Hospitals advised non-urgent patients to seek alternatives to EDs
When should you head to your hospital’s emergency department?
Health facilities are increasingly reiterating that patients should stop and consider whether there is an alternative to going to the ED if they have a non-urgent issue.
The messaging isn’t new. Facilities have made these kinds of requests in the past, such as when seasonal viruses put heavier loads on EDs.
It has, however, seemingly ramped up in recent weeks amid what doctors say is some of the worst overcrowding they have ever seen. And there are concerns that telling people to think twice about going to the ED isn’t the answer.
“Patients declare their own emergencies,” said Dr. Paul Parks, an emergency physician in Medicine Hat, Alta., and a spokesperson for the Canadian Association of Emergency Physicians (CAEP). “There’s no way they know if that chest pain is just muscle ache or heartburn or a heart attack. That’s actually what the job of an emergency physician and a functional ED is — to quickly see these patients so we know which ones are really acute and life- and limb-threatening and which ones aren’t.”
The association is calling on provincial ministers of health to create a national forum to share ideas and create a guide to deal with the multitude of problems facing the health-care system.
Parks calls such messaging a “knee-jerk reaction” to overcrowding that is “not effective at all.”
Over the past two weeks, health networks and hospitals stretching from Hamilton to Bowmanville, and as far north as Kawartha Lakes, have issued statements encouraging patients with non-urgent illnesses to seek alternative care options, such as community health clinics, pharmacists, after-hours clinics or virtual care.
They emphasize, however, that patients experiencing medical emergencies should always go to an ED.
Oak Valley Health, which operates two hospital sites in Markham and Uxbridge, emphasized how busy its emergency departments have been.
“Wait times are made longer because many patients in the ED are waiting for beds to become available in other parts of the hospital, where we are well over capacity,” said Terri Stuart-McEwan, VP of clinical programs at Oak Valley Health.
She added that December saw a 200 per cent increase in patient volumes compared to the same period pre-pandemic, while Markham Stouffville Hospital currently hosts the ninth-busiest ED in Ontario.
A Canada-wide problem
GTA hospitals are not alone in their struggles. We’re seeing them nationwide.
Two weeks ago, the Health Ministry in Quebec, where the occupancy rate in the province’s EDs sits at an average of 125 per cent, asked patients to use EDs only if their condition was urgent. The move was widely criticized in the medical community. Last week, B.C. Health Minister Adrian Dix said hospitals in that province were treating a record 10,435 people at once, a substantial number of them with respiratory illnesses. In recent weeks in Alberta, patients visiting Edmonton-area EDs faced reported wait times as long as 12 hours. New Brunswick’s francophone health authority two weeks ago urged patients needing non-urgent care to seek alternatives to EDs due to capacity issues.
On Wednesday, the Ontario Hospital Association said that as of November 2023, the average length of stay in EDs for patients waiting to be admitted was the highest it had been in 12 months provincewide. This was because of shortages of staff and acute-care beds, as well as high numbers of patients in hospital awaiting discharge to home care or long-term care, the OHA said.
There were more than 4,200 alternate-level-of-care patients in acute care beds as of late December, the OHA added, with almost 40 per cent waiting for long-term-care beds.
Is the messaging fair?
ED wait times have long been a challenge for hospitals across the country, but emergency physicians say what they are seeing this year is almost a reframing of who should be going to their local EDs and when.
Dr. Sam Sabbah, medical director of emergency medicine at University Health Network, says he understands why some hospitals feel the need to urge some patients to seek alternative care options, given the immense volumes and staffing problems they face.
But he said he is concerned with such messaging because it risks coming across as laying blame at the feet of patients, “which is not accurate or fair.”
“EDs are overcrowded because of major system issues, not because of patient choice,” said Sabbah.
He pointed to the lack of access to primary care and timely specialist consultations as factors that drive people to EDs.
“No one really enjoys being in the waiting room of an ED for several hours on end,” he said. “In fact, most people are probably having a very bad day, if not one of the worst days of their life, because they’ve had to come see us in the ED.”
On Jan. 9, Oak Valley Health posted a message on X, formerly Twitter, asking patients facing non-emergent situations to consider using its community health clinic.
“These pressures are what led us to post a public notice about longer wait times,” said Stuart-McEwan of Oak Valley Health. “We wanted patients and families to know in advance what to expect.”
A week earlier, Lakeridge Health, which operates hospital sites from Ajax to Bowmanville and as far north as Port Perry, also posted on X asking patients with non-urgent conditions to consider urgent and community care options.
Ross Memorial Hospital in Kawartha Lakes posted a similar message.
Ryan Young, a spokesperson for Ross Memorial, is quick to point out that if patients feel they need to be seen by a doctor and don’t have any other options, “always come to the emergency department.”
“The last thing we ever would want to do is direct someone who does need to be seen away from that care. That’s first and foremost. That being said, the patients we’re seeing come through the doors, they’re sicker than in the past. That’s being bolstered by respiratory illnesses including COVID-19, influenza and RSV,” added Young, noting that the hospital consistently runs at about 110 per cent occupancy on any given day “necessitating the use of hallways and other unconventional spaces for admitted patients.”
Hamilton Health Sciences says efforts to educate the public on the various health-care options available in the community are not new. But in the past week, it has posted a video on X three times urging patients to head to urgent care centres instead of emergency departments if their medical issue is not an emergency, such as cold and flu symptoms, stitches, strains or sprains.
On its website, Trillium Health Partners in Mississauga is also pointing non-emergent patients to community options.
“THP’s message for the community is that our ED is here when you need it and for lower-acuity needs, there are many options in the community,” said spokesperson Priyanka Nasta. “These include family doctors, Health811, the temporary Mississauga Paediatric Care Clinic and walk-in clinics, among others.”
Ontario’s response
Hannah Jensen, a spokesperson for Health Minister Sylvia Jones, said Ontario leads the country with some of the shortest wait times in Canada, but the province knows more needs to be done, which is why it launched “Your Health: A Plan for Connected and Convenient Care,” aimed at bringing care closer to Ontarians’ homes.
Jensen said the government has increased funding to reduce ED wait times, launched a fund to to support innovative staffing models, which she said allows “hospitals to use their staff to their full potential, while breaking barriers to make it easier for internationally and interprovincially educated health-care workers to register and practice in Ontario,” among other things.
She added that the province is also expanding 911 models of care to ensure patients can “connect to the care they need while avoiding unnecessary trips to the emergency room.”
UHN’s Dr. Sabbah said he hopes to see a shift in how the problems in hospitals are being explained.
“From my perspective, I think the messaging should be that the system is under stress and the health-care system needs to evolve strategies to deal with the real problems.”
This article was reported by The Star
