Emergency department pressures result in elective, same-day surgery delays

Officials with Nova Scotia Health have announced the need to postpone certain surgeries as staff in the central and northern health zones cope with intense pressures on emergency departments.

The health authority announced Wednesday that many elective and same-day procedures would be put on hold at least until the end of next week to free up bed space for overcrowded emergency departments.

Dr. Todd Howlett, executive medical director for the central zone, said the decision was not made lightly.

"When we delay surgeries, it affects people adversely and somebody's not getting the care that we would like them to get," he said in a phone interview.

"That's not a little thing and I recognize that it affects patients, it affects their families and many people who have been waiting a long time to get surgery done."

A cascade of challenges

Howlett said volumes at the major emergency departments are up between 20 and 30 per cent and it's exacerbating what amounts to a cascading series of problems.

Staff shortages at some long-term care homes have resulted in them not filling empty beds. Inpatient beds, meanwhile, continue to be taken up by some people waiting to be discharged to a long-term care placement, meaning limited capacity to move people out of emergency departments and into inpatient beds.

Major shortages of nurses and other health-care staff mean some hospital units, including emergency departments, are scrambling to get the help they need, and a recent spike in COVID-19 cases in the northern zone has added a further complication there.

Then there's the increase in demand at emergency departments, something Howlett attributes to a confluence of things including people being more comfortable attending emergency departments than they were earlier in the pandemic and increased demand for mental health services.

Prioritizing emergency department service

With the system facing all of these challenges, Howlett said officials had to prioritize.

"If we can't provide the emergency care to our community, we have to triage that first," he said. "The only way that we can solve that problem is to shut down some of the services that we can shut down."

Procedures were already being postponed and beds closed prior to Wednesday's announcement.

According to the health authority, in the last two weeks more than 180 scheduled inpatient surgeries have been postponed across the province for various reasons, including a lack of beds and staff shortages.

Staffing a challenge everywhere

That number includes almost 100 surgeries at the QEII Health Sciences Centre in Halifax. Forty-five scheduled surgeries from Tuesday to Friday this week at the Colchester East Hants Health Centre in Truro have been postponed, although the site continues to provide urgent and emergency inpatient surgery and some elective day surgeries.

There are no quick fixes to any of this, and Howlett noted the problem is not unique to the province or even the country. During a recent conference call that included someone from Australia, the person mentioned they were dealing with staffing problems in that country and asked if it was an issue in Canada, said Howlett.

"It was an insight that this is happening across the world."