Inside ERs at breaking point, staff provide care while reconciling shortages and closures

Inside ERs at breaking point, staff provide care while reconciling shortages and closures

Monica Griffin, a charge nurse at Kingston Health Sciences Center, is seen in the emergency department in Kingston, Ontario, in September. On that day, a section of the emergency department was closed on the daily shift because the emergency room was under two nurses. (Yanjun Li/CBC – photo credit)

It’s 6:30 a.m. A section of the emergency department at Kingston General Hospital is closed for the day. The lights are off so patients can sleep, but one by one, they are woken up and told they are being transferred.

Monica Griffin, a nurse in charge of an Ontario hospital that is a trauma center for about 500,000 people in the area, said.

the reason? There is not enough staff to keep C-section – for the least sick – open during the daily shift. They are short nurses, so patients must be moved to another location in the department.

It’s like that all the time — or worse, said Griffin.

The persistent and widespread shortage of health care workers means that even a large urban hospital such as Kingston has been affected. Many doctors and nurses across Canada have been calling for help for months, as the COVID-19 pandemic has overwhelmed resources they say are already depleted — leading to an unparalleled wave of staff shortages that they say have reached breaking point.

According to Ontario Health, 18 hospitals in the county have had emergency department service outages since the end of June, often on the night shift, due to a shortage of nurses.

About 46,000 additional hospital staff should be hired in Ontario just to deal with staff turnover, hospital vacancies, as well as the impact of the pandemic and the growing needs of a growing and aging population, according to the Ontario Council of Hospital Unions/ CUPE.

Watch | A hospital in Kingston, Ontario, addresses staffing shortages:

Meanwhile, the average waiting time for the county’s emergency department is now 20.7 hours for patients admitted to the hospital.

When the National Visited, 27-year-old Missy Kalbury had already spent about 20 hours in a C-section parlor and was waiting for surgery on her broken ankle. She said she didn’t realize how busy the hospital was, until she came and saw it for herself.

“I can’t really sleep, people are passing by, always in people’s way…I’d rather be in a room, that’s for sure,” she told CBC News. “They definitely need more people.”

Hospitals of all sizes are affected by staffing challenges

Kingston Health Sciences Center is the largest acute care academic hospital in southeastern Ontario, consisting of two hospitals (including Kingston General Hospital), a cancer center and two research institutes.

Dr. David Messenger, chief of emergency medicine at KHSC, notes that despite the hospital’s size, it is by no means immune to the staffing challenges facing hospitals across the province and Canada.

“A nurse makes a difference in our ability to work sometimes,” Messenger said.

Yangon Lee/CBC

Yangon Lee/CBC

Rural hospitals, where employment margins are often lower, can be hit hardest by this shortage.

In Chesley, Ont., a small community in Bruce County, the local hospital was forced to close its three-room emergency department indefinitely, from 5 p.m. to 7 a.m., due to a shortage of nursing staff. Sometimes the emergency department is also closed during the day as well.

When the hospital is closed overnight, any patients inside who need emergency care will be screened. But as Emergency and Family Physician Dr. Jackie Wong said the NationalAs of 5 p.m., unfortunately, “nobody who comes to the ER for care will have it.”

The hospital provides a list of the closest emergency departments to Chesley for residents. The nearest one is located in Hanover, 19 kilometers away.

“If it’s urgent, we call an ambulance for them,” Wong said.

But she says the need to access 24-hour emergency care is especially important in a small community like this, where it’s impossible for residents to plan for emergencies.

CBC

CBC

“We’re a big farming community, so there’s a lot of machinery involved, so you can have major accidents. Plus, you know…heart attacks or strokes or respiratory problems,” she said. “If you can’t breathe and have to travel for another half an hour, that’s awful.”

Wong said that although the local nurses have taken on several additional shifts since the beginning of the epidemic, over time, “this has taken its toll,” and then “they don’t have the capacity to be able to fill these people.”

Under these pressures, “We care and want to provide care and do our best,” Wong says.

Watch | In Chesley, Ont., the emergency department is struggling to stay open:

‘We knew this was coming’

Messenger says there are backlogs of patients throughout the health care system that culminate in the hospital emergency room.

“There is literally nowhere to bring (patients) to it because all the beds upstairs are full, and many of the beds upstairs are full because people need to go elsewhere for care in the community where there is no available space. So everyone waits, and there they are. This progressive type of roadblock to move effectively and efficiently through the system.”

He says the current situation has taken a long time to form.

“We knew this was coming,” he said. “Emergency physicians, nurses, and organizations across Canada warned that this was imminent.”

“The system has not been provided with the resources it needs in a long period of time”

Messenger is referring to the fact that patients are getting older, which means they have more complex medical needs, and people are getting worse. Many may be without a family doctor. He notes that the mix of what they see in the emergency department is changing — including mental health needs, and an increase in patients with substance use disorders.

“We’ve really become a door to health care for many people who wouldn’t have access to it any other way,” Messenger said.

Yangon Lee/CBC

Yangon Lee/CBC

Complete system under pressure

Dr. David Pechora, president and CEO of the Kingston Health Sciences Center, says the combination of a number of factors — including staff shortages, unmet care needs in the community and deferred care from the pandemic — means the entire system is under stress.

“Our intensive care unit has been full for months and months and months,” he said.

Julia Fournier, the intensive care unit (ICU) program manager, says her overworked staff often have to look for opportunities to try to “double” patients, a nurse to two ratio. Sometimes, they triple, which isn’t audible, she says, in critical care, where the ratio is usually one patient to one nurse.

in a day the National They visited the unit, and it had about half the staff it needed.

Patrick Morrell/CBC

Patrick Morrell/CBC

“I know the nurses provide excellent care, but that extends to them,” Fournier said. She worries about seeing her team struggle “because of moral damage and moral stress. They’re tired. They’ve been through a lot with the epidemic.”

In addition to the occasional and temporary closure of the emergency department, the KHSC also had to limit the number of patients they see in the urgent care center at nearby Hotel Dieu Hospital to make sure there were enough doctors and nurses available for them to keep the emergency department running.

Pichora notes that their urgent care center is popular because people can show up without an appointment or visit a doctor or nurse; And if blood tests, X-rays or CT scans are needed, they are done right then and there. He explained that many of those who come to the urgent care center have a family doctor in the community, but they can’t get an appointment in time or need tests sooner than they can get in the community.

Pichora said the urgent care center is “a bit of a victim of its own success,” in that it is very busy because it is so efficient and convenient for patients. He cited it as a model to consider expanding further as governments look at how to redesign care in county community health teams.

“We will take care of you”

organizations like OMA And the CMA They demand systematic solutions to relieve pressure on hospitals.

These include an increase in the number of healthcare workers through strategies such as licensing more doctors trained abroad and creating a national physician licence.

They also want better access to primary care, centers for patients with fewer complex surgeries, a better system for long-term care and home care for seniors, more hospice and palliative care services, more resources for mental health needs and substance abuse issues, and more. Working on digitizing health data and facilitating more virtual care.

At this point the problems are so large that they really need broader system-wide solutions and “legislative change that would allow for an improved range of practice for different types of caregivers,” Messenger said as they work to find efficiencies within the hospital.

“We’re emergency doctors, aren’t we? We’re action-oriented people who like solutions quickly, and we like to move on to the next thing and solve problems,” he said.

However, Messenger wants to reassure people that despite the challenges, they will be there for those who need care.

“People have to realize it’s not the same system it was 10 years ago… There will be waiting periods for less urgent problems. But we’ll get to you. We’ll take care of you.”

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