Canadian ERs to remain in crisis if action isn’t taken on staffing shortages, patient surges: report

A new report from the Canadian Medical Association Journal painted a stark picture of what could be the future of the country’s emergency departments, as staffing shortages and patient surges put a strain on medical resources. 

The report published Monday said the summer season will likely be “precarious and exhausting months” for health-care workers in emergency departments, with impacts ranging from lengthy wait-times to hospital closures. 

In recent years, hospital resources have been especially strained due to waves of long-COVID cases, respiratory illnesses and an influenza epidemic. However, physicians say Canada’s health-care system has been in a crisis for decades, long before the pandemic highlighted how dire the situation is, especially in the country’s emergency rooms.

“I think that the perception out there is that the pandemic caused a lot of the problems, but really, these problems have predated the pandemic by decades,” Alberta emergency physician Dr. Warren Thirsk told CTV News Channel in an interview on Monday.

“Now that the pandemic has been resolved—I would say—people are wondering why (emergency care) isn’t any better, and in fact, it’s worse.”

The report referred to the crisis as a “perpetual cycle” that is restricting patient care, leading to increased wait times and bed shortages that mean patients are spending more time in the emergency department. This, in turn, has an impact not only on patient care, but also on providers’ well-being.

Several physicians’ groups across the country penned open letters to provincial governments outlining the potential dangers of the crisis. Nearly 200 physicians detailed the gruelling 15-hour waits in Alberta ERs, for example, saying staffing shortages along with lack of long-term care spaces in hospitals are creating backlogs. Physicians in one of British Columbia’s largest health regions, Fraser Health, say their patients are waiting up to 72 hours in the ER and allege some have died waiting.

As for the upcoming summer season, rural hospitals in Ontario are already bracing for closures in smaller communities, similar to last year when staffing shortages led to closures for hours and sometimes days.

IF THE ER IS EVERYONE’S ‘STOPGAP,’ WHO IS THERE TO HELP ER PHYSICIANS IN A CRISIS?

Dr. Thirsk said emergency physicians have long been the “stopgap” for other community hospitals and physicians offices when they’re staffing crises, but if the emergency department is in a crisis itself, there isn’t a “stopgap” for it.

“Emergency departments are burning out across the country and it continues to get worse, and we can’t be the stopgap for every one anymore; we’ve run out of capacity,” Thirsk said.

Decreased access to consistent primary care, including a shortage of family doctors, has been a major driving force to the hospital crisis, president-elect of the Canadian Medical Association and B.C. family physician Dr. Kathleen Ross told CTVNews.ca in a phone interview on Monday.

“Typically, we would see chronic diseases managed more in the community, things like congestive heart failure, COPD, cancer patients, mental health and addictions and you just don’t have sufficient community based care options for patients,” she said. “When they have no options available to them, patients of course go through to the emergency department.”

Additionally, Dr. Ross said, there has been a lack of understanding of Canada’s health-care system for years that is limiting the amount of data on the current state of resources and services at disposal for patients and care-providers. Creating a system that includes up-to-date knowledge on what patients of today need and how providers can attend to them effectively will help in the long-term to treat the population in the future, Dr. Ross explained.

“I think it’s time to revisit what we want our system to look like 10 years down the line, so that we’re able to share resources and expertise and the outcomes of innovative work that’s being done in pockets across the country,” she said.

TAKING A HARD LOOK AT CANADA’S HEALTH-CARE SYSTEM

Provincial programs like B.C.’s Real Time Virtual Support and Ontario’s Peer-to-Peer program are helping provide support to emergency health-care workers in rural communities, the report said. These programs provide coaching and support for staff, and some even handle patient triaging and patient care. However, they still may not be enough to fix the crisis for good, some experts say.

Dr. Ross said these programs, as well as provincial governments seeking ways to streamline the employment of international health-care workers and the federal government’s recent pledge of $46.2 billion in new health-care funding will only be effective if the planning behind these initiatives is strategic.

The main priorities, Dr. Ross said, should be working on employee retention and recruitment, which should include proper financial and mental support for health-care workers who are leaving the profession in droves to retire or pursue other, less demanding, careers.

Smaller changes to administrative care, like implementing more technology where it’s possible, could also help eliminate busy work and speed up the referral process and alleviate staff, she said.

With patient care, Dr. Ross says, urban communities would also benefit from additional support for home-care services, especially for patients who require long-term care and will need physiotherapy, for example, once they’re discharged from the hospital. Additionally, investing in a more collaborative working model among health-care providers is critical to addressing the issues with primary care.

“A true team-based model is best defined by the College of Family Physicians of Canada, where we have at our disposal physicians, nurses, nurse practitioners, physiotherapists, psychologists, pharmacists, all working together as a team, but under that comprehensive, continuous and collaborative care model so that patients know where to go when they need care and aren’t faced with rushing to the emergency department,” she said.

There are several strategic and effective solutions available, Dr. Ross said, adding that she believes it’s time to take action for the sake of both providers and patients.

“We can do this together but we need to be creative innovators, leverage the learnings of everyone and ensure that we can get our health-care system to a place where the health-care workers are happy to pay attention to patients and patients feel safe and secure in the knowledge that they’re going to get care when they need it,” she said.

With files from CTV News Calgary, CTV News Vancouver and CTV News Barrie