Closures on the rise at Nova Scotia's collaborative emergency centres

New figures show closures increased significantly last year at Nova Scotia's collaborative emergency centres compared to the previous year.

The Health Department is required to release an annual report on emergency department closures, which usually comes in December. However, some of those numbers were released early to the legislature's health committee following a request from MLAs.

Data released this week is only for collaborative emergency centres, or CECs, but they show substantial increases in hours closed for 2018-19 compared to the previous fiscal year.

The most notable increases were at sites in New Waterford (6,856 closure hours compared to 4,058 the previous fiscal year) and Springhill (3,177 hours in 2018-19 compared to 1,530 in 2017-18). All of the closure hours in Springhill were unscheduled, while almost all of the closures in New Waterford were scheduled.

CECs are typically staffed by a doctor by day — operating as a normal emergency department — and a nurse and paramedic with telephone access to a doctor at night.

The full results for the CECs were:

Dr. David Petrie, the senior medical director of the province's emergency program of care, said the distinction between scheduled and unscheduled closures is important.

Because closures are almost always tied to staff availability, Petrie said scheduled closures are often based on what's best for a community in terms of balancing service delivery with staffing availability.

Along with New Waterford, almost all the closures in Middle Musquodoboit, Tatamagouche and Annapolis Royal were scheduled. As with Springhill, none of the closures in Parrsboro, Pugwash or Musquodoboit Harbour were scheduled.

Petrie said another important distinction when considering closures is whether they affect patient outcomes.

Even when CECs or community emergency departments are open, Petrie said they're often bypassed by paramedics in favour of tertiary or regional hospitals because of equipment and specialist availability. It's a benefit of having a provincially-integrated ground and air ambulance system, he said.

Tory Leader Tim Houston said the closure numbers illustrate just how strained things are with the system and said it may be time to review CECs as they're currently being used.

"The goal of providing care closer to a community is admirable," he said. "We should be making sure that people can access care in a way that's convenient, quick and that really improves health outcomes.

"But when you start to fade away from that goal, which it seems like we're doing now, it's definitely time to look at it."

NDP health critic Tammy Martin said the problem isn't with the CECs as a concept, which offer staffing in evenings by a combination of nurses and paramedics, with a doctor available by telephone as necessary for consultations.

"I think the model would work if it was staffed properly," she said.

Martin said the increase in closures calls for action. One way to do that would be to consider additional and alternative staffing options, such as the widespread use of physician assistants.

Right now, the health authority is doing a three-year pilot project using three physician assistants to work with orthopedic teams.

Petrie said Nova Scotia Health Authority officials continue to work toward finding the optimal service complement for the province. Although Nova Scotia has a higher number of emergency departments per 100,000 people than New Brunswick, P.E.I. or Ontario, more than pure numbers needs to be considered because of the geographic realities of the province, said Petrie.

"There's a huge ethical issue here," he said. "We need to provide reasonable response to our citizens all around Nova Scotia, including those in the rural areas."

Petrie said the public should be involved "right from the beginning with their local providers" as that work happens and ultimately reaches the political level where any final decisions would be made.

"I'd like to see us all on the same page of coming up with some criteria around how can we make the best system we can for Nova Scoria and have everybody understand that there are sometimes tradeoffs and we need to all speak together around these things and come together, as opposed to making a decision and getting buy in," he said.

"I don't really like that kind of way of doing it."