A Prescription for Emergency Room Overcrowding

by Dr. Keith Martin M.D, Hill Times - Feb 7, 2011   

Fifty two per cent of Canadians agree that our health care system is broken and needs to undergo fundamental change if it is going to meet our needs in the future. One essential change must be reducing the back-logs in Canadian emergency rooms. 

As a physician who practiced emergency medicine, most of the beds in my department were filled, the majority of the time, with patients suffering from chronic diseases who could no longer live at home. Many of their problems did not require treatment in an acute care hospital. They could have received appropriate and less expensive care in a non-acute, complex care facility. Unfortunately, beds in these facilities were rarely available. These individuals, who could no longer care for themselves, wound up in the emergency room, sometimes for days on end. They displaced other patients who needed an acute care hospital bed but wound up sitting in the waiting room for many hours before they could even see a physician because there were no vacant beds in the emergency room. This is cruel, and an inhumane way to care for people when they fall ill.

Many chronically ill patients decompensate unnecessarily at home due to a lack of ongoing home care. These tragedies could be avoided with better access to community services and home visits by nurses. This costs far less and protects the patient from picking up a deadly hospital-borne illness.

The following are a number of simple initiatives that can be implemented quickly to relieve emergency room congestion. They are:

1. Increase the number of complex care and assisted living beds. Appropriate patients should be directed to these beds and away from those in the emergency room.

2. Invest in community services such as: alcohol and drug rehabilitation programs, community care nurses, homecare, emergency shelters and affordable housing. Too many patients wind up in the emergency room who simply cannot meet their basic needs. Their problems are social, not medical.

3. Create a rapid reaction team within hospitals that is comprised of a social worker and a nurse that will help people access the outpatient services and programs they need. This team can also work in the community with a police liaison officer to access hard to reach marginalized people. This would identify medical and social problems before they become acute and direct people to the community services that can deal with them.

4. Implement a triage system in the emergency room that separates acute patients from non-acute patients. This will enable the latter to be diverted to a treatment clinic situated beside the emergency room. This clinic would be staffed by physicians and nurses who can quickly treat simpler problems. This should be open on a 24 hour basis.

These and other solutions will enable our beleaguered health care system to provide for timely access to health care when people fall ill. For our patients, inaction and silence must not be an option.