Rural emergency department shut downs, record waits for care, frustrated patients, exhausted and demoralized staff: It is a summer of chaos in Ontario hospitals that has been decades in the making.
The temporary closures of some rural emergency departments, including in Perth, have become symbols of the crisis. But no hospital in the province is free from the pressures caused by worsening staff shortages and increased demand. The arrival of a highly contagious summer COVID-19 wave has many on edge.
“It is going to be a long, hard summer and it isn’t going to get any better unless we start stabilizing things,” said Dr. Atul Kapur, an emergency physician in Ottawa, and co-chair of the public affairs committee with the Canadian Association of Emergency Physicians.
The crisis in Ontario’s hospitals is directly related to the pandemic. But the pandemic didn’t break the system; it just revealed its deep fault lines.
Emergency room waits have reached historic highs at many hospitals, and Ottawa has some of the longest waits in the province, according to the latest information from Health Quality Ontario.
Compared to a provincial average of 2.1 hours for patients to be initially assessed by a doctor in emergency departments, patients at CHEO wait 3.7 hours, patients at The Ottawa Hospital’s General campus wait 3.6 hours and those at Queensway Carleton wait 3.4 hours. And that is just for an initial assessment.
Patients are spending much longer in emergency, including one man who live tweeted his wait of more than 24 hours for an emergency appendectomy in a Toronto hospital. On average, patients who need to be admitted to hospital are waiting 20.1 hours in Ontario — the target time is eight hours.
In Perth, the emergency department closed after two out of its five nurses got COVID-19. That closure was extended when more staff contracted COVID. It remains closed until at least next week.
“Someone is going to die. It is just a matter of time I’m afraid,” Perth emergency physician Dr. Alan Drummond tweeted Friday of the crisis at hospitals across the country.
On Friday, Cornwall Community Hospital warned of longer than usual waits in emergency amid the highest demand in five years, critical staff shortages and rising numbers of alternate levels of care patients — who don’t need to be in the hospital but have nowhere safe, such as long-term care, to go.
“Cornwall Community Hospital assures the community that its emergency department team is doing everything possible to avoid reducing operating hours or closing its doors — like some emergency departments in Ontario have needed to do.”
Closing an emergency department “is the toughest decision a hospital is ever going to make and it is the very last decision it would ever make,” said Anthony Dale, head of the Ontario Hospital Association.
“No one wants to see this happen.”
Hospitals across Canada are all being hit by staff shortages and increased demand, but the lack of surge capacity in Ontario’s system makes it tougher for many hospitals to cope.
In addition, Ontario hospitals are seeing close to historic highs of alternative level of care patients waiting to move to long-term care or elsewhere. If those patients have nowhere to go, hospitals have fewer beds to treat acute care patients, who often end up on beds in the emergency department or hallways.
“It is all rooted in running a hospital system at 100 per cent (capacity) or higher for 15 years, which greatly reduced its capacity to deal with the unexpected,” said Dale. “For 15 years, successive previous governments chose efficiency over all objectives. We just don’t have the capacity that other jurisdictions do.”
Even before the pandemic, Ontario had fewer beds per capita and a nursing shortage — a gap of 22,000 nurses less than needed, according to Registered Nurses Association of Ontario CEO Doris Grinspun. Many more nurses left during the pandemic and Ontario is competing with jurisdictions around the world to replace them.
Many nurses on the job have been working short-staffed for years, are exhausted from the pandemic and the situation is getting worse.
Registered nurse and health advocate Deb Lefebvre described one scenario at an Ontario hospital in a tweet this week.
“The nurse called at 11 p.m. crying and begging her colleague to come in. She was the only nurse for 21 acute care patients. Colleague got out of bed and dragged her tired, broken body in after just working four 12-hour days. The health care system is collapsing.”
Grinspun said RNAO has long recommended solutions, but some will take time.
“The reality is, we are almost at the point of no return,” she said. “It is not about staffing shortages. It is about nursing shortages. I have been warning about this for years.”
Not only did Ontario start with a nursing shortfall, but exhausted nurses have had their wages capped at one per cent under the Ford government’s Bill 124, which, for some, has been a last straw. Many have moved to other jobs, some who have stayed in nursing now work for privately run agencies.
Among other things, Grinspun said the accreditation of nurses coming into Ontario needs to be expedited. And more nurses should be trained and upgraded — including letting personal support workers train to become registered practical nurses (RPNs) and RPNs train to become registered nurses while they continue to work. She also said there should be a province-wide program to bring retired nurses back to work as mentors and help reduce the burdens.
Ottawa emergency physician Kapur said the Canadian Association of Emergency Physicians has long called on governments to do more to protect health workers from abuse and violence on the job — something that is driving people away, as is wage cap legislation Bill 124 in Ontario.
“We have lost staff. Anything you can do to bring them back by improving conditions and wages” would make a short-term difference, he said.
There have also been calls for the Ontario government to bring back mask mandates and expand fourth doses of vaccines, as well, to dampen the impact of the wave on already fragile hospitals.
“I am not sure what crisis the government is waiting for. The crisis is here,” Kapur said.
Meanwhile, Dr. Virginia Roth, chief of staff at The Ottawa Hospital, said the hospital is doing everything to limit the impact of the challenges on patients and to support nurses and health workers.
“It is really heart wrenching to hear not just the numbers, but individual patients who have had to wait really long times. It is not what we want for sure.”
She said rising numbers of staff off sick with COVID-19 right now are adding to that challenge.
Queensway Carleton Hospital is dealing with an increase in emergency department visits, more ambulances and record numbers of alternate level of care patients.
Yvonne Wilson, the hospital’s vice-president of patient care and chief nursing executive, said a provincial program to bring health-care students in to the hospital to work as an extra set of hands in the summer has taken some of the pressure off and could “build a pipeline” to more permanent staff once they have graduated.
She said the city’s three adult hospitals meet weekly to assess the situation to insure patients in Ottawa continue to get the care they need.
“We recognize we have to keep our doors open.”
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