On shutting hospital ERs: increased waits, increased congestion

As part of ongoing provincial cutbacks, the Niagara Health System hospital closed the Emergency Departments (EDs) in two of its smaller sites last year, converting them into Urgent Care Centres (UCCs). 

The hospital now recognizes that it "has been experiencing serious issues with off load delays" at its three remaining EDs despite a policy for ambulances to bring at least some patients to the converted UCCs (and the maintenance of similar patient volumes at the UCCs).  Nevertheless, sicker patients are now being brought to the EDs. The hospital notes:

At the same time while our volumes in the Emergency Departments in Welland and Niagara Falls have remained relatively stable the acuity level of the patients presenting are higher. As the acuity increases the resources required to manage these patients expands, resulting in more diagnostic testing and physician assessments. This causes an increase in the “time in the ED” hence increases congestion, crowding and potential of OLD (ambulance offload delay).

Translation: the Emergency Departments now have sicker patients who require more care and this causes longer wait times for patients, increased crowding and congestion, and "potential" ambulance offload delays.

The NHS remarks were in an attachment to the Niagara EMS report on increased ambulance offload delays  (discussed earlier here).  In this report, the Niagara EMS described the impact on ambulance services a little bit more baldly: 

The offload delay issue remains the primary public safety challenge within NEMS... the ability to maintain this level of service is becoming increasingly challenging as EMS resources become critically compromised during peak offload periods....

Offload delays at local hospitals continue to occur in area Emergency Departments at an increasing rate. As the frequency and length of offload delays increase, NEMS will continue to experience incidents of critically-low available vehicles (resources) to appropriately respond across the entire region. At times during these peak offload  periods, as few as four ambulances may be available to cover 1,850 sq. km. (My emphasis -- Doug.)

Since 2006, NEMS has seen hospital offload hours increase from 2,504 hours to a projected 9,886 for 2010.

And now, the Niagara Regional Police have released a report indicating that they too are experiencing long delays when dropping people with suspected psychiatric illnesses at local ERs.  The number of times officers had to wait at least five hours before being able to go back out on patrol increased at nearly every local hospital in 2009 compared to 2008, the report says.

Police officers frequently respond to calls involving a person with a mental health issue, sometimes involving a person displaying violent behaviour. Officers cannot leave that person in the ER until the person is assessed. If an ER is busy, officers could be stuck for hours.

Police services board. Member Bob Bentley said off-load delays are having a significant impact on the Niagara Police budget and keep officers tied up for too long.  He said the service needs to approach the provincial government to find solutions.


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