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Emergency room wait times can and should be shorter

We believe emergency room wait times can and should be shorter.

This is one of three major issues we hear from our patients. The other two are the need for more family doctors and the need for more nursing homes

Emergency rooms are familiar places for many New Brunswickers – we visited them 606,000 times last year. They take care of young patients with skateboarding accidents and seniors who have fallen, and everything in between. They are for emergent health needs – traumatic incidents, anaphylactic reactions, broken bones – but are also used as a last resort for care by too many New Brunswickers.

While they’re intended to take care of only acute health care needs, our ERs are clogged up. Almost every New Brunswicker knows someone with a ‘horror story’ when their visit in the ER was long, tedious, and tiring. New Brunswickers who need care are waiting too long for it.

Why is this important?

There is a problem with our ERs, and it starts with perception. Some folks have no better place to go for primary care than the emergency room, and these people there for non-emergencies are often blamed for “taking the place” of people who truly need emergent care. Over the last three years, over 60% of visits to emergency rooms are considered “non- or less urgent.” While many people are there for non-urgent visits, most of the excess wait time in emergency rooms is caused by people in beds in the ER who need to be admitted to the hospital, but there’s no bed for them. This blocks up the emergency room, making everyone – complex and simple cases – wait longer.

The current challenges

The most basic problem with our emergency room wait times is that we really don’t know what they are – they aren’t reported publicly in New Brunswick on an ongoing basis. From very basic data taken in a 2011 survey, we know:

  • We’re waiting too long. 75% of surveyed New Brunswickers who had been to an emergency room in the last year reported a wait time of less than four hours. (While this sounds fairly good, it’s well behind the national benchmark set by health professionals.)
  • Most of us will go to the ER on a semi-annual basis. 42% of New Brunswickers reported going to the ER in the last year.
  • We’re not always there for emergencies. 12% of New Brunswickers cited the ER as the place they most often go when they need care– instead of a family doctor, after-hours clinic or Community Health Centre.

Patients need to be able to count on fast emergency care, and deserve to know their options.

Solving the problem of emergency room wait times is complex. To dramatically improve emergency room wait times for patients, we need concrete action to:

  • Set provincial targets based on national guidelines for ER wait times according to patient acuity, (one hour wait to physician assessment, most patients with simple health problems discharged in four hours, most patients with complex health problems discharged or admitted in eight hours).
  • Execute the recommendations made under our companion policy sheet focused on Alternate Level of Care patients.
  • Report wait times on a hospital-by-hospital basis provincially to encourage change.
  • Employ industrial engineering techniques to analyse patient flow through hospital emergency rooms, identifying blockages and ensuring staffing levels match patient needs through the day.

Other provinces have blazed a trail.

Right now in Ontario, you can see emergency room wait time information on a hospital-by-hospital basis, and they’re tracking their success provincially by Canadian Triage Acuity Scale (CTAS) level.

90% of patients in Ontario with non-emergent needs (CTAS 4 or 5) are treated and discharged from the ER in less than four hours. A big part of their success has been the implementation of Fast Track patient streams. As soon as a triage nurse decides that they are a low acuity patient, they can be rapidly examined and treated to get them out the door.

At Providence Health Care in BC, any blood work a patient needs is ordered almost as soon as they get in the door in the Rapid Assessment Zone, to ensure you aren’t waiting to see the doctor and then waiting for the test they need to help figure out what’s going on inside your body. There are great things happening – we need to learn from them.

Our signature priority to fix the rest of the problem is this: We need to examine when emergency rooms are busiest and strategically add staffing hours to help improve the speed at which patients can be seen. Adding physician hours during peak periods through the day will help ensure the highest acuity patients are treated appropriately, but also enables the creation of things like Fast Track patient streams. Fast Tracks can quickly handle non-emergent patients, ensuring most resources in ERs are focused on patients who really need to be in the ER.

Additional resources are needed most when emergency rooms are busiest (approximately noon to midnight). They should be strategically added in trauma centres, where the proportion of patients accessing ERs for primary care is high, or where wait times are longest.

We continue to ask politicians and health system leaders to adopt a priority of adding emergency room hours in one ER per RHA zone before the end of 2018. Adding flexible physician resources would mean more patients would be seen and moved out of the emergency room within the Canadian benchmark of four hours for low acuity patients, and reduce the need for walk-in clinics.

There is a cost to add more hours of care to emergency rooms in these hospitals, which would be partly offset by fewer system resources used in other facilities, like walk-in clinics. To add the recommended hours of care in nine emergency rooms would cost $7.5 million.

As we add access in emergency rooms, little return is generated to the system. The bulk of the return comes through relieving the pressure on our emergency rooms by improving our Alternate Level of Care and Primary Care attachment rates, as outlined in our other two policy briefs. Faster treatment in ERs – for both complex and simple health needs – is the payoff for patients.