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"One possible fix for Nova Scotia's ER closure problem — fewer ERs"


Chels1267
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https://www.cbc.ca/news/canada/nova-scotia/one-possible-fix-for-nova-scotia-s-er-closure-problem-fewer-ers-1.4777265

I'd really like to hear people's opinion on this idea. I've spent a significant amount of time volunteering in the ER at the Truro hospital, and my honest gut reaction to this is that I get the logic, but disagree. I don't think the hospitals that they'd likely keep are organized to deal with this, but I'd love to hear the opinion of people who're more involved than just a volunteer. What do you think?

 

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9 hours ago, Chels1267 said:

https://www.cbc.ca/news/canada/nova-scotia/one-possible-fix-for-nova-scotia-s-er-closure-problem-fewer-ers-1.4777265

I'd really like to hear people's opinion on this idea. I've spent a significant amount of time volunteering in the ER at the Truro hospital, and my honest gut reaction to this is that I get the logic, but disagree. I don't think the hospitals that they'd likely keep are organized to deal with this, but I'd love to hear the opinion of people who're more involved than just a volunteer. What do you think?

 

I support this. Every province I have ever worked in has too many little ERs scattered around that probably dont really contribute much to overall patient outcomes. For example, around me we have 2 fully staffed ERs and 2 ERs with a physician on call 24 hours a day. That's all within an hour of each other.

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I think it’s an okay idea IF the money and resources saved from closing the community ERs are used to expand the staff, resources and beds at the regional ERs/QEII or open clinics.

There are 10s of thousands in rural NS without family doctors and the regional ERs simply don’t have enough beds and physician coverage to deal with the extra people that closing community ERs would bring in. In New Glasgow, the walk in clinic just “temporarily closed” and the ER is already feeling the heat from that. Level 3’s taking 4-5+ hours to be seen by a physician some days. There are no residents/PAs/NPs in these hospitals and the staff physicians are overworked big time, normally 1 staff physician in the ER from 11pm-11am for an area of 20000+ in Pictou County for example. I don’t know what the ROC is like but it’s bad here and only gonna get worse.

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2 hours ago, NLengr said:

I support this. Every province I have ever worked in has too many little ERs scattered around that probably dont really contribute much to overall patient outcomes. For example, around me we have 2 fully staffed ERs and 2 ERs with a physician on call 24 hours a day. That's all within an hour of each other.

Have to agree with this. Rural ERs often function more like well-supplied and well-staffed walk-in clinics than they do as true ERs. Most don't have the equipment necessary to do full resuscitation (and the physicians covering them may lack the necessary skills in the first place), so these get sent along to larger hospitals anyway. Many don't have the volume to justify full 24 hour coverage either - if they only need a single physician covering during the day, then night-time shifts are necessarily going to involve a lot of down-time for the one physician on at night. Sure, it's nice to have a 24 hour walk-in available closer by for semi-urgent issues, but it's not particularly efficient use of resources, particularly in areas with limited healthcare resources in particular.

Concentration of personnel and equipment into fewer, larger centres, would be better in some cases. Get some real ER docs in there rather than FPs without dedicated ER training running the show, ensure adequate ER equipment availability, and increase the supply of supportive diagnostic services for longer hours. Turn the remaining ERs into what they are, essentially limited urgent care facilities, for daytime/evening hours. Yes, that means some patients have to travel further to get to the closest ER, but it means that they might have less distance to go to get to an ER that actually functions like an ER - not a place without any lab services, diagnostic imaging, the ability to intubate, or even an awake physician.

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On 8/14/2018 at 7:15 PM, NLengr said:

I support this. Every province I have ever worked in has too many little ERs scattered around that probably dont really contribute much to overall patient outcomes. For example, around me we have 2 fully staffed ERs and 2 ERs with a physician on call 24 hours a day. That's all within an hour of each other.

True but NL is dealing with a more dispersed "remote" population. NS absolutely has a lot of little towns that are fairly close together each with its own little "emerg" (well, actually a lot less than in the past). You're really never more than an hour away from (at least) a regional centre, at least three of which are within two hours of Halifax. I don't know what the solution is to the rural/remote issue, but in NS there's already been a lot of consolidation of services and this will undoubtedly continue. I can't understand why industrial Cape Breton alone has four hospitals when Halifax alone gets by with three (if you include the IWK and ignore the NSH). But then Nova Scotians think driving an hour into the City is a "long way". What Newfoundlander hasn't driven across the island to Costco/PriceClub? 

What NS does have going for it is a fairly well organized EMS/air ambulance system. NL has a patchwork of private/public services and way too much reliance and fixed wing transfers. 

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On ‎8‎/‎14‎/‎2018 at 8:15 PM, NLengr said:

I support this. Every province I have ever worked in has too many little ERs scattered around that probably dont really contribute much to overall patient outcomes. For example, around me we have 2 fully staffed ERs and 2 ERs with a physician on call 24 hours a day. That's all within an hour of each other.

I agree with this, but again I raise my initial point: are the hospitals that they would keep actually equipped to deal with this? I live in Truro, we have this grand new hospital that I would assume (probably?) would be one of the ones whose ER is kept open. From my experience even just volunteering there, it basically functions as patch and/or stabilize and then send off to Halifax for the more serious cases. Our hospital has a grand total of 2 ORs. Without actually taking the money and/or resources to expand the kind of services the ER in Truro can offer, we're almost as useless as the small ERs that they'd close.

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