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What drove emergency room physicians to start a GoFundMe to raise money for new nursing home beds in Nova Scotia?

Desperation.

Drs. Rob Miller, 50, Rebecca Brewer, 36, and Keith MacCormick, 59, work in an emergency department — at Valley Regional Hospital in Kentville — that’s too often overcrowded with patients who have no place to go.

And why is that?

On any given night, there are often a dozen or more patients — and sometimes many more — who’ve been seen by an ER doctor, admitted to hospital but who remain stuck in emergency because there are simply no in-patient beds in which to put them.

And the reason for that, these doctors say, is due to a lack of nursing home beds provincewide. That’s why hundreds of expensive hospital beds across Nova Scotia are filled with discharged patients waiting for a spot in a long-term-care facility.

When you combine admitted patients with nowhere to go, a waiting room full of people (many there because they have no family doctor), ambulances arriving with more new patients and only two stretchers for examinations, you’ve got an extremely high-stress work environment — shift after shift, week after week, month after month.

“It’s burning out staff. People are leaving. We lost a lot of people over the winter,” Dr. Miller told me when I met the three physicians in Wolfville on Monday. “A lot of experienced nurses left because the situation was dangerous. People have shied away from using that word. But it was.”

Numerous studies point to emergency department overcrowding being unsafe.

The cost of overcrowding

Patients coming to ERs are often older, and sicker, than in the past. And those who don’t have family doctors present extra challenges.

One study, of emergency departments in acute care hospitals in northern California (“Effect of Emergency Department Crowding on Outcomes of Admitted Patients,” June 2013 Annals of Emergency Medicine), found “ER crowding is associated with increased mortality, length of stay, and costs in a large cohort of admitted patients.”

When ERs — already challenging places to work — get jammed beyond capacity, mistakes, many due to miscommunications, can happen, said Dr. MacCormick. Standards of care suffer and people’s health gets compromised.

“It’s extremely hard to match the standards of the past with the workplace conditions we have now,” he said.

What’s missing, he said, is proper outcome analysis — tracking what happens to patients due to problems within the system.

Patients coming to ERs are often older, and sicker, than in the past. And those who don’t have family doctors present extra challenges.

For example, said Dr. Brewer, if someone’s on medications but have no primary physician, she can’t just give them a refill because she can’t assume their blood work, etc., is up to date. And because they don’t have a family doctor, their health problems may have become more complex, said Dr. MacCormick.

To deal with ER overcrowding, management brought in rapid assessment zones and 12-30 rule (maximum of 12 hours in the ER after a patient has been admitted to hospital; 30 minutes to offload a patient from an ambulance).

But frontline health-care workers see these management-driven fixes as “ridiculous,” said Dr. Miller. “The data behind rapid assessment zones, it’s been studied in the British Medical Journal, as of a few years ago, there’s no data to support it.”

With an RAZ, the idea is to assess patients quickly and get them back out in the waiting area, keeping stretchers open for new patients, said Dr. Brewer. But, in practice, there’s just no room to put them. People are suffering.

Dr. MacCormick has seen people with confirmed cases of appendicitis put back in the waiting room, due to lack of space. He’s seen patients describing traumatic personal injuries behind curtains, within earshot of other patients sitting nearby.

“You’re bringing a patient in sometimes who is barely able to mobilize, putting them onto a stretcher to examine them, and then this patient, who’s very unwell and in a lot of pain, you’re like, ‘OK, now I need you to go back into the waiting room. I need you to crawl out of that stretcher.’ And this poor lady, 80-year-old woman, who had a hard enough time getting out of that wheelchair into the stretcher, you’re looking at them and their family and they’re looking at you like you have two heads ... ‘What do you mean, I now have to go back to the waiting area?’

“And you’re stuck saying, ‘Well, we only have two stretchers. The rest of the hospital’s full,’” Dr. Brewer said. “It’s heartbreaking. You can’t treat people this way. It gets to all of us.”

Sometimes, they run short of telemetry devices used to monitor the heart, etc. So “even though they (the patients) all meet the criteria, we still have to pick and choose,” she said. “Which is a dangerous situation.”

Dr. MacCormick has seen people with confirmed cases of appendicitis put back in the waiting room, due to lack of space. He’s seen patients describing traumatic personal injuries behind curtains, within earshot of other patients sitting nearby.

“The lack of dignity and respect for privacy is astounding,” he said. “Not to even talk about comfort.”

“We don’t have enough capacity in the province to take care of people outside the hospital.”

The shortage of nursing home beds has far-reaching consequences for the health-care system. A single person waiting in a hospital bed for long-term care can block multiple acute care patients.

Patients admitted for acute care often need a hospital bed for just a few days. Meanwhile, those waiting for long-term care in those same hospital beds can languish there for months.

If their stay were 100 days, “30 (acute care) patients could go through that one bed that one person, waiting for a long-term care bed, is taking up,” Dr. Brewer said.

Demand for long-term care beds has far outstripped supply for many years. But the current provincial Liberal government has not added a single new nursing home bed since first being elected in 2013.

“EHS in Nova Scotia is in crisis. Emergency departments are in crisis. The hospitals are in crisis,” said Dr. MacCormick. “And a big part of that is because we don’t have enough capacity in the province to take care of people outside the hospital.”

The three doctors say thousands of nursing home beds will be needed to deal with Nova Scotia’s aging population.

“At the grassroots level, we really don’t feel the NSHA is listening to us.” - Dr. Rob Miller

For local ER doctors, the crisis came to a head on March 7, when 24 admitted patients had to be jammed into the Valley Regional’s 20-room emergency department.

None of the ER doctors had ever seen anything like it, said Dr. Miller.

A couple of weeks later, at an informal meeting, about a dozen doctors discussed what could be done to help get people who didn’t need acute care out of hospital. (They light-heartedly called their effort MEGA, or Make Emergency Great Again — Dr. Miller emphasizes they are not Trump supporters.) That’s where the GoFundMe idea was born.

Obviously, the current target — $100,000 — wouldn’t go far, the doctors acknowledge.

They just want to create public attention, start a discussion, perhaps raise some seed money for a bigger project, they said.

The recent survey showing three-quarters of doctors don’t trust the Nova Scotia Health Authority speaks volumes, said Dr. Miller. Doctors don’t feel they are respected, he said. “At the grassroots level, we really don’t feel the NSHA is listening to us.”

They feel the government is in denial about the level of the health-care crisis in Nova Scotia.

“We need to have a voice that’s independent of politics. Because politicians have a different agenda than clinicians and health-care workers. We have to speak out. We hope that other physicians will join with us and create a collective voice that has some impact,” said Dr. MacCormick.

“When physicians like us start a funding initiative to try to help the government build beds, that’s a pretty desperate grassroots effort.”

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