Get the ambulances back on the road. Figure out how to move patients through emergency departments more efficiently. Whack-a-mole.
That last order wasn’t part of Nova Scotia Health Minister Randy Delorey’s directive to the Nova Scotia Health Authority, telling it to fix the most visible current crisis in the health system. The first two orders did come from Delorey.
And the minister wants results by mid-April at five of the most overwhelmed emergency departments in the province — the Halifax Infirmary, Dartmouth General, Valley, Cape Breton and Colchester regional hospitals — and by the end of May, provincewide.
Whack-a-mole, in addition to being a child’s game, is a metaphor for a piecemeal approach to problem solving, whereby responding to an issue in one area may provide some temporary relief but can just as easily create another problem elsewhere. It is generally applied by some in Nova Scotia’s medical community to describe the standard operating procedure of the province’s health bureaucracies.
The health system is under immense stress from the weight of demand that far exceeds supply. More than 20 per cent of Nova Scotians are over 65 and that number is growing, so the increasing demand on the system was entirely predictable and almost entirely ignored by a succession of governments, and so here we are.
For a year, paramedics have been alerting Nova Scotians to areas of the province that are uncovered or under-covered by ambulance service. The ambulances are not answering calls because they are lined up waiting to offload patients at emergency departments, which in turn are overflowing into nearby storage units, hallways, washrooms and any other space over-worked, over-stressed staff can find to put a patient.
The minister and the government want the health authority to fix all that, so the NSHA is increasing the size of the spigot through which patients flow from ambulances into emergency rooms. It is also attempting to streamline the flow of patients through emergency departments.
And that’s where the next mole will likely appear.
“An organizational policy will be implemented by mid-April that will require ambulances to be offloaded as well as admitted patients pulled from the ED (emergency department) into inpatient care areas within defined timelines,” the NSHA told its medical advisory committee in a recent memo.
The NSHA’s approach rings a bell for doctors familiar with a similar attempt a decade ago to address the chronic overflow of patients at the Halifax Infirmary emergency department. That effort also began with the best of intentions but quickly devolved into what one doc called “a miserable failure.”
It failed because then — like today — there was no room for more patients in hospital wards already full to capacity or overcapacity. That earlier effort to streamline the Infirmary’s emergency department patient flow was abandoned for a bunch of reasons, but one was the animosity it created between staff who were handing off patients and those who had to take them into units that were already too crowded.
The NSHA’s plan will relieve the pressure on emergency services by increasing pressure on inpatient care units, unless the hospitals get as adept at shedding patients as they must now become at taking them in.
But doctors won’t discharge patients from the hospital unless it is safe — for the patient — to do so. That explains why, at any given time, hundreds of Nova Scotia’s 3,500 hospital beds are occupied by Nova Scotians waiting for a place in a nursing home.
The McNeil government has steadfastly refused to add any new nursing home beds in the province, focusing its attention and dollars on improving access to home-care services. The government remains wilfully oblivious to the obvious fact that many Nova Scotians simply become too old, frail or sick to be cared for in their own homes with intermittent home care.
The NSHA, driven by political fiat, will speed up ambulance offload times, and might even bring some efficiencies that help emergency departments manage their unmanageable patient loads. And then, somewhere, the next mole will appear.