Horizon plans ER changes to help cut wait times amid triple threat of respiratory viruses

As New Brunswick hospitals deal with the triple threat of respiratory viruses surging across the country, the Horizon Health Network has emergency room changes planned to cope with staff shortages and help cut wait times.

Dr. Serge Melanson, an ER physician at the Moncton Hospital and Horizon's clinical lead of emergency services, says the innovative solutions should mitigate some of the ongoing influx of patients due to respiratory syncytial virus, or RSV, infections, the flu and COVID-19.

"If we didn't have some of those solutions in play, I would tell you that I'd be extremely worried about what the future might bring," he said.

"But … I think we're going to get through it just OK."

Some of the changes centre around "patient flow" at the larger ERs — from the time patients register, to the time they're triaged, to the time they're first seen by a physician or nurse practitioner, get their testing done and then eventually leave or are admitted, said Melanson.

That process has not changed in the 20 years he's been working as an emergency doctor, he said.

"So we're really challenging ourselves to say, 'What can we do to move the personnel around — those that we have left on the team —  to actually get to the patients a lot faster?'"

Announcement expected within weeks

That could include having a physician stationed at the triage station, or pulling people into a different section of the ER specifically designated for quick turnarounds.

What would be a 10-hour wait today could be "cut in half, or even, you know, substantially better than that," according to Melanson.

New types of staff also need to be deployed to assist registered nurses and other staff who are in short supply and working overtime to bridge the gaps, he said.

"We can't expect people to keep operating [at] this kind of pace indefinitely. It's just unsustainable."

Horizon has been using licensed practical nurses and personal care workers to supplement its teams for a number of weeks with "positive results," said Melanson.

He expects more details to be announced in the coming weeks.

'Stretched to the maximum'

An early and unusual increase in RSV cases is already putting a strain on ERs and pediatric departments "that are already kind of stretched to the maximum," said Melanson.

RSV infections are up at least 800 per cent in the province, compared to the same time last year, the latest figures posted by the Public Health Agency of Canada show. Forty-five New Brunswickers have tested positive for RSV, as of Nov. 12, up from five.

RSV, common in children under two, infects the lungs and respiratory tract.

In adults and older, healthy children, RSV symptoms are typically mild and cold-like, such as runny nose, cough and fever. But the virus can result in severe infection in some people, including infants, older adults, adults with heart or lung disease, or with a weakened immune system.

Although pediatric wards have historically served as overflow for adult patients, hospitals are now looking for opportunities to send pediatric patients to other areas, said Melanson.

"So it's changing the dynamic of what we're accustomed to. But, you know, given all the challenges we've had in the last two-and-a-half years, you can add this to the long list of things that we've needed to quickly pivot and respond to," he said.

3 'formidable viruses'

Flu case counts, positivity rates and outbreaks have also increased in recent weeks, Dr. Yves Léger, the acting chief medical officer of health, has said.

And COVID-19 killed six more New Brunswickers in the past week, hospitalizations because of the virus have increased along with the number of people who require intensive care, Tuesday's COVIDWatch report shows. 

"We're really facing down three formidable viruses," said Melanson.

Staff are also falling ill and staying home to reduce transmission, which puts extra pressure on those who remain, he said.

"So again, you know, just another kind of challenge thrown our way. … But I am confident that we are going to get on top of this issue and we're going to see some positive solutions, you know, moving the needle as it were, in the right direction and really giving the staff the support they need to kind of continue to work to their full capacity."