Ambulances have been known to wait for hours in hospital bays in Nova Scotia because there’s no place for their patients. People routinely wait several hours and sometimes much longer in emergency departments because all the beds are taken in the ER or because there’s a bed bottleneck in other departments.
The Nova Scotia Health Authority was directed to tackle this problem by Health Minister Randy Delorey in March and the authority’s response was put into place on Monday.
The “overcrowding and site overcapacity” directive imposes a deadline of 30 minutes for patients to be transferred from ambulances to the emergency departments at the province’s largest hospitals.
As well, a 12-hour deadline has been put in place for patients who must be transferred to other parts of the hospital or to other sites, and all other ER patients must be discharged within 12 hours of their registration.
The authority acknowledged this would “require a significant change” in how patients are moved through emergency departments.
“We will be required to focus on all aspects of patient care, identify and remove barriers to flow and escalate when appropriate so that we can ensure that patients will get to the right place, in the right time.”
The 30-minute ambulance discharge policy is actually 10 minutes longer than the previous timeframe. While that would seem counter to making the process more efficient, health authority officials said it brings Nova Scotia in line with other jurisdictions in the country.
“This is a 30 minute (period) that incorporates the whole entire transition from ambulance to the ED care space,” said Tanya Penney, senior director of the NSHA’s emergency program, in an interview Monday afternoon. “It’s not truly an increase in time, it’s just a more accurate reflection of the time it takes.”
Penney said the new offload and patient transition timelines are meant to be firm deadlines, not some idealistic goal. The new policy puts the onus not only on the ER but every other part of the health system, from in-patient departments to nursing homes, to do everything possible to improve emergency room efficiencies.
“It is an absolute necessity that we move patients off ambulance structures into ED care spaces within the 30 minutes,” she said. “What prevents us from doing that, and what has prevented us from doing that over the past number of years, is ED overcrowding. ... If we can get those patients out of the emergency department within the 12 hour standards, we will be able to (do) the ED offload times from an ambulance perspective in the 30 minutes.”
The new policies will be put into place first at the Halifax Infirmary, Dartmouth General Hospital, Valley Regional Hospital, Colchester East Hants Health Centre and the Cape Breton Regional Hospital, and then to all ERs across the province.
“The policies that we’re implementing really strive to create standardization and a supportive environment to achieve the goals and targets that are set through the polices,” said Madonna MacDonald, the authority’s vice-president of health, in an interview.
“By working with continuing care, with long-term care, with in-patient units and our EHS (Emergency Health Services) partners and others, we’re trying to understand what the root issues are and how can we (make) improvements.”
A major complaint among emergency room doctors and opposition critics is that too many hospital beds are occupied by people waiting for nursing home placements. ER doctors were so frustrated at the Valley Regional Hospital in Kentville that they set up a GoFundMe account to raise money for nursing home beds.
Penney questioned whether the bottleneck in emergencies can be traced solely to this problem but she and MacDonald said the new approach will aim to keep seniors in their own homes by providing more support for their care, and by boosting the number of hospital care co-ordinators for planning and discharge assessments “to make that process more efficient.”
NDP Leader Gary Burrill, who has been a longtime critic of the province’s nursing home bed shortage, welcomed policies that lay out specific strategies for day-to-day hospital operations. But in an email Monday, he said the government should be required to publicly report on how often they’re meeting health-care benchmarks in areas such as emergency room waits.
Penney and MacDonald said the new emergency room policies will be evaluated on a daily basis.
“We are accountable to report on priorities for action both to the public and to the government so we definitely will be monitoring progress,” MacDonald said.
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