‘Mind boggling’: ERs big and small across Canada struggle amid staffing crisis

Code Blue: Emergency rooms across Canada struggle with staff shortages
Code Blue: Emergency rooms across Canada struggle with staff shortages – Aug 23, 2022

Berni Wood was in the throes of a COVID-19 infection and was struggling to breathe when she was told she would have to wait upwards of 20 hours in a Prince Edward Island emergency room to receive medical care.

The Charlottetown resident tested positive for the coronavirus just before the July 1 long weekend, and a few days into her illness, she began wheezing and couldn’t breathe.

When she arrived by ambulance at the Queen Elizabeth Hospital (QEH) in Charlottetown — P.E.I.’s largest hospital — paramedics had planned to take her into a back room, as she was sick with COVID-19. But there was no room. So she was told to sit in the main waiting room. It was crammed with people.

P.E.I. resident Berni Wood was shocked when she was recently put in an ER with ailing patients while she struggled to breathe with COVID-19. She was told the wait would be up to 20 hours or more. Submitted photo.

She sat down next to a woman who believed she’d had a stroke. Nearby was a man with pains in his chest.

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“I’m sitting around with all these people knowing I am COVID positive, and that really concerned me,” she said.

After three hours, Wood asked a nurse how much longer she would have to wait.

“I was quickly told that the wait would be probably 16 to 20 hours or longer.”

Wood left the ER and called a pharmacist, who was able to prescribe her a puffer to help her breathe.

Wood is just one of millions of Canadians who are increasingly faced with fewer options for medical care, thanks to staffing shortages in health care across Canada, which have led to a cascade of ER closures, extended waiting times and even several deaths of patients who died waiting for medical care.  

Queen Elizabeth Hospital emergency department in Charlottetown, P.E.I. Global News

At least 15 per cent of P.E.I. residents don’t have a family doctor, according to Health P.E.I. data, and when they get sick they often find it impossible to access walk-in clinics because they fill up within minutes of opening. They are left with no option but to go to an emergency room and wait several hours, whether their medical needs are urgent or not. 

The problem has become exacerbated by the intermittent closures and reduced hours of some of the province’s smaller rural emergency departments.

Western Hospital’s Collaborative Emergency Centre, an overnight urgent care centre in western P.E.I., located about 125 kilometres from Charlottetown, was closed earlier this month for the remainder of August, due to a lack of available staff.

Health worker shortages have also closed the emergency room at Western Hospital multiple times this summer, most often during weekends, leaving the thousands of people who live west of Summerside with no option but to drive to Summerside or Charlottetown if they need urgent medical care or hope an ambulance is staffed and available to respond.

Western Hospital in Alberton, P.E.I. Global News

Jason Woodbury, president of the union that represents paramedics in P.E.I., says call volumes have increased in the wake of Western’s frequent ER closures and the long-term closure of the urgent care centre.

This is putting additional pressure on ground ambulance services that are “already in a critical state,” Woodbury said.

“It is not uncommon for vehicles to go unstaffed,” he said. “We’re facing our own staffing crisis within our organization.”

Patients are now faced with longer wait times when they call 911 in western P.E.I. — a situation that has a domino effect on the larger hospitals in Charlottetown and Summerside that must now take diverted patients, Woodbury said.

In July, the QEH was forced to activate Code Orange protocols — normally activated after a major disaster or unexpected influx of patients — after a single-car crash involving just four people, due to the high number of patients already in the hospital’s emergency department at the time.

Health P.E.I. CEO Dr. Michael Gardam says the health authority has been forced to prioritize the province’s three larger emergency departments.

Health P.E.I. CEO Dr. Michael Gardam. Submitted photo.

“Like every health-care system in Canada, we’ve been struggling with staffing this summer,” he said.

“In circumstances where we simply can’t find staff to work at Western, we’re not going to transfer staff from our larger centres because it makes more sense to make sure those larger centres are still running.”

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To keep urban ERs operating, the province also recently withdrew a financial incentive that was previously offered to physicians who filled shifts at Western Hospital.

With only a limited pool of emergency room doctors in the province, it did not make sense to give bonuses to physicians to leave a busier emergency department in the city for the smallest emergency department on the Island, Gardam said.

He noted that this was a program brought in by the provincial government, not Health P.E.I.

“I don’t want to incentivize people to work in a place where, from a population perspective, we need them the least,” Gardam said.

Read more: Health workers to premiers: find solutions to ‘crisis,’ don’t just ask Ottawa for funds

Staffing shortages widespread

The situation in P.E.I. is not unique.

Health-care staffing shortages are plaguing emergency departments in small, rural hospitals from coast to coast, triggering temporary ER closures and reduction of services across Canada.

