Steps are being taken to avoid future crowding situations at the Valley Regional Hospital’s emergency department in Kentville.
Kings North MLA John Lohr said on March 7 that he received a call from a constituent who was concerned with crowding in the emergency department. Lohr said the department was “overtaxed” with “nowhere to put anyone.”
Dr. Lois Bowden is the Nova Scotia Health Authority Western Zone Medical Director Co-Lead; the Valley Regional Hospital Medical Site Lead and is head of the Valley Regional Hospital Emergency Physicians Association. She said they are recognizing an increase in the volume of patients coming into the emergency department.
This is due in part to the fact that it’s flu and virus season. Other reasons include a shortage of family doctors in the Valley region and the fact that the region is one of the few in the province experiencing growth.
In addition to the local population, there is a transient population, especially considering Acadia University and the Nova Scotia Community College Kingstec Campus.
“For all of those reasons, we’re seeing more emergency room visits,” Bowden said.
With more people visiting the emergency department, more are being admitted to hospital. For example, on March 7, there was an unprecedented number of patients admitted through the emergency department in a single day: 24. Bowden said this resulted in an “incredibly hectic” time for the staff.
“It’s a realistic statement to say that, yes, when we have 24 people in our emergency department, we are at our maximum ability,” Bowden said.
She said staff was able to diffuse the situation by the end of the day through a variety of mechanisms that have been put in place to manage such situations.
Although they don’t want to discourage the public from visiting the emergency department, Bowden said there are community resources, such as the 8-1-1 number, that people who are not in a state of emergency can access for health advice.
The Canadian Triage Acuity System is a scoring system that essentially ranks how sick a patient is on a scale of one to five. She said it isn’t the fours and fives, which are on the lower end of the acuity scale, that are clogging the system. They can be treated quickly and move on.
“That’s why we were actually able to totally manage our emergency department last week, even though we had these 24 admitted patients, because most of what comes in is the lower end of acuity,” Bowden said.
Improving patient flow
In the last six weeks, there has been a reorganization within the emergency department to increase efficiency by better managing patient flow. They now have a R.A.Z. (Rapid Assessment Zone). Patients are triaged, are seen by a physician and have lab work or x-rays done if needed. This creates a cyclical flow throughout the department and patients with significant illnesses aren’t left alone and undiagnosed for long periods of time.
Bowden said they are in the process of pulling together a transition team that will be overseen by the emergency department. This is an attempt to improve the off-load wait time for patients arriving by ambulance.
Teams of two EHS paramedics bring patients in on stretchers. If the patient is stable but paramedics are unable to take the patient off the stretcher because there isn’t any room in the emergency department, he or she may have to stay on the stretcher for a couple of hours.
Bowden said they are going to carve out space where patients can be off-loaded into a room with medical personnel on hand, unlike a normal waiting room.
“It’s a way to get those EHS ambulance trucks back out in the community where they’re needed rather than waiting to unload a patient in the emergency department,” Bowden said.
They are also going to devote space for patients being discharged on a particular day who don’t have someone immediately available to pick them up. This will free-up beds sooner so that patients being admitted can have access faster.
“It’s about trying to maintain the flow and get the right people in the right place,” Bowden said.
There was a “tremendously impressive sense of community” throughout the entire hospital on March 7 and she said extraordinary efforts were made on that extraordinary day to ensure that all patients received the necessary care.
Bowden said none of this would be possible without an “incredible staff” and the nurses who stay late and miss breaks, bending over backward to make things work. She is also grateful to members of the public for being patient during busy times.