The Decibel - Emergency rooms in Canada head into another tough summer

Episode Date: May 30, 2023

Throughout the pandemic, Canadians were warned about the potential collapse of emergency rooms. ERs were stretched to the limit, as surges in patients ran up against labour shortages of doctors and health care workers. But now that the worst of the pandemic is over the situation in ERs hasn’t improved. Patients and doctors now paint a grim picture of a dysfunctional medical care system that remains in crisis, with few long -term fixes on the way.Carly Weeks, health reporter for The Globe and Mail, joins the podcast to explain why ERs are being pushed to the brink and what it says about the health care Canadians receive now.Questions? Comments? Ideas? E-mail us at [e-mail]

Here's something I wrote just about a year ago. Canadian ERs face record wait times, closures amid labour shortages and resurgence of viruses. That's from June 2022. That's The Globe's health reporter, Carly Weeks, reading news headlines from last year. Nova Scotia emergency rooms closed for staffing shortages twice as often in the last year. That's from December 2022. Doctor shortages forces Alberta emergency room closure over the long weekend. That was September. Emergency rooms closed in the BC interior. Paramedics union says ambulances are unstaffed.

That's August 2022. Coming out of the worst of the pandemic, healthcare systems were stretched to the breaking point, and there were pleas from across the country to address staffing and funding shortages. So those were all last year. Are things any better in our ERs now? No. Today, Carly helps us understand why Canada's emergency rooms are still in a dire situation, and what we need to do to fix things. I'm Mainika Raman-Wilms, and this is The Decibel from The Globe and Mail. Carly, you've talked to a number of people who work in ERs, nurses, doctors. How would they describe the state of emergency rooms across Canada right now?

Most places in Canada right now are experiencing some level of crisis in their emergency rooms. And I know that sounds really unwelcome at a time when a lot of us are simply wanting to put the health care nightmares of the last few years behind us. But the sad reality is that not enough has changed within healthcare to really bring this crisis under control and tackle the root causes. Yeah. I've heard ERs being described as like the canary in the coal mine of healthcare. Can you explain what that would mean? Yeah, definitely. I mean, the emergency rooms are called the canary in the coal mine because whatever is going on and whatever is going wrong in the emergency room is often a signal of just how bad things are in the rest of the system. You know, a simple example of that is that, you know, if there's really long wait times, that means there's a lot of people who are coming in. Why are there more people coming in?

Perhaps because some of them have nowhere else to go. They don't have access to a family doctor or another primary care provider. There's probably a lot of people who are in hospital. The hospital's running over capacity, and they simply have nowhere to put anyone from the emergency room. So all of the beds in the emergency room are already overflowing, and so it's really hard for the physicians working there to see anyone new. It really is a barometer for what's going on in the rest of the

system. And what it tells us right now is that the rest of the system is really struggling. I remember too, especially when we're talking about stuff that was happening in 2022, Carly, I remember we were seeing headlines about patients actually dying in the ERs waiting for care. Are things as bad, like are we seeing that kind of situation continue still? I mean, there were certainly a number of stories that came out last year about that. They continue throughout the fall and even in the winter. And the good news, if there's any, is that that sort of peak crisis seems to have subsided a bit. But we're headed back into a busy summer season with people who are going to be taking vacation.

So, again, is our system better equipped to help prevent some of those tragedies that occurred last year? Just to remind people, there is one story of a 91-year-old woman who called an ambulance, her family called an ambulance in Quebec, and she died waiting for it because no one came. This is how sort of stretched and strained things are. We've been hearing about staff shortages for a long time. We've talked about this before, especially during the pandemic, but are staff shortages still a long time. We've talked about this before, especially during the pandemic. But are staff shortages still a major issue when it comes to ERs? They're the issues that are underlying a lot of the problems we're seeing right now.

So do we have a shortage of hospital beds? Yes. Long-term care beds? Yes. Community care? Yes. But underscoring all of that, who's staffing those beds? Who's providing the care?

And every place that I speak to, who's staffing those beds, who's providing the care. And every place that I speak to, every institution, every worker, they say that is really at the heart of what's going on here. So when you don't have enough nurses, and the ones who are left are kind of run ragged, taking care of too many patients, being asked to do too much, kind of burnout and stress in the system, staff shortages leading to, you know, temporary closures of emergency rooms, problems throughout the system that are all exacerbated by these shortages. Yeah. And this whole issue of staff shortages, I mean, this relates back to people waiting for a long time in the ER because they're just not getting seen as quickly as they would before.

