New Brunswick

Taking the pulse of 6 ERs before they lose overnight service: How busy were they?

Six community hospitals are all losing their overnight emergency room service between midnight and 8 a.m. as part of reforms announced by the province earlier this week, but a closer look at their statistics shows there are significant differences in patient visits among these ERs.

Sussex was the busiest, Stella-Maris-de-Kent saw most serious cases, figures show

Protests were held outside some of the affected hospitals earlier this week, including the Sussex Health Centre, pictured above. (Graham Thompson/CBC)

Sussex Health Centre was the busiest last year of the six New Brunswick hospitals losing their overnight emergency room service, according to figures from the Department of Health.

It had 2,368 patients visit between midnight and 8 a.m. in 2018-19, an average of 6.49 per night.

That's more than double the 903 overnight visitors at Sackville Memorial Hospital, the figures show.

Stella-Maris-de-Kent Hospital in Sainte-Anne-de-Kent dealt with the highest number of the most serious patients, with 950 assessed as being Level 1, 2 or 3, based on the Canadian Triage and Acuity Scale.

Level 1, or resuscitation, refers to conditions that are threats to life or limb, Level 2, or emergent, refers to conditions that are a potential threat to life, limb or function, and Level 3, or urgent, are serious conditions that require emergency intervention.

Those Level 1-3 patients represented more than 40 per cent of Stella-Maris-de-Kent's overnight caseload, and more than four times the 222 serious cases seen overnight in Sackville.

It looks like Plaster Rock-area residents will face the longest trip to an emergency room with 24-hour service come March 11, when the six emergency rooms stop accepting patients after 10 p.m. and close at midnight to 8 a.m. 

They would normally visit the Grand Falls General Hospital or the Hotel-Dieu of St. Joseph in Perth-Andover, which are both about 38 kilometres away, or a 30-minute drive, according to Google Maps.

But they will now have to travel to either Edmundston Regional Hospital or Upper River Valley Hospital in Waterville, which are both about 98 kilometres away, or a 70-minute drive one-way.

The Progressive Conservative minority government announced the contentious health-care reforms on Tuesday, sparking angry protests, political divide and talk of an early provincial election.

Horizon Health Network CEO Karen McGrath, Health Minister Ted Flemming and Vitalité Health Network CEO Gilles Lanteigne announced the cuts to ER operating hours at six hospitals on Tuesday. (Jacques Poitras/CBC)

In addition to the overnight ER closures, patients in need of hospital care will not be admitted to any of the six hospitals, which also include Enfant-Jésus Hospital in Caraquet. The acute-care beds will be converted to long-term chronic-care beds.

Horizon Health Network CEO Karen McGrath and Vitalité Health Network CEO Gilles Lanteigne have said the changes are needed because of staffing shortages, the aging population and increasing mental health needs.

They said each of the hospitals has seen an average of only five emergency room visits per night, most of them not actual emergencies, and that 95 per cent of patients will still be within 72 kilometres of a 24-hour emergency room.

Nearly 10,000 overnight patients

CBC News obtained the detailed Department of Health data. 

The data shows the six ERs saw a combined total of 9,969 patients between midnight and 8 a.m. in 2018-19.

Of those, more than a third, or 3,665, were considered the most serious types of cases.

It's unclear how many additional patients visited the ERs between 10 p.m. and midnight, the period during which they will now stop accepting patients in advance of the closures. The data is only divided into the periods of 8 a.m. to 4 p.m., 4 p.m. to midnight and midnight to 8 a.m.

The number of patients seen between 4 p.m. and midnight, however, ranged between 9,954 at Stella-Maris-de-Kent and 5,493 at Hotel-Dieu of St. Joseph. Stella-Maris also saw the highest number of most serious cases during this eight-hour period, with 3,610 Level 1-3 patients, well above Enfant-Jésus Hospital, which ranked second with 2,575, and Sackville's lowest rank with 891.

The overnight total for all six ERs for 2019-20 was shaping up to be 10,272 if it had stayed at the same pace as the first nine months, which saw 7,704 patients visit, 2,609 of them urgent or worse.

