Last 3 months of 2022 had most deaths in N.S. ERs in any quarter in 6 years

Newly released numbers show the fourth quarter of 2022 had more deaths in emergency departments in Nova Scotia than any three-month period in the past six years.

The numbers, obtained by the Nova Scotia NDP caucus through a freedom of information request and shared with CBC News, show 180 people died in emergency departments across the province between Oct. 1 and Dec. 31 of last year. That includes 32 deaths in the last two weeks of the year. 

The previous record was 154 deaths in the first three months of 2022. 

CBC previously reported that emergency department deaths were at a six-year high. This came from numbers obtained by the NDP after the death of young mother Allison Holthoff in an Amherst, N.S., hospital on Dec. 31. 

But the numbers weren't complete — they didn't include the last two weeks of 2022. Recently, the figures for the last two weeks of the year were provided to the NDP. 

In 2022, 590 people in Nova Scotia died in emergency departments, up from 505 in 2021 and 393 in 2020. 

The number of deaths compared to patients is still extremely low, at 0.11 per cent. But the percentage was at its highest in 2022 compared to the previous five years.

"Of course, any death is concerning," said Susan Leblanc, MLA for Dartmouth North and the NDP's health spokesperson. "And so to find out that there were 32 additional deaths in the last two weeks of 2022 is pretty substantial."

Nova Scotia Health response

Nova Scotia Health didn't make anyone available for an interview, but sent an emailed statement.

"Unfortunately, a very small number of patients who visit emergency departments have illness or injuries so severe they cannot survive, or treatment provided is not successful," said spokesperson Brendan Elliott. 

Elliott said it's important to note that Nova Scotia's emergency departments are back to pre-COVID volumes and have been experiencing an "increase in patient acuity," which means people are showing up sicker. 

"In ... 2017 a little more than 13 per cent of patients were triaged as Level 1 or 2, the highest levels on the triage scale. In calendar year 2022 more than 20 per cent of patients were triaged at Level 1 or 2," Elliott wrote.

"The more serious the care needed when a patient presents at an emergency department, the less likely there will be a successful outcome."

But Leblanc said the fact that patients are sicker when they arrive at the emergency department shows the cracks elsewhere in the system. 

As of Feb. 1, 13.5 per cent of Nova Scotians, or 133,595 people, didn't have a family doctor or nurse practitioner.

She said this is one reason people are showing up in emergency departments with more serious illness, but there are other issues at hand as well. 

"Essentially it speaks to a bunch of aspects of the health-care system," Leblanc said. "People are staying in the emergency rooms longer because there's no beds in the hospital to admit to. There's no beds in the hospital to admit to because there's no room in long-term care.... you know, the system is backed up and held up."

Changes to ERs announced after Holthoff's death

Shortly after Allison Holthoff's death, the province announced a long list of changes aimed at improving care at emergency departments, including ways to ensure patients with the most urgent needs get help first, improve ambulance response times and offer more places for people to receive care.

To get urgent cases seen faster, the government said it would deploy teams led by doctors to triage patients and get them out of ambulances and into ERs faster. 

Health Minister Michelle Thompson also said physician assistants and nurse practitioners would be added to teams working in emergency departments.

But in the three months since this announcement, Leblanc said change hasn't come fast enough. 

"There's little bits and pieces happening here and there," she said. "But overall, if you look at the overall sort of ecology ... of the emergency department, I would say that the improvements that the government promised in January have not happened yet."

Elliott, also speaking for the Department of Health and Wellness, said the work to bring in solutions is ongoing. 

He said patient advocates and waiting room care providers are now working at multiple hospitals. Physician assistants are now working at two hospitals, and flow lead and offload assessment teams are now in place at four sites.