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Comment: Many patients in emergency are being left for hours without an assigned doctor

Hospital emergency departments cope with the “new normal”
Emergency department entrance at Nanaimo Regional General Hospital. via VANCOUVER SUN

A commentary by an emergency physician.

It has been three months since the emergency department at Nanaimo Regional General Hospital began holding patients without any physician assigned to care for them.

When the identical unattached patient situation occurred this spring in Fraser Health, with the ensuing uproar, it resulted in visits by Health Minister Adrian Dix and quick, albeit temporary solutions.

Recently, new promises for Fraser Health were made. I presume then that Nanaimo has been chosen by our health-care masters to be the leading edge for their “New Normal in Hospital Patient Management.”

On many emergency department shifts the numbers of orphaned patients has reached the mid-teens. Most of these patients on stretchers will be assigned a doctor within 48 hours, but it’s that first 48 hours that is the most critical period during a patient’s admission. No clear end to this unsafe situation is in sight.

At the moment the Ministry of Health seems content with these circumstances, much as they have been content with, and shown no effective action toward, provincial emergency-department overcrowding during their years as government – nor the Liberals before them. How long would the public tolerate no teachers in classrooms for extended periods but with the assurance that there is one available immediately down the hall for critical problems?

Canadian emergency departments are the reflecting pool of our crumbling health-care system. Our emergency department problems are system problems. Emergency department overcrowding is an outflow, not an inflow problem. We deal with the consequences when drainage backs up in the system.

Nationally, patient care standards have declined while emergency department wait times have increased dramatically. Canadians have become boiled frogs during this decline. It would seem that “unsafe overcrowded emergency departments” have become part of our national fabric and both provincial and federal governments stopped caring seriously about this situation a long, long time ago.

No provincial or national task force has been formed. No formal enquiry is looking for solutions. No major overhauls of Canada’s health system.

Nothing more than the decades-old platitudes, “we are spending this and building that” and “re-formatting, recruiting, redefining things” and that problem is the fault of “the provinces” or, alternatively, “the Feds.”

Whatever improvements have been made have been too little and too late. Shortsighted solutions and constrained capital expenditures have been overtaken by an aging population and rapid population growth; entirely predictable 20 years ago. Political finger-pointing doesn’t seem to help much either.

Physicians have largely become boiled frogs too as we weave past numerous occupied stretchers in emergency department hallways on our way to perform necessary tasks, sometimes ignoring patient requests as we hurry by.

Nowhere else in our Canadian health-care system is first-world medicine so closely aligned with that of the Third World. And, like the Third World, I now tell families that having a family member always at the bedside is the best way to ensure comfort and support for the basic needs of their loved ones.

This is incredibly demoralizing for staff, especially nurses. Is it any wonder why so many are leaving?

When I work certain shifts and I’m assigned to cover requests concerning our unattached/orphaned patient flock, I often spend one or two hours dealing with their issues instead of dealing with acute emergency department patient presentations.

This delay in providing service to recent arrivals results in increased wait times and increased morbidity and mortality for new emergency department patients.

At the moment it seems no one at the Ministry of Health is too bothered by Nanaimo Regional General Hospital emergency department circumstances.

Just as management policies introduced in the 1990s to hold admitted patients with assigned doctors for days in the emergency department became acceptable, and then standard practice nationally, it appears now that admitted patients, with no physician assigned to care for them, will become standard operating practice and “the new normal.”

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