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bottaro: a return to first-touch care can rebuild trust in emergency rooms
9 minute read
prior to the pandemic, as many as 83 hospitals across the country were operating beyond 100 per cent for over 30 days, with 39 of those hitting 120 per cent for at least one day.
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i remember one night i spent in the hospital with a friend who had a bicycling accident—his face growing larger by the minute, his eye being forced shut, and a ball of swelling tissue and blood the size of an orange protruding out of his face.
we sat and waited for over an hour without so much as the offer of an ice pack.
when i finally said enough is enough, i went up to triage myself, asking for one, and the response i got was disheartening, to say the least. the emergency room didn’t have ice packs, but the nurse would ‘see what he could do’. he came back with a ziplock bag and a few pieces of ice.
another incident left my view of the care provided in hospitals marred when another friend of mine sat in a crowded waiting room with appendicitis. the nurse didn’t take the time to examine her thoroughly, and she even went so far as to insinuate the pain was being faked for access to drugs. that nurse didn’t know what was happening, but had she taken more time to investigate, her conclusions may have been different.
when visiting the emergency room, many people are panicked and scared and look to medical professionals to give them the care they need to go home safe and sound. they sit at the triage, are asked a few questions, and are designated a spot in line depending on the severity of their health concern. but what happens between their moment with triage and their visit with the doctor? an hours-long wait where they are nothing but a number in line, clogging up an already overcrowded hospital.
it begs the question—why are the initial points of care in emergency rooms so brief?
it’s to the point where someone with appendicitis is being forced to wait for hours, in excruciating pain, and without any offer of first-aid or relief, for a doctor to diagnose her. while my friend was eventually admitted to surgery—just over a day after her initial arrival—it’s hard to think about what could have happened if things were just a little busier that day.
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it’s not common for people to die while waiting in canadian emergency rooms. still, it has happened due to a lack of resources and the inability to prioritize people for their conditions. we’ve seen too many examples in recent years of those failed by the emergency room—allison holtoff of nova scotia, three unnamed patients from winnipeg, red deer, and new brunswick, and gilberte gosselin of quebec are all painful reminders of the grave consequences that can occur in our current system.
the nurses who work in these wards are capable of providing basic first aid, at the very least. so, why are they so quick to say, “the doctor will see you soon,” when they could offer more first-touch care in waiting rooms?
because, let’s face it, there aren’t enough nurses. and there isn’t enough space for everyone who needs prompt care.
but just because staff and space are lacking, does that mean patients in desperate need of care should suffer? it’s not that simple.
the current state of hospital emergency rooms in this country is abysmal, with overcrowding, underfunding, and understaffing being stark issues. but what part of that is behind the lack of first-touch care and adequate triage?
overcrowded hospitals
in june 2023, the canadian medical association journal published an article about a series of letters that emergency physicians had written about working in overcrowded and understaffed emergency rooms. the letters indicated that these issues severely hindered their ability to provide the care their patients deserved.
according to the canadian health coalition, there are roughly 7.7 acute beds in canadian hospitals per 1,000 people, when that number should be close to double that at 14.7. however, that’s not the only overcrowding problem.
the capacity level at which patients are coming to the hospital and needing care is well over the recommended 85 to 90 per cent, which emergency departments are able to handle. according to the report by the chc, occupancy rates are near 100 per cent.
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this issue isn’t new, either. prior to the pandemic, as many as 83 hospitals across the country were operating beyond 100 per cent for over 30 days, with 39 of those hitting 120 per cent for at least one day, marking a significant problem of overcrowding that leaves patients without the care they need and medical professionals overburdened.
shortage of nurses and family doctors
many believe that the covid-19 pandemic is to blame for the shortage of nurses, which also affects emergency care. however, canada’s nursing shortage at a glance report from the canadian federation of nurses unions found that there were far too few in the profession long before the first case of the viral infection landed on canadian soil. the pandemic simply amplified already-existent problems within the healthcare system.
according to statista, there were 27,700 registered nurse job vacancies nationwide in the second quarter of 2024. when the number of hospital visits continues to grow, totalling roughly 15.5 million from 2023 to 2024, up from 15.1 million the year before, it clearly shows why providing first-touch care in emergency rooms is so challenging. if you have 100 people to feed and only one loaf of bread, everybody is going to walk away hungry.
the country’s shortage of family physicians is also forcing more people to the emergency room for issues that don’t require immediate care, leading to an overcrowded system. according to the canadian institutes of health information, one in seven people who go to the hospital for care doesn’t need to be there as their conditions, ailments, or health complaints are much better suited for primary care.
but when 5.4 million people lack access to primary care, they must choose between a walk-in clinic and the emergency department, both of which are overrun with patients and have long wait times.
