Growing and aging population driving long ER wait times on P.E.I., says N.B. doctor
Non-critical patients aren’t to blame for long emergency room waits, says Dr. Fraser Mackay
Long emergency room wait times on P.E.I. are a symptom of a health-care system struggling to keep up with population growth and an aging demographic, says an emergency physician in Saint John, N.B.
Health P.E.I. issued a media release last week saying that hospitals across the Island are over capacity, leading to increased emergency department wait times. The release said that emergency response measures are being implemented to improve patient flow.
Dr. Fraser Mackay, chair of the rural, remote, and small urban section of the Canadian Association of Emergency Physicians, said many hospitals across Canada face the same challenges.
"The basics of it is, quite simply, a supply-and-demand mismatch that has been growing steadily for a couple of decades in terms of population growth and aging," Mackay said.
"We have one of the lowest bed-to-population ratios for hospitals in developed nations, and our long-term care capacity and aging-at-home capacity and support for that aspect of things is also well behind our needs. And this has been progressive for a very long time."
More staff 'not going to change anything'
While recruiting more health-care workers is important, Mackay said it won't necessarily reduce ER wait times in larger areas. Instead, long waits are often due to "access block" — when ER beds are occupied by patients waiting to be admitted to other departments.
"Right now, if you have an emergency department that is blocked... because of admitted patients, you can throw another few doctors into that, it's not going to change anything," he said.
Rural hospitals in P.E.I., including Kings County Hospital in Three Rivers and Western Hospital in Alberton, often experience ER closures due to staffing shortages. But Mackay said that's a separate issue from access block.
Non-urgent patients not to blame
Mackay said there are patients coming to the ER for non-urgent issues, such as medication refills, but they are not driving the longer wait times. He said these patients often have no primary care provider or easily accessible walk-in clinic to turn to.
"There's lots of theoretical things that can help them here, but they come to the ER because we don't have a health-care system, and so our infrastructure has let these patients down," he said.
"Could they be better served in other places? Yes. Do we blame them for coming to the ER? No, because they don't really have a lot of options."
When these low-acuity patients come to the ER, it leads to another complication: they tie up critical resources. When these patients occupy ER beds, it may delay care for other patients.
"That bed and that nursing staff and that oxygen on the wall and that IV pump and... that monitor are being used for a patient that shouldn't be in emergency anymore. And so that bed is not accessible to the patient in the waiting room," he said.
"You multiply that by most of your beds in the emergency department, and there's your problem."
Virtual care can help, if done properly
The Canadian Association of Emergency Physicians has outlined short and long-term strategies in a 300-page document called EM:POWER. Key recommendations include better human resource planning, an accountability framework to track patient flow, and expanding proven systems across the country.
Virtual care is also a major focus. Mackay said it has the potential to transform health care, but it must be designed in an intentional manner.
"It's got to be integrated with the rest of the health-care system, as opposed to little you know, boutique virtual walk-in centres that aren't integrated at all," he said.
"Those have actually been demonstrated to not only do nothing to improve the numbers in terms of patients getting the care they need, but there's concern that in some ways, it's detracting from the health-care system."
Implementing these solutions will require robust data, political will and collaboration across all levels of health care, Mackay added.
With files from Island Morning