Halifax emergency department cracks down: beds for urgent patients first
'The last thing we want is for emergency patients to be hurt even more'
In effort to reduce the crunch at Nova Scotia's largest emergency department — where patients can sometimes lie on stretchers in hallways for as long as 12 hours — non-urgent patients will no longer be "blocking" eight emergency beds, according to the chief of the department.
The eight beds currently form the Halifax Infirmary's Rapid Assessment Unit, which is located down a hall about 60 metres from the emergency department.
Opened in 2010, the unit was designed to take medically stable patients who no longer require emergency care but still need to be seen by a specialist to determine the next step.
In its first year, the unit was touted as diverting nearly 2,900 patients from the emergency department, creating more space for patients needing emergency care and reducing the number of people waiting on stretchers.
But in the following years, those Rapid Assessment Unit beds were increasingly booked by specialists for patients needing predictable procedures and followup visits, said Dr. Sam Campbell, chief of the Charles V. Keating Emergency and Trauma Centre.
As of Wednesday, hospital staff were notified rules are being imposed to stop that practice.
"The thing is, if they can wait, they should wait. And if they can't wait, they shouldn't wait. And that's all we're trying to enforce," said Campbell.
From now on, the Rapid Assessment Unit beds will no longer be booked by other clinics. Instead, they will be booked by the emergency department charge nurse to ensure the sickest patients get a bed first.
In a memo leaked to CBC News, hospital staff were advised Wednesday that the Rapid Assessment Unit is now known as Pod 7, and is "now considered an extension of the [emergency department] exclusively and the flow to that area will be decided internally with the ED staff."
The change brings together the management of 46 emergency beds. There are also plans to keep Pod 7 open around the clock as opposed to just 12 hours a day, as it currently operates.
The emergency department was designed to handle 180 patients a day, but regularly sees around 215. There was a day in early January when 257 patients were seen — that set a new record, said Campbell.
The department is "consistently" running over capacity and "there are frequently EHS trucks and patients lined up in the ED," the memo states.
While extremely sick people are seen immediately, and most are seen within two to three hours, Campbell said some patients have spent as long as 12 hours on an ambulance stretcher. In the waiting room, some patients have sat for 14 hours.
General surgery, orthopedics, plastics, neurology and urology were the top five specialties that provided care through the Rapid Assessment Unit.
"We understand this is a big change for services that have enjoyed the benefits of [the unit]," states the memo.
Campbell said specialists should be reassured that their patients with emergency needs will be treated in Pod 7 as they were previously.
He recognizes enforcing the rules may affect patients who are waiting for treatment at overburdened clinics, and he's sympathetic, but Campbell is advocating for the most urgent.
"The question is: should we allow people who don't have emergency problems to use emergency space while people who have emergencies are waiting for it?"
In recent months, the paramedics union has launched its #CodeCritical campaign to draw attention to the problem of so-called "hallway medicine" — where patients lie on stretchers under paramedic care as they wait to see an emergency doctor.
Campbell said eight beds won't eliminate the emergency room wait, but will restore "fairness in terms of the right person getting to the right bed at the right time."
"People are struggling, we're all struggling," he said. "The last thing we want is for emergency patients to be hurt even more."