Three days in a St. John's ER

Jessica Doria-Brown is a freelance journalist who the CBC asked to observe three days in a St. John's emergency room.

Jessica's assignment was to spend several days sitting for four to sevenhours at a time in the waiting at the Health Sciences Centrein St. Johns.

Day One (between 16:00 and 24:00 on a Tuesday)

Jessica said the day ended up being what she would say is typical in this emergency room. Patients arriving toward the beginning of the shift waited an average oftwo hours before being called, and she generally saw them leave about two hours later, indicating a wait time (on average) offour hours.

Day Two (between 00:00 and 06:00 on a Saturday)

Jessica said this was by far the most interesting shiftshe spent in the emergency room.There were 21 people waiting when she arrived, and when she left at 6 a.m., only five patients had been called.One woman who told hershe arrived at 7 p.m. the previous evening was told she wouldnt be seen until 4 or 5 a.m., and ended up leaving at 2 a.m.A manshe spoke with around 2:30 a.m. toldher he had just been warned he wouldn't be seen until 9 a.m. or 10 a.m.that morning.

This shift was the least staffed, and the impact on waiting room dynamics was evident throughout.Jessica said shewitnessed vomiting, screaming (patient to nurse), drunken staggering and additional injuries while in the waiting room. Almost everyone who left beforeshe did at 6 a.m. did so out of exasperation, and had not seen by a doctor.

Day Three (between 09:00 and 15:30 on a Thursday)

This shift was exceptionally fast and efficient.WhenJessica arrived there were 14 people waiting.Between 11:30 a.m. and 12:30 p.m., almost 20 new patients arrived.All of them had been called (and most had been seen and already gone home) by the time she left at 3 p.m.

Jessica's Observations

Jessica saidshe chosevarying times of the day and different days of the week.Once there, she made a note of everyone currently waiting, then noted new patients as they arrived.She recorded the time when each patient was called, and where possible the time they were discharged.She also spent a considerable amount of time chatting with patients about how long they'd been waiting and whether or not they were satisfied with the service they were receiving.

Almost everyoneshe spoke with complained about wait times.In the emergency room, she determined there are many variables in the wait times for treatment. She saidpatients sometimesplay arole in extending wait times and exacerbating an already-stressed emergency health-care system.

The following are some of the problems Jessica found in the emergency room:

A shortage of family doctors

Too many people in St. John's don't have a family physician.Those who are fortunate enough to have a family doctor often end up waiting several weeks for an appointment.

Many of the patients she spoke with admitted to being there despite supposedly having access to a family doctor.To them, taking a day off work to sit in an emergency room was preferable to waiting weeks for medical care.

Better access to family doctors would inevitably free up time and space in emergency rooms, and decrease wait times for those with actual medical emergencies.

Public education

Many of the patients she spoke with don't see the emergency room as a place to go "only in an emergency.They see it simply as a place to get medical care.Furthermore, many patients said they hadn't considered going to a walk-in clinic, and some said they werent even aware of any clinics in the city.

Jessica said her time in the emergency room indicated to her that additional medical resources are definitely needed in the city.Still, she said better use of existing resources would help alleviate the pressure on emergency rooms.

Resources within Eastern Health

Jessica's view was limited to the nurses in the triage area.The majority of them were friendly, exceedingly patient, and efficient.She was surprised that no one ever asked her whatshe was doing there, or thatnobody seemed to notice thatshe'd been there several times in one week.

FromJessica's perspective, the emergency room worked best when it was fully staffed.With minimal staff, patients were waiting six to 12 (or more) hours to see a doctor.With full staff, and despite a full waiting room, patients were in and out in two to three hours.

There are evidently many more variables too, just beyond the doors where patients wait once they are called.Bed shortages, equipment shortages, and specialist shortages.

Despite all this, Jessica said the system is working but it's definitely stressed.