Do we have any sense of numbers, Carly, in terms of how long people are actually waiting to get care in emergency rooms? Yeah, we do. And there's a lot of data that's out there. It's hard to sometimes compare it to previous years. But I pulled out some numbers because I think that this gives a comparable snapshot of what's going on in one province, this province being Ontario, in terms of how things have changed before the pandemic and where we are now. So June 2019, well before COVID hit the scene, if you were in a person in the emergency room waiting to be admitted, so you were sick enough that you needed to be admitted from the emergency room, you were waiting on average just over 16 hours. Wow. It's a really long time for a person to be sitting in, you know, a loud, crowded, you know, sometimes awful emergency

room environment waiting to be admitted into a bed. Flash forward through everything we've been through to March 2023, that 16-hour wait time is now 19 hours. So it's worse. And I think that what this really speaks to is that hospitals and the people who work in them and the people who are working in health have been sort of treading water for such a long time. And they're waiting for someone to throw them that proverbial life preserver, and it still is not happening. And I think that's why we're starting to see more and more frustrated workers really publicly sounding that alarm saying we can't do this anymore. Yeah. And I think we'll get into some of the reasons of, you know, maybe why that is and some of the solutions, hopefully.

But I guess I just want to come back to the ideas of people waiting in the yards. What is actually bringing people to emergency rooms? Last year, of course, we were dealing with COVID very much in emergency phase then. There's still COVID cases around, of course. But really, when we're looking at the reasons people go to emergency rooms these days, what are those? I mean, there's a whole range of reasons. So you're going to have people coming in with, you know, unexplained abdominal pain, you know, fevers in children, you're going to see all of those kinds of, you know, acute problems that need to be looked at. But, you know, given the state of

the system and the lack of care and specialist care, emergency rooms are seeing, you know, people who are coming in with cancer, people who are coming in in a state of mental health crisis. The emergency rooms and the way they are right now is certainly not a place that's designed for or good for people who are in that state of crisis, but there's nowhere for them to go. So they're seeing like the entire spectrum of sort of health care problems. And then, as I mentioned, also some people who are coming in simply to get a prescription refilled. I know there was an example of Memorial Hospital in Surrey. Can we talk a little bit about that? This is one of the biggest

hospitals in the country. So what's going on there? Yeah. So what's going on there is that, you know, doctors who are working in that facility say they are simply overwhelmed and overrun with patients. They don't have enough staff. They don't have enough beds. They've cited mental health crises as one of the top challenges that they're seeing. The doctors have been so concerned about what they describe as a complete catastrophic red alert state of crisis that they went public trying to sound the alarm in BC and trying to bring attention to what they're dealing with.

And they say that patients have actually died because of the substandard care that is happening in the emergency room right now. We spoke to Fraser Health, who's in charge of services there. They dispute the idea that patients have died as a result. They say they're working with the province. But at the end of the day, the people who are working in the hospital say this is as worse as it's ever been. Perhaps what's even more disturbing is that they're not the only hospitals who are sounding the alarm. There's been other hospitals, other provinces, like a group of doctors in Calgary have come forward since then saying

we are dealing with something similar. The hospitals are simply overwhelmed and about to collapse. It's a really scary thing to hear. We'll be back in a minute. In some places, the issue has, of course, gotten so bad that they've opted to actually just close the emergency room down altogether. And this is happening in Minden, Ontario. Can you tell us about what's going on there, Carly? So Minden, for those who aren't aware, is sort of a rural cottage country area of Ontario.

