TIM GUEST
The pressures on our health-care system resulting in overcrowded hospitals are well-known.
Patients requiring admission wait in emergency departments for a bed in the hospital; this results in others waiting, some in the care of EHS paramedics, before they can be seen by emergency department staff, or worse leaving without being assessed. Elsewhere in hospitals, patients no longer needing care in hospital remain in beds while awaiting a more appropriate service in the community including placement in long-term care.
Amid this, it’s important to acknowledge the dedicated work of ER, inpatient, continuing care and other Nova Scotia Health Authority staff and physicians as well as our EHS, and long-term-care and home-care colleagues. Their focus on safe, quality care through increasingly challenging conditions is an outstanding service to Nova Scotians.
This year, we have seen extremely high patient occupancy in hospitals around the province, and as a result, some unprecedented circumstances in emergency departments. NSHA is making changes to ensure we are caring for patients in the right place, at the right time, throughout the provincial health system.
A new policy took effect June 3 that requires ambulances to be offloaded, and admitted patients to be moved up to inpatient hospital beds (or potentially other non-traditional places) from the ER, within defined timelines. The initial focus of this work will be at the largest and busiest sites — QEII, Colchester East Hants Health Centre, and Dartmouth General, Cape Breton Regional and Valley Regional hospitals — but will expand to all remaining sites. Those standards are hard to achieve, and we anticipate it will take time to hit them consistently. As patients and family members, this is some of what you might experience as part of our work to improve patient flow:
- shorter stays for you in the ER by moving you to an inpatient bed sooner. This could happen even before a traditional room is available on that unit.
- from the first day you’re admitted, working with you on a plan to safely get you home, wherever that may be, as soon as you are able, with the supports you need, or to other care facilities such as long-term care.
- caring for you in the hospital that meets your care needs closest to your home.
- planning ahead to be ready to go home by 11 a.m. on your discharge day. We appreciate the co-operation of a patient’s family or support network in this.
Other internal process changes connected to these new policies build on existing approaches to patient-flow challenges, that have been developed at NSHA and replicated elsewhere, such as expanding the use of paramedics in home-based palliative care and rolling out the INSPIRED program that’s helping people with chronic obstructive pulmonary disease better manage their health at home and avoid the need to visit the emergency department.
We are also meeting with our strategic partners including long-term care, home care, and the departments of Health and Wellness and Community Services — it will take all of our collaborative efforts to succeed in making the changes we need.
While all of this work will assist our staff and physicians everywhere in improving the movement of patients through our system, external factors may make gains difficult to see. Our population is older, increasingly relocating from rural to larger communities, and has a high need for health services. This adds pressure, particularly on the larger emergency departments.
To the people we serve, we ask for your patience as we work to move changes from a policy level to day-to-day practice. We appreciate the frustrations of long stays in emergency departments and delays that may keep you in hospital longer than you need to be. We are making headway to address these challenges for everyone who depends on our system.
Tim Guest is the NSHA’s vice-president, health services, and chief nurse executive.
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