Taking Better Care of Seniors in the ER

I've been out of town for much of the past week.  I had intended to blog a bit more during my absence but found myself running literally from one event to another.  I thought I'd clue you in so that you get a sense of what some people on my side of the gurney are really anxious about. Basically, I crisscrossed the country.  In Halifax, I gave my thoughts on how to make health care sustainable and compassionate for seniors. 

In Halifax, I presented two public addresses on future of health care for seniors in the emergency departments there and in other parts of Nova Scotia.  Believe me, it's quite a serious issue there.  Many of the roots of the problem are well known.  Cutbacks to med school enrollment took MDs out of the system.  That's a problem that's being rectified but will take years to correct.  Moreover, in the fee-for-service assembly line type of primary health care that many GPs deliver, there's simply never enough time to properly look after the increasingly complex needs of frail senors. 

The result is that a growing number of seniors with increasingly neglected medical problems turn to the ER when their health takes a turn for the worst. When they get there, seniors soon discover another serious limitation of the system.

As with most other parts of Canada, Nova Scotia has saved money by taking nursing home and acute care beds out of the system.  As a result, acute hospitals like the Halifax Infirmary have a surplus of nursing home patients occupying acute care beds while they await placement.  Each nursing home type patient occupying an acute bed means another patient in the ER must remain on the stretcher there.  In turn, every admitted patient occupying a stretcher in the ER means another patients with equal or even greater need must wait in the waiting room. 

There are additional consequences to the system.  In our second season of White Coat, Black Art, we did a story about the impact of this dance of beds on the work done by paramedics.  In the past, local paramedics bringing patients to Halifax ERs could count on being able to offload their patients to ER stretchers within 20 minutes and return to rescuing people in need.  Since 2008, paramedics have found that Halifax ERs are increasingly unable to offload patients quickly due to lack of beds.  As a result, I interviewed paramedics who spend an entire 12 hour shift at the bedside of a patient they've brought to the ER but are unable to offload.

Read a past blog post on Off-Load Delay in the ER.

I discussed some potential fixes to the system with Dr. Ken Rockwood, a noted geriratrician and educator at Dalhousie University.  In his remarks, Dr. Rockwood said each of us who works on medicine's front lines needs to learn more about caring for seniors.  He said we need to borrow a page from our pediatric colleagues.  Just as pediatricians say that infants are not small adults, geriatricians say frail seniors are not merely old adults.  He told a public gathering at the Lord Nelson Hotel in Halfiax that the health problems facing seniors are quite different from those facing younger patients.  He said people like me need to acquire new knowledge if we're going to meet their complex health needs. 

As I pointed out to the gathering, a major obstacle to providing the very best care to seniors is the lack of geriatricians in Canada.  It's estimated there are fewer than 300 specialists in Canada and their average age is rising.  We need to make geriatrics a highly paid specialty for young physicians and a highly sought after residency. 

In my opinion, we also need to recruit and train many more nurse practitioners as geriatric specialists. 

It's time to stop worrying about politics and turf.  There's simply too much business to go around to fret about such trivialities. 

Next:  getting young doctors to become proficient in the arts.

Comments are closed.