Emergency rooms in northeast Ontario bending but not breaking
Over the July long weekend, more than 20 emergency rooms across the province were forced to close, as a surge in visits clashed with already overburdened and understaffed facilities.
The long weekend closures, which hit southern and rural northwestern hospitals particularly hard, are just the latest alarm bell in an ongoing staffing crisis that has health-care workers calling for assistance.
Late last month, Nickel Belt MPP and NDP health critic France Gelinas criticized the provincial government for allegedly withholding $1.8 billion for health care as part of a mid-year budget cut for 2021-22.
The cuts were revealed in a report released by the Financial Accountability Office of Ontario on July 19, as multiple emergency departments across the province temporarily shut down due to staff shortages.
During a virtual press conference on Wednesday, Gelinas reiterated her concerns that EDs are struggling to stay afloat.
“People have to wait 38 hours — people who are sick enough to be admitted into our hospital,” she said. “The doctors don’t want them to go back home; they need to be admitted. And they will sit in a waiting room, in our hospital ER for 38 hours before being admitted. That’s like six meals, a sleep, over a day and a half, and you are sick enough to be admitted into our hospital.”
On Thursday, Ontario’s health minister directed regulatory colleges for nurses and doctors to develop plans to more quickly register internationally educated professionals, a move nursing groups and critics say falls short of the premier’s promise to do everything in his power to address an emergency room staffing crisis.
Sylvia Jones sent directives Thursday to the College of Nurses of Ontario and the College of Physicians and Surgeons of Ontario directing them to make every effort to register those nurses and doctors “as expeditiously as possible” so they can practice in the province and provide reports in two weeks on how they will accomplish that.
The minister also directed the nursing college to develop supports for the internationally trained nurses — for example, to bring their skills to Ontario standards — to allow them to practice “in a timely way.”
Hospitals have been under strain in the province in recent weeks, with some emergency rooms forced to close for hours or days at a time due to staff shortages. More temporary closures are expected this weekend in Clinton, Ont., and St. Mary’s, Ont.
Nursing groups, hospital executives, other health-care professionals and advocates have said that burnout after being on the COVID-19 front lines for more than two years and not being properly compensated have caused people to leave the profession in droves.
Cathryn Hoy, president of the Ontario Nurses’ Association, said the system will benefit from more internationally trained nurses, but she wants to see the report from the college before assessing whether this particular directive will help.
As well, she said that the news of the directive alone does not amount to Premier Doug Ford doing everything in his power to address the staffing crisis, as he promised at a news conference Wednesday.
“This still goes hand in hand with Bill 124,” Hoy said, referencing legislation passed in 2019 that capped wage increases for public sector workers at one per cent for three years.
“You’re going to bring all these internationally trained nurses in, which yes is going to help because they’re nurses, but at the end of the day, who is going to support them and orientate them and mentor them, because there are not enough nurses to do the work that we need in Ontario? So we need to get the retired nurses back and the only way you’re going to get that is if you repeal Bill 124.”
Ford indicated Wednesday that he would not be repealing the wage restraint legislation or increasing a $5,000 retention bonus for nurses. He also noted that the provisions of the legislation expire and won’t apply to the next contract negotiations for nurses.
So far in northeastern Ontario, emergency rooms have avoided any catastrophic incidents. None of the emergency rooms in the region has yet reported any closures.
But with staffing concerns ongoing, the situation remains precarious, and patients are growing increasingly frustrated.
At Health Sciences North, long waits in the emergency department have become a cause for concern for patients who have experienced the issue in the understaffed and overflowing hospital.
In an emailed response to a request for comment, spokesperson Jessica Lopatka said it currently takes most patients almost nine hours between ED triage to a decision to admit or discharge.
In most cases, patients have to wait nearly four hours before being assessed by a physician.
Though the time between triage and admission to an inpatient bed has improved, Lopatka said there has been a minor increase in the time it takes to be assessed by a physician since 2019.
While HSN’s wait times remain below provincial averages (4.5 hours from triage to physician assessment and 14 hours from triage to admission/discharge decision), staff shortages are still exacerbating the problem.
“HSN has been experiencing significant staffing challenges across our organization particularly over the last two months in acute, emergency and critical care areas,” Lopatka said in a statement, citing retirement rates, people choosing alternative employment options, and a limited number of graduates to recruit as some of the reasons for the shortage.
In June and July, HSN’s ED averaged 205 visitors each day, consistent with numbers seen before the pandemic, with a surge space in place to manage peak patient volumes.
Lopatka said the proportion of patients who are sicker or present with higher complexity cases has gone up.
“Despite these circumstances, HSN has never closed the Emergency Department or come close to doing so,” she said. “At times, it has been necessary to operate at less than the full complement of staff, and we are thankful to all of our healthcare workers who continue to work overtime and take extra shifts to provide the best possible care under these difficult conditions.”
St. Joseph’s General Hospital in Elliot Lake is facing a similar challenge. CEO Jeremy Stevenson outlined those concerns in an article for The Elliot Lake Standard two weeks ago.
According to Stevenson, the emergency department has narrowly avoided closure on numerous occasions.
“While emergency department closure is something we have yet to experience, we are not immune to the situations other rural hospitals have experienced and continue to prepare for the possibility,” Stevenson wrote. “We are working hard for you every day in an effort to keep our ED open despite the challenges, and we appreciate the ongoing support of our community to stand behind our hospital and our team.”
Short-staffing in the ED has had a ripple effect within the community. Physicians who typically work outside of the hospital have been stepping in to provide the support necessary to keep the facility running. As a result, some patients have had appointments with their doctors in their community offices cancelled.
“Without their willingness to provide this support, there have been many occasions on which our emergency department would have had to close to emergency care,” said Stevenson.
Stevenson wrote that patients only use the ED for true emergencies, and seek alternate non-urgent care from their family physician to prevent unnecessary surges.
At other hospitals across the region, the situation is less clear.
In a response to a request for comment, a spokesperson for the Espanola Regional Hospital and Health Centre said it was not taking media requests regarding hospital operations.
According to its website, the Espanola hospital’s emergency department operates 24 hours a day and services around 15,000 people each year. It also mentions that treatment in the ED may take several hours if the patient needs testing, if the physician needs to consult a specialist, or if a more critical patient comes in.
While staffing information wasn’t provided, a number of job openings are listed on the hospital’s website and social media, including for a part-time emergency and acute care ward clerk. It is also hiring registered nurses and registered practical nurses, as well as personal support workers.
Similarly, the Manitoulin Health Centre, which operates two sites in Little Current and Mindemoya, declined to provide information about its ED.
“We are very proud of our team for their continued dedication to provide quality health care services to the community,” said spokesperson Kelly Timmermans in an emailed response. “We continue to be very busy in the emergency department with our local residents and an influx of seasonal/tourist visitors.”
The MHC is in the process of renovating and expanding the Mindemoya Emergency Department, a project that has experienced significant delays due to pandemic-related supply chain issues. In May, the organization announced that the completion date of the project was being pushed once again, from July to September.
According to the MHC website, Mindemoya emergency room handles 49 per cent of the 9,500 patients who visit its EDs. In July and August last year, it said ED visits had jumped three per cent. The expansion project will increase the size of the ED by 1,700 square feet and provide more working space for staff, as well as privacy for patients.
— with files from Canadian Press
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Over the July long weekend, more than
