Listen when Canada’s emergency doctors warn of a crisis
TheStar.com – opinion/editorials – Canada’s emergency physicians warn ER overcrowding is creating a public health crisis and doctors say it’s time for every level of government to take action.
Nov 20 2013. Editorial
It’s an experience all too familiar for thousands of Canadians — they rush to a hospital emergency department and then wait . . . and wait . . . and wait for care.
This isn’t merely an inconvenience. A new position paper from the country’s emergency doctors warns that delays in treatment, due to crowding, increase patients’ risk of death and also the odds of a second emergency department visit within a week.
“It constitutes a public health crisis,” warns the Canadian Association of Emergency Physicians. As a first step toward lasting change the group is calling for comprehensive national data collection, to gauge the extent of the problem, and Canada-wide benchmarks for improvement.
This makes eminent sense. Several provinces, including Ontario, already track emergency department wait-times and have set targets for timely treatment. But these approaches vary. Delays are measured in assorted ways. There’s a lack of consistency.
In Ontario’s case, most patients (nine out of 10) spent about four hours in emergency if they were receiving care for a minor problem this September. That’s spot-on target. But handling more complex conditions, requiring extra time for diagnosis and treatment, required 9.8 hours in ER — almost two hours over Ontario’s target.
All these performance results may seem rather slow but, according to the province, they reflect a significant improvement over patient time spent in emergency care in 2008.
The emergency physicians’ association is urging provincial health ministries to agree on common reporting standards and shared targets “so Canadians can know how their community compares to others across the country.”
Once uniform data is available it could be drawn together to create a practical, nationwide database of emergency department statistics that would be a boon to researchers investigating ways to enhance the system’s performance.
Some solutions are obvious. A major factor congealing patient flow in a hospital’s emergency department is a lack of acute care beds elsewhere in the facility. Simply put, there’s often no place for newly admitted patients to go, so they languish in ER.
The new position paper notes that this country had only 1.7 acute care beds per 1,000 people in 2009 — ranking Canada 33rd out of 34 OECD countries in 2009. More available beds are needed, and one way to get them is to do a more efficient job of moving hospital patients in need of long-term care into more appropriate facilities. The ER doctors say this shift of chronically ill patients (commonly called “bed-blockers”) should be a local, provincial and national priority.
Some progress has been made in reducing emergency wait-times, especially in Ontario. But it’s not nearly enough, especially with the system facing ever-mounting pressure from an aging population. When Canada’s emergency physicians warn of looming crisis, governments — at every level — need to pay attention. Beyond that, they need to act.
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