Saturday, January 28, 2023

New ‘hub and spoke’ model in the works for ESMH

Hospital open, but ER remains closed through January

  • January 11 2023
  • By Alec Bruce, Local Journalism Initiative Reporter    

SHEET HARBOUR — The emergency department at Eastern Shore Memorial Hospital in Sheet Harbour may be closed this month, but provincial officials are hoping to keep it open for good, through a new healthcare model tailor-made for the area, as soon as this summer.

“The current status for January is that the hospital is open, primary care is open, but the emergency department needs a physician,” Roberta Duchesne, Nova Scotia Health’s (NSH’s) Director of Community and Rural Sites, told the Sheet Harbour and Area Chamber of Commerce in a presentation on Jan. 4. “Currently, we don’t have one.”

She added, “We’ve been working on developing a new model of care. We [expect] to have it good to go, all fleshed out, by the end of August, in the hopes of being able to implement it as we go.”

Meanwhile, said Eastern Shore MLA Kent Smith at the meeting, “In the short term, we’re looking at creative ways to find additional funding to compensate [an ER doctor] to come here and work.”

According to Duchesne, the new model being developed will utilize the combined resources of the three area facilities – Twin Oaks Memorial Hospital, Musquodoboit Valley Hospital and ESMH – to fill gaps at any one. “This hub and spoke approach means we are not splitting our resources [and not being] effective, but focussing on the things that we can do really well together.”

Added ESMH’s Health Services Manager Amy Donnelly at the meeting: “We’re trying to make it so that each [hospital] works in conjunction with the others. Let’s say Twin Oaks is closed, then we [ESMH] are definitely not. Or, if we are closed, then Middle [Musquodoboit] and Twin are open – that kind of thing. [It’s about] coordinating our schedules together so that the community has at least one of the hospitals.”

On Dec. 28, NSH announced that the ESMH emergency department – which has been closed as much as 70 per cent of the time over the past two years, due to doctor shortages – would be shut down from Jan. 1 to 31, 2023.

In an email to The Journal last month, NSH spokesperson Krista Keough confirmed that this was the first time the hospital’s ER has been closed for this long at one time. She stated: “Emergency department closures occur for various reasons; however, most often, they are due to physician/staff availability.”

At last week’s meeting, Smith said that physician staffing problems at ESMH are directly related to the provincial funding plan in place for the hospital.

“Every facility in the province has a designation,” he explained. “If you’re a big hospital, you’re a level one emergency department. And as [the hospital] gets a little bit smaller, the levels [go down] to level two, level three, level four. And then there are other facilities that are collaborative emergency centers, or CCCs.”

He continued: “As this relates to Eastern Shore Memorial Hospital, we are classified as a level four emergency department. And, when you look that in the master agreement [between] Doctors Nova Scotia the Province of Nova Scotia, [you see] that a doctor at an emergency level four site gets paid $77.18 per hour. An [ER] doctor at level three facility makes $154.31 per hour. Twin Oaks and in Musquodoboit Valley [hospitals] are both designated as CCSs, so an [ER] doctor working in those facilities makes $151.92 per hour.”

Asked by a Chamber of Commerce representative at the meeting what Twin Oaks and Musquodoboit Hospitals “do differently” to justify the difference in pay for ER doctors there, Smith replied: “Nothing … This all relates to the classification of this facility [ESMH], which is what we are working on, and have been working on [to change].”

Another Chamber rep noted: “At times, Twin Oaks has had a paramedic and a nurse and a doctor gets called in [only] if needed. The [doctor may] tell them over the phone what to do. Can’t we do something like that?”

Smith replied: “That’s exactly what I’ve been asking for quite some time. It’s maddening when you sit back and look at these two facilities [that] are an hour apart with very similar population demographics. But Twin Oaks keeps their ER open between 8 p.m. and 8 a.m. with a paramedic and a nurse and their closure rates are under 10 per cent. And we have to keep our ER department open with a family doctor – with an emergency room doctor – and our closure rates are 70 per cent on a good month.”

He added: “This is part and parcel of me saying to people, ‘Why can’t we change the funding model? We change the funding model, we change the classification of the facility, and that [also] gives us more flexibility on who we can be primary care provider.’”

Apart from a financial new deal for ER doctors at ESMH – which has had access to two physician locums (fill-ins) in recent months and employs one nurse practitioner – the new hub and spoke approach could involve training and recruiting RN prescribers, which the Nova Scotia College of Nursing define as nurses, “with an expanded scope of practice that enables them to prescribe medications and devices and order relevant screening or diagnostic tests within their specific area of prescribing competence and practice. RN prescribers have completed additional education and met additional registration requirements.”

Said Duchesne: “In Nova Scotia, the only advanced practice nurses are nurse practitioners and clinical nurse specialists. There is nothing else. This is new to our province, [but] we are training all of our [nursing] staff to be RN prescribers.”

Still, for now and through the rest of the month, she advised Sheet Harbour and area residents, “If you have any emergency, call 9-1-1.”