Niagara, ON - With seasonal health pressures facing Niagara's Emergency Departments (EDs), the Niagara Health System (NHS) is asking the public to help their health-care providers ensure they receive the best possible emergency medical care.
"This is always a busy time of year for our EDs, and our health-care team is doing a tremendous job of meeting the health-care needs of our communities in very challenging times," says Dr. William Shragge, NHS Chief of Staff. "In order to maintain our ability to provide quality and safe patient care, we are appealing to the public to help our physicians, nurses and other professional staff in a number of important aspects."
"We know that a visit to the ED can be a very stressful and difficult experience for patients and their loved ones," adds Dr. Shragge. "One of the areas we are committed to improving upon is our communication with the public as a whole and with our ED patients and their families specifically so they will have a better understanding and comfort level of what takes place in the EDs."
Understanding how to use the ED can help make a visit go much smoother. ED care is for serious illness or injury such as chest pain, difficulty breathing, severe pain, sudden, severe headaches, vision problems, sudden weakness, trouble speaking, dizziness, numbness and/or tingling in the face, arm or leg and critical conditions, such as loss of blood.
The Canadian Triage and Acuity Scale (CTAS), used by the NHS and hospitals across Canada, is designed to systematically ensure that patients who need the most immediate care are assessed by physicians first.
"A registered nurse specially trained in triage assesses patients as quickly as possible upon their arrival to the ED to determine their urgency for care," says Marcia Ladouceur, Acting Health Program Director for Emergency Medicine. "How soon patients are seen by a doctor depends on how sick or how badly injured they are, not on the time that they arrived in the ED. Patients will not be seen sooner because they arrived by ambulance. The sickest patients are always seen first."
Although it may seem that an ED is not busy, what goes on behind the ED doors tells a far different story. With an increasing number of seriously ill patients coming to the EDs, particularly in St. Catharines, the care these patients require is more complex, taking significantly more time and resources for blood work, x-rays, CT scans, and other tests and consultations.
Another misconception is that patients who are acutely ill can avoid longer wait times at the St. Catharines General ED by going to the Prompt Care Centre (PCC) at the Ontario Street Site instead.
The PCC is staffed by the same highly trained team of emergency doctors and nurses as at the St. Catharines ED. They offer medical attention and treatment for adults and children experiencing urgent, but non-life threatening complaints. Conditions that are treated include fever, cough, sore throats, ear aches, strains and sprains, cuts and broken bones.
"Patients who present at the PCC and require more urgent emergency care are transferred by ambulance to the SCG ED because their condition requires more intensive treatment," says Ladouceur. "It's important for people to know where to go to get the appropriate care."
Ideally, patients with urgent but non-life threatening conditions would visit the PCC, leaving the SCG ED better able to care for patients with more serious illnesses or injuries. Based on projections for the current fiscal year, it is estimated that close to 9,000 patients who will present at the PCC would be more appropriately cared for at the SCG ED. For the same time period, it is estimated that almost 14,000 patients who will present at the SCG ED could be more appropriately cared for at the PCC.
"What goes on in the Emergency Department is also directly related to what occurs in inpatient areas of the hospital," says Anne Atkinson, Vice President of the St. Catharines General and Ontario Street sites. "There are a number of profound impacts that our patients in the EDs might experience during their visit."
For example, inpatients are urged to prepare for their discharge on a timely basis (10 a.m. is the daily discharge time) so they are able to leave their room on time upon discharge. This currently occurs only 17 per cent of the time, causing patients admitted from the ED to wait in the ED for a free bed on an inpatient floor.
The lack of long-term care beds in the community also has a profound impact on ED wait times. There is a shortage of inpatient beds for ED patients once they are admitted to hospital since one third of all NHS acute and chronic care beds are occupied by Alternate Level of Care (ALC) patients. These patients would be more appropriately cared for in a long-term care or rehab bed or home care services but must stay in hospital while waiting for these services.
In addition to all of this, a local population that is older, sicker and poorer than the rest of Ontario is a serious factor that contributes to the high use of Niagara's EDs. A shortage of 90 family physicians in the Niagara community is putting additional pressure on the EDs, resulting in both increased patient visits and acuity, and therefore creating backlogs in the EDs.
The NHS operates the largest system of EDs in Ontario, with five 24/7 EDs and a 14/7 PCC across the Niagara region, and a combined total of 200,250 patient visits during the 2006/07 fiscal year. One in every 10 ED patients was admitted to hospital during that period of time.
"There is no question that our EDs face tremendous pressures. EDs across the province, if not Canada, face similar pressures," says Dr. Shragge. "Despite all of the challenges, Niagara's health-care team is 100 per cent committed to providing quality, safe patient care. We are working very hard with our LHIN partners and on various other initiatives to develop solutions and improve emergency medical care for our patients."
Emergency Department Fact Sheet
The Niagara Health System operates the largest system of Emergency Departments in Ontario, with five 24/7 Emergency Departments (located at Douglas Memorial Hospital Site in Fort Erie, Greater Niagara General Site in Niagara Falls, Port Colborne General Site, St. Catharines General Site and Welland Hospital Site) and a 14/7 Prompt Care Centre (Ontario Street Site, St. Catharines).
Combined total patient visits for fiscal 2006-2007: 200,250
One in 10 ED patients are admitted to hospital in Niagara.
Based on projections for the current fiscal year, it is estimated that close to 9,000 patients who will present at the Prompt Care Centre in St. Catharines would be more appropriately cared for at the SCG ED. For the same time period, it is estimated that almost 14,000 patients who will present at the SCG ED could be more appropriately cared for at the Prompt Care Centre.
ED wait times averages for all NHS EDs:
- 1.5 hours: average time it takes for initial physician assessment
- 4.75 hours: average time from initial physician assessment to decision to admit patient to hospital
- 9.7 hours: average time from decision to admit to patient occupying an inpatient bed
The Canadian Triage and Acuity Scale (CTAS):
- Level 1 – Most Severe – life or limb threatening – this is a resuscitation
- Level 2 – Emergency – very serious and may quickly deteriorate to Level 1
- Level 3 – Urgent – serious and cause for concern – may deteriorate
- Level 4 – Less Urgent – can wait safely and appropriate for Prompt Care, Dr.'s office or Clinic
- Level 5 – Non-Urgent – can safely wait and appropriate for Prompt Care, Dr's office or Clinical
Alternate Level of Care (ALC) patients:
At any given time, more than one third (39%) of NHS acute and chronic care beds are occupied by ALC patients who require care that an acute-care hospital does not provide but is not available to them in the community due to a shortage of long-term care beds, rehab beds and other community services.
Niagara health-care demographics:
- 17.3% of Niagara's population is 65+ compared to Ontario at 13.5%, and the HNHB LHIN at 14.7%
- By 2021, population 65 and older is projected to increase to 20%, while the population under the age of 15 will decrease to 10%.
- Niagara Population - 21% smokers, 34% overweight (with an additional 16.5% obese), 42% inactive (47% of women are inactive and 37% of men)
- Currently short 90 family physicians for the Niagara Region
- Leading causes of death for both men and women in Niagara is heart disease, lung cancer, cerebrovascular disease and chronic lung disease.
- Leading cause of hospitalization is circulatory disease, digestive and respiratory illness. Highest rate of hospital days attributed to mental illness and circulatory disease.
- Community health/support agencies report unmet service needs, lengthy waits, lack of adequate funding and recruitment difficulties.