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Plan to improve ER care lacks rural solutions

  • January 25 2023
  • By Lois Ann Dort, Local Journalism Initiative Reporter    

GUYSBOROUGH – The Houston government, which was elected on a platform to fix healthcare, announced a long list of actions meant to increase access to emergency care in the province and reduce wait times for care on Jan. 18.

In a press release, the province stated, “The plan to improve emergency care will ensure people with the most urgent needs receive care first. It will improve ambulance response times and offer more places for people to receive care, easing pressure on emergency departments.”

The plan includes actions to ensure those with the most urgent needs get care quicker, supports for paramedics and the provision of more places where people can receive care – such as at pharmacies – reducing pressure on emergency care.

While these actions may improve care in emergency departments, the issue which plagues emergency care in rural areas, especially in the Municipality of the District of Guysborough and in the community of Sheet Harbour, is the closure of the emergency department [ED] due to lack of physician or nursing coverage.

The plan, as outlined last week and online [https://novascotia.ca/actionforhealth/], doesn’t include the word closure, although it does address recruitment, noting that a community fund will support, “efforts to attract healthcare professionals, beginning in Cumberland County and Cape Breton.”

During a technical briefing on Jan. 18, given that closures and not wait times are the main issue in rural hospitals, The Journal questioned why the province was continuing to rely on physicians to keep EDs open in those areas. A nurse practitioner or ED nurse is capable of triaging and giving treatment to most patients seen in rural EDs. The data on Canadian Triage and Acuity Scale triage levels in rural hospitals proves that point; most people who visit rural EDs don’t have life-threatening conditions. The Journal asked, would nurse practitioners be allowed to keep an ED open without the presence of a physician?

Colin Stevenson, chief, System Integration, Department of Health and Wellness fielded the question. He stated, “From an emergency department perspective, part of understanding what an emergency department is, is understanding they type of patients that they’re going to see and the level of care that they’re going to provide. Within the province of Nova Scotia we have a variety of emergency departments: Level 1 generally the Halifax Infirmary and the IWK, Level 2 which are our regionals, Level 3 or Level 4 are urgent treatment centres. Based on the volume of activity, we want to make sure that that emergency department or urgent treatment centre is staffed appropriately to see the type of patients that it is. If it is not able to receive ambulances, and if it is not staffed to actually see a patient that may require an emergency response in a life-threatening situation, and by that I mean it doesn’t have the appropriate personnel in order to respond to that, it may or may not be able to be called an emergency department on the system response plan. Which is why, in areas where we are having a harder time being able to have consistent physician staffing for an emergency department, our focus really is on understanding what the volume of activity is, the type of visits that they see and finding ways to stabilize it so people actually have more reliable and consistent access.

“We have been having great success around the province by introducing the urgent care model, or urgent treatment centre model. We’ve actually been able to increase hours in physician coverage for that type of model because they’re more comfortable…to provide care within that type of environment. There’s a lot of work still continuing with Guysborough and Canso because of the two facilities and the need to create a stable environment between those facilities to deliver the appropriate care there. I can’t commit that a nurse practitioner only model would be something that would support the requirements of those communities,” Stevenson said.

In the press conference with Michelle Thompson, Minister of Health and Wellness, which directly followed the technical briefing, The Journal put the question of pay discrepancy to the minister. In an article this month, The Journal reported that in the master agreement between Doctors Nova Scotia and the province, doctors at a Level 4 site are paid $77.18 per hour while those at a Level 3 facility are paid $154.31 per hour. The discrepancy in pay for physicians may inhibit the ability to recruit doctors and keep EDs open in rural areas.

Asked what would be done to address the situation, Thompson said, “Certainly those rates in the master agreement are negotiated between government and Doctors Nova Scotia and…as we would with other collective agreements, we work within the parameters of those. That’s not to say that there’s not more work that can be done, but those are the rates that have been negotiated and agreed upon and so we need to continue to do that. But, we are always open to different opportunities going forward in terms of negotiations.”

Asked when the next round of negotiations between Doctors Nova Scotia and the province would take place, Thompson replied, “It’s now.”