Progressive Conservative MLA Bruce Northrup, whose Sussex-Fundy-St. Martins riding includes the Sussex Health Centre, said Thursday he can't support the changes. He contends the next closest city emergency departments are already overburdened. (Jacques Poitras/CBC)

Although the Sussex Health Centre was the busiest of the six ERs in 2018-19, its total of 2,368 overnight visits was down from the previous year's 2,475.

Its number of serious cases was up, however, at 803, compared with 746, for an average of 2.20 a night, the figures show.

The total overnight visits at three of the other hospitals, meanwhile, increased last year.

Sackville Memorial Hospital saw 90 more patients for a total of 903, Hotel-Dieu of St. Joseph was up 80 to 1,135, and L'Enfant-Jesus rose by 54 to 1,963.

Their per-night averages remained relatively low at 2.47, 3.11 and 5.38 respectively.

Urgent or higher cases represented 0.61, 1 and 2.01 of those, according to the figures.

Maximum distance 114 km

Asked about the location of the five per cent of patients who will not be within 72 kilometres of a 24-hour hospital, spokesman Bruce Macfarlane said the calculation was made by measuring the driving distance between the centre of a community to the nearest hospital using Statistics Canada's census subdivision groups.

"There may be people living on the outskirts of a community who are slightly beyond the driving distance," he said.

"As such, the 5% that is beyond the 72km distance are not necessarily in a single community or area. It is distributed across the province in more isolated rural communities similar to other provinces and territories."

He did say the maximum a patient will have to travel at night is 116 kilometres. The average is 26 kilometres.

A photo of a white ambulance taken of the side of the vehcile, with a dark red stripe on it that says paramedics.
The changes are expected to cause a 'significant increase in the number of calls,' said Chris Hood, executive director of the Paramedics Association of New Brunswick. (Radio-Canada/Guy R. LeBlanc)

Dr. Alan Drummond, a rural physician in Perth, Ont., who works in the ER and is co-chair of public affairs for the Canadian Association of Emergency Physicians, said small community hospitals are "the quintessential health-care safety net for rural Canadians who don't want to be forced to travel an extra hour on wintry, windy roads in the middle of the night with a sick child or a sick loved one."

If patients have to drive more than 30 minutes to reach an emergency room, said Drummond, advanced life-support equipment and paramedics need to be on board ambulances.

"You need to make sure that you have a robust and responsive helicopter ambulance service because sometimes roads are impassable, and I think you need to have a very good communications strategy to facilitate communication between the transporting and receiving hospitals," he said.

Meeting to discuss ambulance volumes

Lanteigne, of ​​​Vitalité, said Ambulance New Brunswick is currently meeting its targets and has made great strides with better-trained paramedics, more technology on the ambulances and improved communication with emergency rooms.

But members of the two regional health authorities and government officials will meet with Ambulance New Brunswick  in the coming days to consider the additional volume of patients the cutbacks will bring.

Lanteigne said half the people who visit emergency rooms are there because they can't access a family doctor within five days. Part of the goal is to increase access to primary care by freeing up overnight ER doctors and hiring nurse practitioners. (Radio-Canada)

In addition, "we have to make sure that the transfer corridors are well established with the regional hospitals; that they have capacity to be able to receive these patients," Lanteigne said.

"So there are a number of really minute details here that we need to make sure because what we're aiming here is to have certain services that are going to be safe and of quality and that are sustainable."

Chris Hood, executive director of the Paramedics Association of New Brunswick, said of the 1,100 paramedics in the province, 70 have advanced care training. They could put that training to better use to help more patients, especially now because there will be "sicker patients who will be travelling longer distances," he said.

Lanteigne said he is confident the government will "make adjustments, if required."

Not 'putting lives at risk'

Some people have accused the government and the regional health authorities of putting lives at risk with the reforms.

"Any changes are very disrupting," Lanteigne said in response. But after studying the data, he rejects the notion they are putting anyone in danger.

"In fact, we're improving the system because we're maintaining these emergency room services seven days a week, 16 hours, which is considerable access because that's when there are more people that are utilizing these services," he said.

