N.S. emergency departments 'pushed to the limit,' new report shows

A new report on the state of the province's emergency departments paints a dire picture of unexpected closures, long ambulance offload wait times, lengthy waits for care and patients leaving without being seen.

The annual accountability report shows that the number of hours ERs were unexpectedly closed has doubled since the previous year.

New figures released by the Health Department show that ERs experienced unplanned closures for 31,697 hours — or 1,320 days — between April 1, 2021, and March 31, 2022. That's up from 15,056 hours — or 627 days — the previous year.

Unplanned closures are usually a result of the unavailability of emergency department staff, including doctors, nurses or paramedics, according to the report.

Nineteen community hospitals experienced unexpected closures over the reporting period.

The Eastern Shore Memorial Hospital was most affected, as it was open for just 30 per cent of its scheduled hours. The Musquodoboit Valley Memorial Hospital was a close second, open for just 35 per cent of its planned hours, and the Victoria County Memorial Hospital was open for 54 per cent.

Across the province, emergency departments were open for 89 per cent of their planned hours, down from 94 per cent in 2020-2021.

Health Minister Michelle Thompson said in an interview that the period covered in the new report reflects much of the Omicron wave of COVID-19, which infected thousands of Nova Scotians in late 2021 and early 2022. Isolation requirements at the time meant hospital staff were unable to report to work when they were sick or had close contacts who were sick.

In a statement, Thompson acknowledged the pressures the system is facing.

"The report shows what our health-care professionals and many Nova Scotians already know — our emergency departments have been pushed to the limit," she said.

"We don't want any Nova Scotian to think twice about seeking care, which is why we are working every day to address emergency department issues and many others needed to fix healthcare."

Government working on solutions

The statement said the government is planning hospital expansions that include new and improved emergency rooms and more than 400 new beds. Urgent treatment centres, which care for patients with unexpected but not life-threatening conditions, are also being expanded.

The province is also working to encourage internationally trained doctors to practise in the province, guaranteeing jobs for nurse graduates, placing mobile primary care clinics in communities facing the greatest pressure and expanding virtual care, the statement said.

Thompson said she believes next year's report will show some improvements.

"While we talk about the numbers, you know, not being great, it shows us where we need to go and I think it's a really important validation not only for patients in terms of what they're experiencing, but for our health-care workers.

"They're working very, very hard and under great strain and so it's very important to me that we be transparent and accountable with these numbers and that we work to improve it and we can show that progress."

ER wait times

Nova Scotians experienced significant waits in emergency departments, both in waiting to be offloaded from an ambulance and in waiting to see a health-care provider after being triaged.

Ambulance offload times were highest at the Halifax Infirmary, where paramedics and patients had to wait on average for over two hours — 129.4 minutes — to be transferred to the care of the hospital.

Other hospitals with average offload times of over an hour included: the Cobequid Community Health Centre at 93.8 minutes, the Dartmouth General Hospital at 89.2 minutes and the Colchester East Hants Health Centre at 86.5 minutes.

The average ambulance offload time across the province was 33.1 minutes.

Once patients were in the ERs and triaged, they still faced an average wait time of two hours.

Wait times were longest at the Sacred Heart Community Health Centre in Chéticamp, N.S., where patients waited an average of 6.17 hours. Cape Breton Regional Hospital had the second-longest average wait time, at 4.68 hours.

Others with average wait times of three hours or more included Yarmouth Regional Hospital at 3.46 hours, Colchester East Hants Health Centre at 3.17 hours, Aberdeen Hospital at 3.16 hours, Inverness Consolidated Memorial Hospital at 3.19 hours, Eastern Memorial Hospital at 3.08 hours, and Dartmouth General Hospital at 3.03 hours.

For the first time, the report tracked how many patients left the emergency room without being seen.

In 2021-2022, eight per cent of patients — or 43,142 people — left before they were seen by staff. That number was highest at the South Shore Regional Hospital, at 15 per cent, and Cape Breton Regional Hospital, at 14.8 per cent.

Focus on primary care essential

Dr. Leisha Hawker, the president of Doctors Nova Scotia, said she was not surprised by the findings in the report.

"It really just shows that the emergency department is a bit of a catch-all or a safety net for many Nova Scotians who aren't able to access care in other ways."

Hawker said solutions to the crisis in the province's ERs need to consider primary care.

"Really what we need to focus on is primary care and bolstering that up because that's the foundation for the health-care system," she said. "If we had more access to primary care, we would reduce the burden significantly on the emergency departments."