ER walk-ins who walk out will be called for follow-up

Eastern Health nurses will be using HealthLine starting next week to follow up with patients who leave the emergency room without being seen by a doctor to ensure they are receiving care they need.

Gail Downing, director of emergency services with Eastern Health, says people will be rated on a scale of one to five — one being the sickest and five being the least sick — upon entering the emergency room, and anyone who falls into the middle category will get a follow up call if they leave without getting medical attention.

She said anyone who is rated at a one or a two will typically be in a condition that they will need to see the doctor, and someone at a four or five would be the least likely to need serious attention, but those who are rated a three may go either way.

"Threes are the ones that we're not really sure what's going on with them. They're coming in, they're going to be seen by an emergency doctor, they may be referred to internal medicine or surgery, they're going to have blood work, they're going to have X-rays, so that could be the dicey ones in terms of what their outcome is going to be," Downing said.

"We want to make sure this is the group that's targeted and this is the group that's followed up, so there's a smaller percentage of our group who leave without being seen."

On average, more than seven per cent of the people walking into an emergency room end up leaving without being seen by a physician.

According to Downing, there are a number of reasons people may leave an emergency room without being seen, but it doesn't mean they don't need treatment.

"During the course of the time while they're waiting to see a doctor or nurse practitioner, for whatever reason, either if the waiting is long, they're tired, they have appointments, they have childcare — for some reason, they have to leave our department and go back home," she said.

However, Downing said that if a nurse calling on the HealthLine tells you it might be wise to head back to the hospital, that doesn't necessarily mean you won't be waiting again.

"By saying to them to come back, it doesn't mean that because we recommend they come back again … that they're going to get prioritized," she said.

"The nurse will do triage again, assess the patient, and it may mean, unfortunately for people, that they still have to wait. I guess what we're saying is, you came to us with a care concern, and we want to help you."

More nurses would decrease wait times, union says

Debbie Forward, president of the Newfoundland and Labrador Nurses' Union, said increasing the number of nurse practitioners in emergency rooms would help alleviate wait times, as well as ensure more people are receiving treatment.

She said nurse practitioners would be able to see those people who would fall into the four or five category, freeing doctors up to see the more serious cases.

"A lot of people that are accessing emergency aren't really emergencies — they're there because they have nowhere else to go," Forward said.

"If it's two o'clock in the morning and you feel like you need to see a physician or you need to see a nurse practitioner, pretty well the only place you have to go is an emergency department."

Forward said the project is a good effort, but it won't solve the problem at its root.

"It's a great thing to do and I applaud them for making sure we talk to people and [find out] why they left and do they still need care, but the priority always needs to be 'are people having timely access — how can we generally improve that access to the system?'"

Eastern Health's effort is a pilot project for its seven hospitals, but if it proves successful, it could be rolled out across the province.