Nova Scotia

Nearly half of Nova Scotia's ER patients don't have actual emergencies

About half of Nova Scotians who went to an emergency department in 2015-2016 didn't have a true emergency, but showed up for a variety of reasons.

Doctor shortages, patient judgment calls and hospital size factor into numbers

A sign with the word "emergency" written on it
There are a variety of reasons why almost half the people who visited Nova Scotia emergency departments in 2015-16 didn't have actual emergencies. (CBC)

Almost half of the people who showed up at emergency departments across the province in the past year didn't actually have a medical emergency, according to the Nova Scotia Health Authority.

Data tracked by the health authority about the seriousness of patients' conditions show that many people are using emergency departments for conditions that are not emergencies and could be addressed by a family doctor or another primary care provider.

Seven out of the 10 highest rates of non-emergency patients come from hospitals in the eastern zone of the health authority. That zone includes Cape Breton, where there is a chronic doctor shortage.

Multiple explanations

But that doesn't tell the full story of the numbers.

Anyone who arrives at an emergency department is triaged first, where they are assigned a ranking from one to five based on the seriousness of their condition. Level 1 — or resuscitation conditions — is the most serious while Level 5 — or non-urgent conditions — is the least serious.

In 2015-2016, 48 per cent of the almost 550,000 people who went to an emergency department were classified as Level 4 or Level 5.

The top 10 hospitals with the highest rate of non-emergency patients ranged from 75 per cent to 82 per cent.

Beverly Greene, senior director of the emergency program of care for the provincial health authority, said the numbers reflect that sometimes, in some communities, there is no access to evening or weekend primary care.

The 10 hospitals with the highest percentage of non-emergent patients in 2015-2016 are Eastern Memorial, Guysborough Memorial, New Waterford Consolidated, Inverness, Lillian Fraser, Digby General, Sacred Heart, North Cumberland, Victoria County and St. Mary's Memorial.

In other cases, however, small community hospitals will sometimes have doctors who see patients while they're already at the hospital working a shift. One site, for example, sees patients from 8 a.m. to 10 a.m. in the emergency department.

When it comes to people's awareness of what's an emergency and what isn't, Greene said most people are pretty good at determining what makes sense for them. It's not as though people want to spend the day hanging out in an emergency department, she said.

"They go there because, in their frame of reference, that seems to be the most reasonable place to go."

Sometimes, however, patients don't have another option.

'You have no choice'

Jan Pulfrey and her husband have lived in Jordan Falls, just outside Shelburne, for nine years. For the first seven years they didn't have a family doctor; it's only been in the last two years they've had access to a nurse practitioner.

That lack of access to primary care meant sometimes, something as simple as needing antibiotics required a trip to the emergency department. Long waits were inevitable because they weren't urgent cases, said Pulfrey.

"You have no choice," she said. "If you don't have a doctor at all, the only thing you can do is go and sit in the ER and just wait until they can see you."

The 10 hospitals with the lowest percentage of non-emergent patients in 2015-2016 are the QEII, Dartmouth General, Cape Breton Regional, Colchester East Hants, Annapolis Community, South Shore Regional, St. Martha's, Aberdeen, Glace Bay Health Centre and Cobequid. (CBC News Graphics)

Those long waits are especially frustrating when it's obvious that the issue isn't an emergency, said Pulfrey.

"You feel like a time waster," she said. "[But] for those people that don't have anywhere to go to, that is what you have to do."

The former NDP government opened collaborative emergency centres around the province in places that faced chronic emergency department closures and, in some cases, where there were also doctor shortages.

Trying a new approach

The result has been better access in most cases. Greene said the CECs, in concert with collaborative practices, are helping to increase people's access to primary care. The health authority has signalled a plan to move toward more collaborative practices, with one announced on Friday for Sydney.

And although collaborative practices are generally associated with primary health care, Greene said there is the ability to deal with people who would come to the emergency department as a Level 4 or 5.

While a glance at the numbers might suggest emergency departments are filled with people who don't need to be there, Greene said sometimes it makes sense for people with less-pressing issues to bypass the doctor's office.

Not always inappropriate

It is generally more direct, for example, for a patient to go to the emergency department for an X-ray or stitches.

"It isn't always inappropriate to go to an emergency department for [non-emergent conditions]," said Greene.

Pulfrey knows how challenging the situation is; she doesn't pretend to have the answers and she believes health officials are working as hard as they can to solve the problem.

But in the meantime, problems facing the health system have the potential to exacerbate other issues such as rural out-migration. Pulfrey and her husband are contemplating moving in the coming years to ensure they are somewhere with access to regular medical care as they get older.

With files from the CBC's Jack Julian