Backlogged: Why St. John's emergency rooms are choking
If you go to an emergency room in St. John's with a serious medical problem, chances are good you will end up somewhere you're not expecting to be: the corridor.
Numbers and risks
85,000: Number of visits to the emergency rooms at the Health Sciences Centre and St. Clare's Mercy Hospital over the last year.
190: Number of occurrence reports, which include reported mistakes.
21: Number of adverse events, defined as resulting in unintended harm to the patient, and related to care and/or services provided to the patient.
8: Number of 'close calls,' defined as potentially adverse events that didn't occur because of corrective actions, timely intervention or chance.
Source: Eastern Health
The emergency rooms at the Health Sciences Centre and St. Clare's Mercy Hospital are often filled to the brim and unable to deal quickly with incoming patients, because there is often no room to move patients into upstairs floors. About 85,000 patients move through emergency each year.
As a result, said Dr. Scott Wilson, Eastern Health's chief of emergency services, there is no option but to hold patients in beds in the corridors of the overfilled ERs. That, in turn, means longer waiting times for anyone seeking help at the emergency rooms.
"So, inpatients lining our hallways is the biggest reason why you wait six hours just to have your sore throat done, or your chest pain checked out, or your twisted ankle looked at," Wilson told CBC News.
There are other consequences, including the risk of error.
Wilson said studies show that patients who languish in emergency for more than eight hours after being admitted are at greater risk for contracting other illnesses, or for suffering adverse effects like mistakes.
Last year, the emergency department, involving both the HSC and St. Clare's, had 21 adverse events and eight "close calls." A close call is defined as a potentially adverse event that was prevented because of quick and corrective action, or chance.
Wilson said there needs to be more home care, rehabilitation and palliative care, to help move patients out of ward floors in the hospital. That way, he said, the emergency rooms would be able to move patients out of the hospital faster.
Make hospitals work like hotels: MD
Wilson has a strong suggestion: adopt a management strategy modelled on a very different industry.
"We should be like hotels. Checkout time is 11 o'clock, so we can clean that bed and get the next patient who needs that bed up here," he said.
"If we're waiting to the late afternoon for that one patient to exit that bed, [that] we've identified to leave, that has a major domino effect once again on everything, whether it be the OR, the ICU or me."
At St. Clare's hospital, a proposed expansion to the physical space of the ER would help get patients out of corridors, but it won't solve the backlog.
There are other stress factors, including an ongoing shortage of nurses in the emergency department.
Pamela Collins, a veteran ER nurse, said the pressure can be intense.
"It creates a situation where you feel like things are unsafe," Collins said.
"You're trying to provide the best patient care you can, but when your workload is excessive, you know, nobody can be expected to keep up with the demand that we're seeing now."
Cathy Burke, a manager of emergency and ambulance services with Eastern Health, said the authority has hired experts to conduct a patient flow study, to help find solutions to the backlog.