"And in addition, we're putting more resources in the community."

Another 336 doctor hours

For example, the physicians who were working in the ERs overnight will now be freed up to work during the busier daytime hours either in an ER, a family practice, a clinic or other medical service, said Lanteigne.

He could not estimate how many more patients the physicians might see because it will be up to them if they want to work and how much. Some are so-called locums from out of province who temporarily fill in during absences or illnesses.

But it's the equivalent of 336 hours a week, he said.

"We know it's not going to be 336 hours, but it's not going to be zero either. So it's going to be somewhere in there."

A nurse practitioner will also be hired in each of the six communities, said Lanteigne. Each nurse practitioner will see about 20 to 25 patients a day, he said.

In addition, nurse practitioner clinics will open in Saint John, Fredericton and Moncton with six nurses each, which is expected to reduce the number of people waiting for family doctors by 18,000 or 54 per cent. Some nurse practitioners will also be added to the ERs in those three cities to see less urgent (Level 4) and non-urgent (Level 5) patients.

"It's not like we're moving from a perfect functioning system right now," said Lanteigne. "Everybody agrees that the health system is in crisis and that we need to make changes.

"We think it's the best solution for what's happening now and at the end, we'll be able to sustain the service, we'll be able to have quality and [safe] services."

Do I think that consultation was warranted in this case? No, I don't, because it is only us as leaders [who] know the full picture of what we're facing.- Karen McGrath, Horizon Health Network CEO

There will be a transition period once the changes take effect March 11 to ensure people get accustomed and everything goes smoothly, Lanteigne stressed. He did not say how long the transition period would last.

The changes take effect just one day after the legislature is scheduled to resume sitting. But Department of Health officials and the health authorities' CEOs will appear before the public accounts committee next week.

MLAs and other critics of the changes have complained the government didn't consult the six communities but instead surprised them with the planned cuts to ER hours. 

But McGrath, of Horizon, said her job was to come up with a plan for sustaining the network's health-care service. 

"Do I think that consultation was warranted in this case?" she asked. "No, I don't, because it is only us as leaders [who] know the full picture of what we're facing.

"So people in Sussex know the situation in Sussex. They do not know the situation in Saint John or in Minto or anywhere else. So what I am looking at is sustainability of the system." 

The following data is from the Department of Health's Management Information System. The data is subject to a quality assurance process and used nationally and internationally for analysis and comparison, said Vitalité spokesperson Thomas Lizotte.

Horizon's 3 affected hospitals:

Sussex Health Centre2016-172017-182018-19
Total overnight visits2,4572,4752,368
Average per night6.736.786.49
Total Levels 1, 2 and 3 (urgent)748746803
Average per night2.052.042.20
Sackville Memorial Hospital2016-172017-182018-19
Total overnight visits717813903
Average per night1.962.232.47
Total Levels 1, 2 and 3 (urgent)203173222
Average per night0.560.470.61
Hotel-Dieu of St. Joseph2016-172017-182018-19
Total overnight visits1,0751,0551,135
Average per night2.952,893.11
Total Levels 1, 2 and 3 (urgent)256287365
Average per night0.700.791

Vitalité's 3 affected hospitals:

Enfant-Jésus Hospital2016-172017-182018-19
Total overnight visits1,8831,9091,963
Average per night5.165.235.38
Total Levels 1, 2 and 3 (urgent)738687734
Average per night2.021.882.01
Grand Falls General Hospital2016-172017-182018-19
Total overnight visits1,5231,5691,400
Average per night4.454.303.84
Total Levels 1, 2 and 3 (urgent)701674591
Average per night1.921.851.62
Stella-Maris-de-Kent Hospital2016-172017-182018-19
Total overnight visits2,2912,2422,200
Average per night6.286.146.03
Total Levels 1, 2 and 3 (urgent)1,0301,013950
Average per night2.822.782.60

Travel distances:

 Daytime Nighttime
95 per centWithin 48 kmWithin 72 km
90 per centWithin 37 kmWithin 63 km
Maximum89 km116 km
Average18 km26 km