There's a small health facility that provides emergency services there. And then about 20 kilometers away, about a 25-minute drive, there's another affiliated hospital where patients can get emergency care. The hospital officials say that they have been contending with staff shortages and other problems for such a long time that they've had to make the difficult decision to simply

close down emergency at the Minden site. So this has incited a huge panic and outcry from people who are living in that community. You know, understandably so, because they're saying now, if I'm in a state of emergency, I'm going to have to drive 25 minutes to get to this hospital. What is that going to mean? I had the chance to speak to the CEO of that healthcare system who basically said they were left with no other choices. Their hands were tied because, you know, their staff are in the position of having to come into work when they are extremely ill or, you know, facing all kinds of other challenges because they know that if they don't come into work, that the entire emergency department might close. And they said that they can no longer go on

putting staff in that position of having to work unacceptably long hours under this constant threat of you might be the one to close down the ER that day if you don't show up to work. So this is the best case scenario of all of the bad choices that they had. And, you know, this one example of this, you know, small emergency room doesn't affect the entire services across the country, but it does represent something that is going on. And, you know, I had the chance to speak to a physician, a long-time emergency physician, who actually has explained to me, this is the kind of situation that we're going to see more and more happening in regions across the country. It's no longer reasonable to expect that you're going to have a fully staffed emergency room in your local

community. You're going to instead have to rely on calling 911 and waiting for the ambulance to arrive to get those services. We simply do not have the resources to staff things any better than that. That's pretty scary. I mean, that could be life or death for some people. And it likely will be. And, you know, the hospitals and the people who work in them are trying their best to, you know, work in this system and the constraints that they have. And certainly, I think that they would take issue with that statement. We have lots of hospitals that are simply closing down their ERs overnight

for long weekends, you know, over entire summers across various regions in Canada. So Carly, hospitals have been strained throughout the pandemic. We're still in a really difficult position. So why haven't we seen any improvements here? I think that is the key question that a lot of people ask themselves. I talk to health care leaders, people who work in health care all the time, and I've been covering this health care beat for like 15 years. So I've come to know the answer off by heart. And I think what's really maddening to a lot of people who are in this space, who are in the medical community, is that no one's listening because the solutions are out there. So in a nutshell, you know, the reason why we're facing the same problems year after year, again and again, is that we've not actually taken the time to deal with the real problem.

So the problem isn't that people are coming to the ER. People are sick. They need to be seen. But what are the drivers? Why are they coming into the emergency room? And so in part, it's because they don't have access to primary care. They don't have access to primary care because physicians in training are not choosing to go into family medicine anymore, because it's a very difficult, thankless job that involves a lot of overhead and paperwork and not enough patient care and not enough compensation for the hours that they put in. Our primary care system has not been organized very efficiently. And so, you know, people are not able to get same-day appointments or appointments even in the next week or two.

We're not using, you know, nurses to the top of their capacity to use them to help solve a lot of the problems. There's so much more that we can be doing to be efficient. So, for example, if someone has a bad stomach ache or something, they call their doctor, their doctor can't see them for a week, they end up in the ER because they want attention today, essentially. Exactly. Where else are they going to go? Another really good example is, you know, our hospitals were sort of designed in an era when people came in for an immediate need, and then they were able to get better, go home. We have

a huge number of people in an aging population, a huge number of people who are getting older, living with chronic conditions that may, you know, if they don't have access to someone who can kind of help them manage their needs on that weekly or monthly basis, they might simply deteriorate. They end up in the emergency room. There's no beds for them. The emergency room should be reserved for people who are in a state of emergency, but we're nowhere close to that being a reality because we're not doing the work to make it so.

And so when we talk about doing the work, like what would that entail, I guess? Because these are big questions, you know, a shortage of family physicians. And like, so I guess what is some of this work that needs to be done? Where do we start? I mean, according to a lot of the experts I speak to, it really is sort of a wholesale reimagining of the healthcare system. There's solutions that we can start employing today that can, you know, reap benefits in the long term. There's also some short-term things we can do to help ease this crisis, you know, like for people that want to work here, make it easier for them to get credentials to start immediately working. Some of the larger fixes involve things like really rethinking how are physicians

reimbursed? You know, BC is trying an experiment right now where they're taking physicians away from a fee-for-service model into sort of more of a rostered patient model. So very briefly, without getting into all the weeds, a lot of physicians get paid based on services they perform. So, you know, that can incentivize seeing a large number of people. Maybe it de-incentivizes, you know, managing people with chronic illness who need a lot of time and attention. And that's not to say family physicians are not willing to put in this time, but it's a really difficult thing to do because a lot of their time is being spent on things like paperwork. You know, if you're managing,

