Overcrowding at the province’s largest emergency department is getting worse. Patients wait up to 12 hours in the Halifax Infirmary hallway, dubbed ‘ambulance alley.’ Paramedics spend entire shifts there, unable to respond to calls. Physicians sometimes see patients in those hallways. This week, StarMetro Halifax talks to people on the ground in a series we call Code Crisis. Today, we hear from the head of the union representing the hospital’s nurses and a representative from the Nova Scotia Health Coalition.

HALIFAX—Wait times at the Halifax Infirmary’s emergency department have reached “a dangerous tipping point,” according to the head of the union representing the hospital’s nurses.

“Patient and health-care worker safety are at risk,” Jason MacLean, president of the Nova Scotia Government & General Employees Union, stated last month.

In an interview, he said he stands by that, adding, “The system is busting at the seams.”

MacLean spoke out in March after overcrowding at the Halifax Infirmary emergency department reached a point where 16 ambulance teams were waiting with patients, and some patients waited in a hallway on stretchers for up to 12 hours before being seen.

He said the situation has been deteriorating for quite some time, and he’s not surprised it has reached this point. He describes instances where patients repeatedly return to emergency sick. They may give up and leave without being seen due to the long wait times, or they are repeatedly sent home, only being admitted to the hospital once the situation becomes dire.

“These are the stories that we’re hearing from our members.”

MacLean said while many nurses are “deeply concerned” and wanted to share their stories, they were worried about potential repercussions from their employer if they publicly spoke out.

The Nova Scotia Health Authority also attempted to find a Halifax Infirmary emergency department nurse willing to speak about the daily challenges she faces, but the nurse backed out on the morning of the scheduled interview.

With no nurse willing to speak on the record, MacLean agreed to share a few concerns on behalf of nurses who’ve spoken to the union.

“It’s so hectic that they can’t keep it staffed, and they’re pulling people off of other floors who don’t have training for the emergency department in there doing the work,” he explained.

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In addition, MacLean said the acuity level of emergency department patients is increasing. This means many more are showing up very ill or in danger of becoming very ill.

Throw in a provincewide doctor shortage and it’s worsening an already brewing storm in the Halifax Infirmary’s emergency department.

“They’re opening up the recovery areas just to store people because they don’t have anywhere to put anybody else,” MacLean said.

The NSGEU’s March 2017 Code Critical report on emergency departments cites one Halifax Infirmary nurse described putting a patient in a family waiting room for the evening with a cell phone and a number to call if there were concerns.

“Staff are concerned that hallways do not provide oxygen or suction for patients who are ill enough to require hospitalization,” the report stated, referring to the Halifax Infirmary’s so-called ambulance alley.

MacLean said overcrowding and long waits have plagued emergency departments in other parts of the province for years. In many smaller communities, the emergency department is the only fall-back when people don’t have a family doctor or easy access to one.

A recent data summary report prepared for the Nova Scotia Health Authority shows 45,555 people on the Need a Family Practice registry had not yet been placed with a family doctor as of April 1, 2018.

Between March 1 and April 1, a total of 2,001 Nova Scotians found a physician through the registry. But in that same period, 3,398 new registrants were added.

Of the 45,555 Nova Scotians on the registry seeking a family doctor, more than 50 per cent (24,462) are in the central zone, which includes Halifax.

But the real number of people without access to a primary care provider is likely higher. The NSHA’s own data summary document says the registry “does not capture every Nova Scotian without access to a primary-care provider: Not everyone is aware of the registry, and others are not actively seeking a primary-care provider.”

MacLean said the physician shortage plays a key role in the current emergency department crisis in Halifax.

“With the elevated growth on the (Halifax) peninsula, and with so many people not having doctors, when they have an ailment, they can’t see a doctor and some don’t know about walk-in clinics. And then people want to be seen now, so they’re not waiting until the next day to go to a clinic,” he said.

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“They use the emergency department as their clinic. On top of that we have people being sent in from all over the province (by ambulance).”

MacLean said nurses who regularly work the Halifax Infirmary’s emergency department are often overwhelmed, overworked and feeling “a great deal” of extra stress and pressure.

The phenomena of people leaving the emergency department before being seen, or repeatedly coming back to be assessed for the same issues, are “only indicative of the stress that’s on the emergency department because we didn’t have reports of this before. We had people that could come in, they could get looked at without any haste, and have their ailment addressed,” he said.

Chris Parsons has heard many stories from Nova Scotians—patients and health-care providers alike—who’ve struggled to cope with emergency department overcrowding at the Halifax Infirmary and in other parts of the province.

Parsons is the provincial co-ordinator for the Nova Scotia Health Coalition, a non-profit advocacy group working to protect and expand public health care.

“The problems are right on the surface ... it is quite astounding when you just walk into an emergency room,” he said.

“You walk in and you’re like, ‘This does not feel like an efficient, well run system right now.’ When people are holding on by a thread, you can feel that they’re holding on by a thread.”

Parsons described emergency health care as a flashpoint because it’s one of the most visible issues in the sector.

He said the crisis is due to our aging demographic, a need for more long-term care beds, a lack of primary-care providers, and the fact many Nova Scotians are unable to access the prescription drugs they need. This can result in medical crises due to medications not being taken, or even people using the emergency room to get a prescription, because they do not have a family doctor.

Parsons also said most people overlook that many of the problems in the overall health-care system are tied to societal and economic challenges facing many Nova Scotians. These include poverty, social isolation, struggles with substance abuse and untreated mental health issues.

“Because of a lack of proper and sustainable funding in the rest of the health-care system, all those problems then get dumped into the emergency-care system. It looks the worst there, and in some ways is perhaps the worst there, because that’s the place where there’s no place further for it to go,” Parsons said.

“That’s why you see these problems in the ER, why you see the backed up ambulances and hallways filled with stretchers. I think that for a lot of people it’s become a symbol for these much bigger problems not just in the healthcare system, but in the social safety net in the province in general.”

While Parsons continues talking with a StarMetro reporter in a coffee shop in the north end of Halifax, an older woman with her arm in a cast stops in front of the table and politely interrupts the conversation.

“I know quite a bit about this. Write something, do something, say something. We need to fix this system,” she said emphatically.

Parsons agreed. He also said one of his biggest fears is that by focusing on some of the more dramatic stories coming out of the Halifax Infirmary, we lose the bigger picture.

“I think it ignores the fact that the average person is just having an unnecessary grind to get through there,” Parsons said.

“While the worst cases are bad, for the average person this is just causing them not to seek care a lot of the time. And then those every day problems? They become those worst case scenarios.”

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