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we can’t expect nurses to just buck up and keep going no matter the consequences to their own health, especially after the chaos that ensued during the covid-19 pandemic.
we also can’t expect the nearly 14,000 doctors who are gearing up for retirement to stay on for a few more years because there aren’t enough replacements—an issue that stems from caps on medical school admissions and non-transferable international degrees.
a lack of funding and misspending
in a 2018 report by global news, concerned ontario doctors (cod) says that the canadian government’s utter failure to provide funding to pay for staff and other tools is the main culprit behind the severe state of the healthcare system. the report notes that between 2015 and 2018, billions of dollars were cut from the front-line care budget.
when the government announced their 2023 healthcare spending budget, there was a $46.2 billion increase. while that sounds promising, provinces continue to underspend.
for example, a report by the financial accountability office found that in 2023, ontario spent $7.2 billion less than expected on healthcare. with the lack of funding being an issue, why was the province so frugal in its spending?
those in the healthcare system have shouted as loud as possible, calling for more funding to get more front-line hospital workers. their pleas have gone unheard. even when the budget increases, the provinces fail to utilize their entire health budgets, knowing very well that more funding could improve the situation.
it’s like children who take $20 to get milk at the store for their parents, buy the cheapest one they can find, and then pocket the change instead of giving it back to their parents.
leaving canadians to fend for themselves
as a result of the treatment – or lack thereof – canadians face in emergency rooms, many are simply giving up altogether.
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between april 2022 and march 2023, over 1.3 million people who went to the emergency room for care ended up leaving before seeing a doctor, according to a report by the cihi.
one such case was a 67-year-old woman, charlene snow, who gave up after waiting roughly seven hours and went home. she died less than an hour later.
had charlene been given better first-touch care at the hospital, would she have waited less time to see a doctor? if there had been better triage practices or more nurses in the department to look after the people waiting, would her serious condition have been spotted before it was too late?
the people waiting for hours and then leaving before receiving care may also practice more patience if there were healthcare providers seeing them while they waited with first-aid or even simple check-ins on how they were feeling. a little bedside manner can go a long way in the emergency department, even if patients don’t have access to a bed. but without enough staff, keeping an eye on everyone is impossible.
when the level of care goes down, so much so that people are willing to play russian roulette with their ailments, a lack of trust builds. and that distrust also plays a role, with more and more people seeing the system as shattered.
according to a survey commissioned by the canadian medical association in 2023, only 26 per cent of canadians consider the healthcare system to be “in excellent or very good condition.” this number was as high as 48 per cent in the same survey conducted in 2015.
that means 74 per cent of canadians see the healthcare system as less than good. and given the data on wait times, lack of first-touch care, and people dying in emergency rooms or at home after leaving before being seen, they’re not wrong.
bring first-touch care back: solutions for the long haul
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so, what are the options for giving canadians universal healthcare they can rely on? bring first-touch care back into the system.
the first step is addressing the shortage of nurses and doctors, a problem that can be solved through better funding and better access to medical training in the country. allowing personal support workers the chance to work as first-touch providers in an emergency room is another option, giving ers a better-staffed approach.
provide the funds needed to improve access to medical training, fill vacancies, and encourage people to take on one of the most demanding jobs by providing better benefits for mental health treatment, paid time off to recharge, and anything else needed to create a better environment.
give grants and incentives to international graduates who want to apply their medical training here, even if more classes are needed to make it transferable.
anticipate the loss of physicians in the aging population so that people are ready when the problem arises, not ten years later.
and most importantly, we need to hold the government accountable for the money spent on healthcare at a federal and provincial level.
these changes won’t address the high number of canadians that seek out emergency care, but having more hands on deck and funding for first-aid tools in the emergency room can provide a better care experience.
more people may be able to go home after just seeing a nurse or psw if they’re not really meant to be there for emergency care. those that do require it will have to wait less time and be put into the queue accurately after a more thorough examination. and those who are bleeding and in pain will get the initial care they need to make waiting a lot less excruciating.
until we can manage to change the system, the system will not change. and unfortunately for canadians, we cannot afford to continue living with a broken health system without being forced to deal with the severe consequences.
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