­cal Staff As­so­ci­a­tion.

The Nova Sco­tia Health Au­thor­ity wants you to know that the emer­gency in emer­gency is not unique to Cape Bre­ton, nor is it a phe­nom­e­non pe­cu­liar to Nova Sco­tia. While mis­ery is said to love com­pany, the au­thor­ity’s mes­sage about the width and breadth of the prob­lem pro­vides no com­fort to pa­tients or staff sur­viv­ing – some barely – in the mo­ment.

The Health Depart­ment be­lieves the hos­pi­tal re­de­vel­op­ment in Cape Bre­ton ad­dresses prob­lems like over­whelmed emer­gency de­part­ments. The emer­gency depart­ment at the re­gional hos­pi­tal will be ex­panded by 40 per cent and Glace Bay’s emer­gency depart­ment will get big­ger too. Of course, hos­pi­tals in North Syd­ney and New Water­ford will close, tak­ing their emer­gency de­part­ments with them.

Chris Mil­burn is head of emer­gency ser­vices in the NSHA’s east­ern zone, which in­cludes all of Cape Bre­ton along with Antigo­nish and Guys­bor­ough coun­ties on the main­land. He says big­ger emer­gency de­part­ments aren’t the an­swer if there aren’t doc­tors to staff them, or when emer­gency beds are filled by pa­tients who’ve been ad­mit­ted and are wait­ing for an in­pa­tient bed.

Mil­burn ex­pects the doc­tor short­age to get worse be­fore it gets any bet­ter.

“The physi­cian re­source pic­ture is re­ally bad right now,” he said. The provin­cial locum pro­gram “is keep­ing us afloat” by ro­tat­ing docs into the re­gion to work on a short­term ba­sis.

Nova Sco­tia com­petes for physi­cians with prov­inces, states and na­tions that pay more and tax less.

The re­de­vel­op­ment plans in Cape Bre­ton in­clude some added long-term care beds – the first new nurs­ing home beds the cur­rent gov­ern­ment, now in its sixth year, has ap­proved.

The gov­ern­ment has been miserly with new nurs­ing home beds, de­spite the bot­tle­neck cre­ated when hos­pi­tal beds are “blocked” – oc­cu­pied by folks wait­ing for a place in a nurs­ing home – as they fre­quently are in hos­pi­tals across the prov­ince.

As a prac­tis­ing physi­cian with a lead­er­ship role in the au­thor­ity, Mil­burn sees the prob­lems in health care from a cou­ple of per­spec­tives, but the one he ad­vo­cates is the big pic­ture.

“Health care has been go­ing in this di­rec­tion for over 25 years,” he said, while the prob­lems in the sys­tem per­sisted and grew. But there’s never been a re­al­is­tic and rea­son­able dis­cus­sion about how to ad­dress those prob­lems and en­sure the sys­tem is sus­tain­able. That dis­cus­sion is over­due and ur­gent.

Yet, Nova Sco­tia’s gov­ern­ment has shown no ap­petite for hav­ing, let alone lead­ing, any di­a­logue, dis­course, con­ver­sa­tion or con­sul­ta­tion of that na­ture.

The pol­i­tics of health care are per­ilous, so gov­ern­ments and their sur­ro­gates – like the health au­thor­ity – of­fer up so­lu­tions for symp­toms while the un­der­ly­ing prob­lems fes­ter. Peo­ple are told the glass is half full even when the ev­i­dence sug­gests it’s bone dry.

Mean­while, long waits in emer­gency de­part­ments be­come in­ter­minable with the slight­est uptick in de­mand. Hos­pi­tals op­er­ate at 100-per-cent ca­pac­ity as a mat­ter of course. A surge in pa­tients, what­ever the cause, pushes de­mand past ca­pac­ity and cre­ates the chaotic con­di­tions de­scribed so aptly in so few words by Dr. Keat­ing.

It also cre­ates dan­ger. Pa­tients leave be­fore they are treated, of­ten be­cause they are just too sick to stay.

Some will reap­pear but oth­ers, says Dr. Fraser, “in­evitably die from lack of care. It is a straight num­bers game; sooner or later some­one will go home with a se­ri­ous health con­di­tion and die.”

It feels like that rea­son­able dis­cus­sion, if it will truly help, can’t wait any longer.

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