Repeated closures of the emergency room in Clearwater, B.C., this year prompted the community’s mayor, Merlin Blackwell, to raise concerns publicly about the health and safety of his residents.

But the local hospital was just one of a number of small, rural ERs in B.C. that have experienced temporary closures and diversions, including those in Oliver, Port Hardy, Port MacNeill and Ashcroft.

Two patients who suffered heart attacks in Ashcroft died within the last month while waiting for ambulances. In at least one of these cases, the temporary closure of the local ER played a role in the ambulance’s delayed response.

In New Brunswick, three patients have died in three different hospital emergency departments in the last month-and-a-half.

Read more: Ashcroft, B.C. senior dies while waiting for ambulance

Ashcroft senior’s death raises concerns about health care access
Ashcroft senior’s death raises concerns about health care access – Aug 14, 2022

In July, six emergency rooms, including one in Montreal, were temporarily shut in Quebec; at least three were closed In New Brunswick; 14 hospitals in Ontario closed ERs, beds and ICU units; and a third of rural Manitoba ERs closed due to staffing shortages.

There were also ER and bed closures and service reductions in multiple towns and cities in Alberta, Saskatchewan, Nova Scotia, Newfoundland and Labrador, and all three territories have experienced interruptions to urgent health services.

The culprit? Burnout and heavy workloads, which is leading many health workers to reduce their hours, retire early or simply quit, says the Canadian Medical Association.

Nurses and doctors, exhausted after two relentless years of working through a public health emergency, are now treating patients who delayed medical care during pandemic lockdowns and are now sicker. This means there are more critically ill patients who need more care, but fewer people to care for them, as health workers continue to leave or downsize their jobs.

Read more: Health workers face burnout, even as COVID levels ease (June 5, 2022)

The Perth and Smiths Falls District Hospital, located an hour outside Ottawa, is among the many smaller hospitals affected by the staffing crisis.

The emergency department there was closed for three weeks earlier this summer after COVID-19 outbreaks among ER staff led to critical staffing shortages.

But the pandemic is only part of the problem.

Michael Cohen, the hospital’s president and CEO, says for many months prior to the recent closure, the hospital had been losing nurses and was unable to recruit enough people to replace them.

Perth Hospital emergency entrance. Global Kingston

In some cases, nurses were leaving their jobs at the hospital to take lower-paying jobs in the community, Cohen said.

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The only reason the Perth hospital was able to reopen in late July is that it brought in temporary nurses through a private agency at a significant additional cost for the hospital. But Cohen says this is only a “temporary stop-gap.”

Most agency nurses came to Perth only temporarily and live in areas far outside the Perth region, such as Toronto, Oakville and Mississauga.

“We’re very concerned about the fall. We have vacant positions that, unfortunately, we’re not getting any applicants for,” Cohen said.

“We’re really grateful to (agency nurses) to have them leave their families and their home to come and help us out. But we know that it’s not a long-term solution,” Cohen said.

Read more: Ontario Health wants public-private integration as hospitals struggle with staffing

Differences in big-city, small-town outcomes

Even big-city hospitals in areas like Toronto, Vancouver and Montreal are struggling.

But the outcomes for these hospitals play out differently. In a large, urban hospital, emergency rooms are staffed with more nurses and doctors during a given shift, which means if several nurses leave or become sick with COVID-19 — an ongoing and persistent problem in hospitals across the country — there is still enough staff to keep the ER open.

But increasingly, even hospitals in urban centres are being forced to reduce services.

The Lachine Hospital emergency room, which is part of the McGill University Health Centre network and has been rated one of Canada’s top hospitals, experienced service reductions earlier this year, including having to divert ambulance patients from the ER overnight.

After significant public outcry, the services were eventually restored.

Lachine Hospital physicians pitching in to pay premium to keep staff
Lachine Hospital physicians pitching in to pay premium to keep staff – Feb 11, 2022

“It’s really mind-boggling that this can happen to a hospital right close to the downtown,” said Dr. Paul Saba, president of the council of physicians at Lachine.

The fact that Lachine has been designated by the Quebec National Assembly as the only francophone hospital in West Island serving a predominantly francophone community made the service disruptions even more surprising, given the Francois Legault government’s strong championing of francophone services, Saba added.

Closures of beds and emergency care in at least 10 other hospitals in Quebec over the last year have placed further strain on downtown hospitals, Saba said.

And while COVID-19 has played a big role in Canada’s health staffing crisis, it’s not the only reason hospitals across Canada are experiencing unprecedented pressures.

“The problem is, our system hasn’t had any maneuverability or margin to allow for any excessive strain,” Saba said.

“When there’s a strain on the system, like a surge because of COVID, there’s no surge capacity. And we’ve allowed that to happen because of poor health care policy-making decisions.”

– with files from Global News reporter Jamie Mauracher