if you're a physician managing an office, you're hiring staff, you're, you know, buying supplies, like there's all kinds of things that family physicians are doing that aren't patient care involved. So they end up working a lot of unpaid overtime. So BC is working on changing that model. We'll have to see how that goes. Ontario has a model that only about one quarter of family physicians are in. It's called a teams-based model. So it's a family physician who basically gets assigned a roster of patients. Some of them you may not see in a year. Some of them you may spend a ton of time with. But regardless of the needs of your patients, you're going to get paid sort of fairly and get a good compensation regardless of what you do in

a certain day or how much time you spend with one patient versus another. You're also working with teams of nurses, in some cases, you know, physiotherapists, dieticians, social workers, who can help meet the entire needs of a patient population. And other doctors as well, too, right? Aren't there other, like, within a team environment like that, you have other doctors in the practice? You're going to have other doctors. So you're going to get those same-day appointments to help you avoid the emergency room. It might not be your doctor, but it might be a nurse practitioner or a doctor who can get you what you need and get you taken care of. So you're avoiding those trips to the emergency room.

And that's not to say this is going to solve all the problems. We still need to figure out how to really get a better long-term care system. Beyond just building a new home here, they're really building a wholesale system to meet the needs of the elderly and people who are frail. But these are things that can and arguably should be done to address this crisis for the long term once and for all. Okay. I want to ask you about money too, because this is always an issue when we talk about healthcare in Canada as well. In February, Prime Minister Justin Trudeau announced a $196 billion healthcare deal, which promises to increase funding to the provinces over the next 10 years.

To bring it back to ER specifically, which is where we're seeing a lot of issues today, is this funding going to help ERs at all? You know, I sound like a cynical, grizzled reporter when I say this, but the chances are it won't. And it also, it comes down to, you know, how the money is spent and allocated. So there could be some bright spots in there. And there's certainly hospitals that are trying innovative things and trying to be adaptive and making things better for their patients. But I say that it's not going to change a whole lot because we're still working in the parameters of a system that relies on,

you know, people having to go to the emergency room because they don't have primary care and they don't have primary care because people aren't choosing family medicine or family medicine is not organized in a way to allow people to work more efficiently. You know, it's, you start to sound like a broken record, but until you address those underlying issues, not much will change. Now we could be surprised and hear from a province saying, we're going to do the hard thing and we're going to, you know, get all of health leaders together in this area. We're going to change the system for the better. We haven't seen that yet. This is a pretty sobering reality check, Carly.

Honestly, when we're looking at the state of our hospitals and our ERs in particular, I wonder, did you speak to any hospitals, I guess, that actually did find a way to improve the situation in their ER? Like, is there, I guess, is there, are there any bright spots here that we can look to? Definitely. And I would say on a whole, you know, the health care system is full of people who are innovative thinkers, who are adapting. One hospital I'll highlight, Kingston Health Sciences Centre in Kingston, Ontario. They've tried really hard to figure out how can we reduce the number of people who are coming to the emergency room for non-emergency purposes. And so this is not telling people to stay home or discourage

people from coming in. This is saying there's actually more appropriate places for you to go. And so working with people who actually have access to primary care, but were coming to the emergency room first because they were under this impression that they were somehow going to be seen faster or their needs were going to be taken care of or treated with sort of more importance than if they went to their family provider. And so they've undertaken this huge initiative to engage with the community and try and reduce the number of people who are coming in for reasons that were not necessary, could be seen elsewhere.

And they've seen a 30% reduction. That's a huge win. But at the end of the day, the CEO said that means that they don't have patients lining their hallways and stretchers every day, just some days. To give you a sense, yeah, that doesn't mean it's a win for the whole system. Although I've sounded the alarm and sounded very much like doom and gloom, I think it's also worth pointing out that the people who work in healthcare are so dedicated and so hardworking that you can, I think, be reassured as Canadians, you know, that the people who are working in our system are trying to make change happen and do the best they

can with limited resources. And so I think that, you know, there's a lot of commendable people who are who we need to sort of stop and recognize as well, they're trying to make change happen. And hopefully they'll be successful. Yeah, that's important to remember too. Carly, thank you so much for taking the time to speak with me. Of course, anytime. That's it for today.

I'm Mainika Raman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrian Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.