X-ray visits to emergency rooms are making a bad situation worse: ER doc

When Nova Scotia put a stop to walk-in appointments at X-ray clinics two years ago due to COVID-19, it created long waits for scheduled appointments — and one emergency room doctor says patients are circumventing the lineup by going to ERs across the central zone instead.  

Dr. Mike Clory, the emergency department chief at Cobequid Community Health Centre in Lower Sackville, says the number of patients showing up seeking X-rays has become a significant problem for already-strained emergency rooms.

Before the pandemic, people who needed a general X-ray could walk into an X-ray clinic with a requisition from their family doctor and have the procedure done on the same day. They now have to book an appointment at one of the centres that offer diagnostic imaging across the province, which Clory said can mean up to a three-week wait.

To cut that wait time, Clory said patients often head to emergency departments instead.

"I know family physicians are frustrated by this, patients are frustrated by it, and the emergency departments are frustrated because people come in, they have to register, and then they're there for an X-ray," said Clory. "You know, it's not really a true emergency."

Province using online booking platform

When the pandemic hit, Nova Scotia Health (NSH) launched an online booking platform for X-ray appointments in the the province to reduce the number of patients in clinic waiting rooms.

"This provided control over how many patients we could contain in the reduced waiting room space," reads a statement from the health authority.

The health authority also launched an urgent booking line so physicians could book appointments.

NSH said it has no plans to restore the walk-in appointments.

Emergency rooms already at or over capacity

The crisis in emergency rooms has been building since the start of the pandemic. Staffing shortages, combined with fewer family doctors, have led to increased numbers of people seeking care at an ER.

In July, the provincial NDP released records showing 43,000 people walked away from an ER without being treated last year, up 60 per cent from the year before.

Clory said the patients who go to emergency departments for X-rays mean "more people that our triage nurse has to triage, so it's more work for them.

"And then it's more patients waiting to be seen by the doctors, and by the time we see them, they're frustrated with the long wait."

Family doctors must provide X-ray requisitions 

In early August, Rosemary Zwanenburg, a farrier in Lower Sackville, accidentally drove a horseshoe nail through her pinky.

When she went to the emergency room, it was already at capacity. The emergency doctor offered her a five-minute consult.

"His primary concerns would have been infection and then whether or not the nail touched the bone … and said that he would recommend an X-ray," she said.

While he wrote her a prescription for antibiotics, he couldn't give her a requisition for an X-ray, so he told her to come back the following day.

"Emergency physicians will order X-rays and follow up with them but they have no process to follow up on the results of something that would be ordered as an outpatient," said Clory " So emergency physicians don't do that."

Zwanenburg said getting the X-ray meant either another long wait in the ER, or waiting another couple of weeks for an appointment with her family doctor. So she just went home — despite concerns about her injury.

"Certainly I would have felt more comfortable if I had gotten an X-ray and we could have confirmed one way or the other that it was, you know, that the bone was involved or not," she said.