"Code Census only moves the problem of overcrowding onto in-patient floors. It does nothing to address the underlying problem of an overall lack of capacity and resources that are needed to deal with the growing demands on our health care system." — Jason MacLean, NSGEU President
Halifax (28 March 2017) — On March 27, the Nova Scotia Government and General Employees Union (NSGEU/NUPGE) released a report outlining a number of serious concerns regarding patient safety as a result of a continued year-over-year increase in the number of patients registered at the Halifax Infirmary Emergency Department (HI ED).
Overcrowding has become the new norm in Nova Scotia
This report, entitled, Code Critical, was developed by a working committee comprised of union staff, legal counsel and NSGEU/NUPGE health care members in response ongoing Code Census calls at the hospital. The lack of beds has led to patients being placed in hallways, or being double- and even triple-bunked, in order to create capacity in the Emergency Department.
"Code Census only moves the problem of overcrowding onto in-patient floors. It does nothing to address the underlying problem of an overall lack of capacity and resources that are needed to deal with the growing demands on our health care system," said Jason MacLean, NSGEU President.
"When Code Census was created in 2009, it was used seldomly. Now, Code Census calls have reached all-time high numbers. In fact, the Halifax Infirmary saw a record number of 23 Code Census calls in just 31 days in January 2017."
More patients turn to emergency rooms but hospitals lack resources and capacity to cope
Through conversations with frontline health care workers, as well as through a series of Freedom of Information requests, NSGEU/NUPGE discovered some disturbing statistics and trends, all of which align with the concerns members have raised.
- There were almost 14,000 more patients showing up to the HI ED in 2016 than there were in 2009, the year Code Census was created. This represents a 23 per cent increase.
- The average number of patients showing up daily has grown from 161 to 204 in the last 8 years. Staff say they routinely get up to 250 patients per day. Moreover, they report these patients are sicker and have more complex needs than in the past.
- Record numbers of patients also mean record numbers for wait times. In 2016, an average of 161 patients per month waited more than 24 hours. Staff say it is not uncommon for people to wait over 100 hours between registration and discharge or transfer to a floor.
- From September 2014 to August 2016, wait times from triage to admission were almost always at least 3 times to 4 times higher than the NSHA's own 8-hour target.
In-patient floor issues cause delays
On the in-patient floors, there are a number of factors causing delays, as well.
There are more patients than ever awaiting discharge to Alternative Level Care (ALC) and Long-Term Care (LTC) facilities. In fact, staff say it is not uncommon for ALC patients to have extended stays of up to a year or longer while they wait for a bed to open up at a facility.
The Veteran's Memorial Building is housing long-term care patients from Dartmouth General while that facility is under construction, which means it can no longer help alleviate overcrowding from the HI;
Patients from other Atlantic provinces, specifically PEI, are often kept at the HI for extended periods of time before a bed at a hospital in their home province opens up, or they are able to access home care services.
Problems at Halifax Infirmary emergency department spill over to rest of the province
The problems at the HI ED are having an impact on services throughout the province. Increased ambulance arrivals, increased wait times to discharge patients, and extreme line ups for ambulances to get into the hospital are all factors that decrease the number of paramedics that are available to care for other people.
When log jams occur, other facilities feel the burden of the increased use of emergency rooms. For example, the patient registrations at the emergency department at Cobequid Community Health Centre have increased by 21 per cent from 2012 to 2015.
Recommendations bring opportunities to improve health care for Nova Scotians
Ultimately, only increased capacity will truly fix this growing crisis. But the 15 recommendations that are outlined in this report are certainly a step in the right direction. They are relatively inexpensive, and can be implemented quickly.
"Too often, governments try to fix problems by bringing in high-paid consultants. This report, authored by the real experts — the people working on the frontlines of health care — makes reasonable suggestions for changes that employees believe will help make the problem more manageable and ultimately make their patients safer," said MacLean.
The National Union of Public and General Employees (NUPGE) is one of Canada's largest labour organizations with over 370,000 members. Our mission is to improve the lives of working families and to build a stronger Canada by ensuring our common wealth is used for the common good. ~ NUPGE