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Health officials are clamping down on inappropriate referrals to the rapid assessment unit at the Halifax Infirmary.

The unit, which is part of the hospital’s emergency department, is meant to deal only with patients who need to be assessed as soon as possible.

But specialists and clinics regularly send non-urgent cases to the unit and have done so for years, which has exacerbated already severe bed shortages at the emergency department.

“We’re not changing the rules, we’re not changing the processes, we’re not changing anything,” said Dr. Sam Campbell, head of the emergency department, who sounded frustrated in a recent phone interview.

“We’re just enforcing the rules, these are the rules that were always there. ... These are beds staffed by emergency department staff for the use of emergency patients. So all we’re saying is we should not be using emergency space for non-emergency patients while there are emergency patients waiting for care.”

The Rapid Assessment Unit was established in 2011 primarily to care for patients referred from another emergency department who had to urgently see a specialist in Halifax.

But over the years, more and more patients have slipped into the unit who didn’t fall into that category.

“For example, one patient this morning who had surgery two weeks ago . . . (was) told after two weeks they would need to have a tube removed,” Campbell recounted, “so it was scheduled and they were told just to come to emergency and they would go to the RAU to have the tube removed.

“These are clinic appointments and we do sympathize with people, the clinics are overwhelmed so they don’t know what to do with their clinic patients. However if I’ve got a respirology clinic and I’m overflowing so I tell my patients to go to the opthalmology department, it wouldn’t be fair because then the people with sore eyes wouldn’t be seen.”

So how do patients who obviously aren’t hobbled by a broken leg or a bleeding head get through to an emergency bed?

“It has been because of the services that have been able to utilize the space for emergency consults, they have morphed that into using the space for the rest of their consults,” said Lori Sanderson, health service director for central zone emergency department, who was on the call with Campbell.

“It’s been a slide,” Campbell agreed, “because we’ve given them easy access to the RAU, they’ve started just pushing the limits a bit and then pushing the limits a bit more and over the years, we’ve (tried) to stand up to them and say, ‘Listen, you really can’t do this, it’s hurting patients’ and it’s got to the extent where we’ve said OK, we’re now going to remind you that it’s an emergency department.”

That reminder, which was given via an email to specialists and clinics on Thursday, led to alarm and confusion among some health-care providers, including one who anonymously emailed The Chronicle Herald saying the RAU was being closed.

“Often times, this would keep patients out of the ER. Sometimes, it could be patients coming in for urgent wound checks, intravenous antibiotics, and assessment of other semi-urgent or urgent issues,” the email read.

The email illustrates the perception among some doctors that the Rapid Assessment Unit isn’t part of the emergency department, and that even processes such as registering the patient isn’t necessary.

“(They say) I’ll just nip you in and not register you,” Campbell said. “It totally shouldn’t happen for so many reasons. ... In the last two days (after the notice was sent out) people are phoning me saying ‘What, you expect me to register the patients before they're seen?’ And I’m amazed that they’d even ask that.”

Sanderson said a memo outlining the proper use of the RAU was distributed to physician leads and clinic directors in December. Her department is helping doctors on a case-by-case basis determine where a patient should be placed.