St. John's ERs bottlenecked and busier than ever, says doctor

The emergency rooms at two hospitals in St.John's are busier now than before the pandemic, says Eastern Health's chief of staff, and filled with patients requiring intense and urgent care.

Dr. Doug Drover said the emergency rooms at St. Clare's Mercy Hospital and the Health Sciences Centre are "extremely busy," with the number of patients exceeding that prior to COVID-19. Adding to the problem: the people showing up need more attention.

"Normally, about two-thirds of our patients are less urgent. So they don't need the urgent emergentcare that's provided in the ER department," said Drover.

"It appears over the last number of monthsthat that's reversed. So actually two-thirds of our patients are requiring much more intense care than previously."

The departments are operating most of the time at a 100 per cent occupancy rate, and at times exceeding that, he said.

Admitting and getting these patients seen is one issue, said Drover, and discharging them is another, creating "a bit of a bottleneck," he said. There are about 30 patients admitted a day between the two departments, but about 80 patients who need to be transferred elsewhere occupying acute-care beds.

"That makes the problem worse," he told CBC TV's Here & Now.

Although some people are waiting for beds up to 12 to 14 hours, "they do get ongoing care, so there's no concern there."

Nurse shortage 'severe'

The causes behind the emergency department crunch are complex, he said, but in part come down to staffing.

"We have a severe shortage of nurses," he said, adding there are hundreds of vacancies across Newfoundland and Labrador.

That echoes what the Registered Nurses' Union of Newfoundland and Labrador has been saying for some time: that unfilled positions are stressing existing nurses' workloads and causing service problems. In June, Eastern Health stopped admitting new patients to four long-term care homes in St. John's due to nurse shortages.

What's happening in long-term care is trickling down to the emergency departments, said Drover.

"We've had great problems within the city making sure that we have our long-term care facilities staffed fully by our nurses. So that prevents problems in offloading ourpatients," he said.

The nursing issue and flow of patients to those facilities is being looked at by Eastern Health he said, with "all kinds of innovative approaches" being taken. Those include education incentives for nurses willing to take weeks-long shifts in long-term care, letting them choose shiftsand allowing them vacation time in the fall. The health authority is also working with the federal government to speed up the process to recruit nurses from abroad, he said.

Between those steps and other avenues to get nurses into long-term care, Drover predicts the emergency room issues will be a short-term problem.

"I believe we could very soon have some of that pressure taken off," Drover said.

Eastern Health is hoping to transfer about 50 patients out of acute care "in the very near future," he said, "which will pretty well eliminate the acute pressures that we have right now."

A virtual ER?

Other emergency departments on the island are also having challenges this summer, as the health authority in Central Newfoundland looks to new models of care to solve recurring staffing problems.

A lack of doctors has meant a lack of emergency services at times on both Fogo Island and at the Connaigre Peninsula Health Centre in Harbour Breton. The latter health centre is now the focus of a new Central Health pilot project:a "virtual emergency room."

With no doctors on some shifts, staff in the centre will be able to assess and take the vital signs of any patients coming in who don't require urgent care, said Dr. David Carroll, Central Health's chief of staff. Those patients will then be connected virtually to a physician in Grand Falls-Windsor for treatment.

The pilot comes out of "a crisis opportunity," Carroll said, to cover some 12-hour shifts when no physicians are available. The idea is to expand the virtual emergency rooms to other small rural hospitals "to offer stability and backup in times of shortage and in times of unexpected physician leave."

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