Critics say ER wait numbers back up complaints

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Barb Sweet
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Details about ER wait times revealed in The Telegram back up public complaints about too-long lineups for medical attention, says the leader of the NDP.

“It’s just not acceptable,” said Lorraine Michael. “These numbers show we are correct. This is a critical issue.”

On Tuesday, The Telegram reported that for 91 per cent of visits to the emergency room at St. Clare’s and the Health Sciences Centre in St. John’s, the recommended wait time for a first assessment by a doctor was not met 75 per cent of the time, based over the period April to October.

That access is set out in benchmarks, or targeted wait times.

Patients who come to the ER are triage based on five levels of urgency and each has a recommended wait time. The first two levels of triage are the sickest patients, those where there is danger to life or limb, and Eastern Health has said meeting benchmarks is not an issue for them, as they are seen immediately or nearly immediately. Those patients represent seven per cent of emergency room visits.

Liberal MHA Andrew Parsons, the Opposition health critic, credited Eastern Health with making some improvement to city ER wait times in the last few years, but the system is at the breaking point now and the provincial government must take the responsibility to find better ways of supporting health care, as it sets the budget.

“This is a government that is constantly touting it has invested this much, this much,” he said, adding if the outcomes aren’t there, it’s not being done right.

Parsons said the Burin and Bonavista peninsulas and Clarenville hospitals combined are more than meeting expectations when it comes to patients not leaving emergency without being seen, while the rural Avalon and city hospitals’ performance is concerning.

That suggests to Parsons that hospitals should be co-operating together to find solutions that work.

Michael said she’s disturbed at the province for repeatedly insisting it’s taking charge, when ER overcrowding has been going on for years and isn’t abating.

And she said annual reports from health authorities should acknowledge in concrete numbers where the challenges are.

“The lack of urgency is bothering me,” Michael said.

She said most sick people are treated right away, as they should be, but the problem is the capacity is not there to handle the rest of the numbers in the waiting room, either with staff or space.

 Michael said a new system needs to be put in place that would include community clinics for the less ill patients and that requires resources.

Health Minister Susan Sullivan said Tuesday the province is concerned about the pressure on ER and has taken steps in certain ERs, such as reconfiguring nurses and doctors’ schedules, adding to their hours and adding nurse practitioners. A fifth fast-track system will be implemented in Grand Falls-Windsor.

As for Eastern Health’s situation, it has done five reviews and is about to do three more that will provide a clearer picture of what the trouble is and where the bottle neck is, and that information will be the basis for any further changes, Sullivan said.

She said since tackling emergency wait times became a strategy 18 months ago, there have been improvements — the Health Sciences Centre wait time for initial assesment by a doctor has decreased by 17 per cent, while visits are up by 16 per cent.

“We are seeing some improvements, but are not satisfied yet,” Sullivan said. “We feel we are on the right track.”

Not all hospitals collect wait time data, and that is being worked on as well.

The fact that city hospitals are seeing 6.8 per cent of patients walking away without being seen is a concern, said Dr. Howard Ovens, director of Schwartz/Reisman Emergency Centre at Mount Sinai Hospital in Toronto and one of the five authors of a position paper on ER overcrowding released by the Canadian Association of Emergency Physicians (CAEP).

Left without being seen usually reflects how long people are waiting, as well as how chaotic the waiting room is when they arrive, Ovens told The Telegram, adding the number leaving shouldn’t be much above two to three per cent.

Eastern Health’s benchmark is 3.5 per cent.

But Ovens also noted CAEP recognizes that its ER wait time guidelines of five years ago, which have influenced hospital benchmarks, were overly optimistic.

“They were published originally as goals. In the real world, very few people were felt to be meeting them,” he said.

However, judging Eastern Health’s performance is tough, he said, because hospitals across the country aren’t measuring their data the same way, if they are measuring at all, and that needs to change so there is a clear picture of ER wait times in order to bring about improvements.

“How can you give them a slap on the back or a high five or kick where they need it,” he said of the disparities in collecting and measuring data.

CAEP is recommending hospitals should strive for the target of a median ER wait of one hour before initial assessment by a doctor and that 90 per cent of the patients would wait no more than three hours for that initial assessment by a doctor.

 

 

bsweet@thetelegram.com

Organizations: The Telegram, Health Sciences Centre, Reisman Emergency Centre Mount Sinai Hospital Canadian Association Emergency Physicians

Geographic location: Clarenville, Toronto

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  • Tired ER nurse...
    November 27, 2013 - 08:04

    Just curious....how much data has been collected on the patients who categorize as C5....and there are lots of them! Those whose rash on their arm that has been there for the past 2 months, suddenly becomes an emergency at 10 pm on a Friday night...or the week old stubbed toe that complains the loudest when told there's an actual emergency delaying their ability to get the fast food type service they've been told is their right. Maybe this is a part of the reason our waiting rooms are clogged...Both sides of this issue need to be addressed, the medical side, and public education of what constitutes a true emergency. As a professional working in this system, my goal is to best serve everyone who presents in my dept...no one wants anyone to fall between the cracks. Unfortunately they do sometimes...maybe a part of that reason who be the unnecessary interactions thrust at us, that overwhelm and make it difficult to prioritize and care for those who need our undivided attention. Believe it or not, those who complain the loudest(not all mind you), and make an already taxed work environment that much more difficult, these are the people who really have no place in most ER's. Both side of this coin need to be addressed...as professionals, we are bound by confidentiality...we cannot be case specific with our concerns, or address the media directly. We are left the option of expressing these concerns to a board that doesn't seem to think the issue is that pressing. Any helpful suggestions would be greatly appreciated....we're drowning in here!