At this moment, thousands of Canadians are waiting in crowded hospitals for their turn to see an emergency physician. For some, the wait will be deadly.
Recent media reports of young people dying in Canada’s hospitals are, sadly, just the tip of the iceberg. As emergency physicians, we witness the Russian Roulette our politicians are playing even as we struggle to identify and treat life-threatening emergencies.
Our frustration and grief bubble at the surface as we try to keep a crumbling front line from collapsing altogether. Our job is already tough enough; among the thousands of emergencies we see, major and minor, only a few may be deadly in the ED.
It’s our job to identify who will die without immediate intervention, a job that sometimes feels like finding a needle in a haystack. Threats to life aren’t always obvious. Dying patients may look well when they arrive at triage yet get sicker as they wait for hours. The average Canadian ED may be too overwhelmed and understaffed to notice.
When a young person dies of a treatable disease, a devastated health team is left wondering, “What would have happened if we could have gotten to them quicker?”
The truth is, such deaths are not a failure of one hospital, one nurse or one doctor. They are failures of our health system. One recent analysis estimates that each year, as many as 15,000 Canadians die because of hospital crowding – a “hidden pandemic” of unnecessary death.
Even in a perfect health system, let alone a stressed one like Canada’s, skilled doctors and surgeons can’t save every life. This is a reality emergency doctors must live with. But to have governments under-resource us to the point of breaking is beyond untenable; it’s unconscionable.
All Canadians deserve better.
The solutions to overcrowding are as well-known as is the heartache that accompanies untimely deaths. Yet, we feel like broken records. For decades, media has reported on deadly tragedies coupled with provincial underfunding while conditions on the ground continue to worsen.
Canada has one of the fewest inpatient hospital beds per-capita.
Among Organization for Economic Co-operation and Development countries, Canada has one of the fewest inpatient hospital beds per-capita. Patients who need to be admitted to hospital wards may wait for days in the ED, so there is less space and fewer nurses available to care for arriving emergencies. Patients crowd chaotic waiting rooms, slowly trickling into the few free stretchers as wait times balloon.
Something else is hidden under the surface of underfunding. Emergency doctors, trained to detect subtle but deadly conditions, are being beaten down by the unending logjams. Duelling pressures challenge emergency medicine from both ends. A lack of access to primary care pushes even more patients through the doors, stressing already stretched resources. And as hospitals trim the fat to stay in the black, access to the tools we need to diagnose life-threatening conditions – urgent laboratory tests, imaging studies and cutting-edge in-patient care – is becoming harder to come by.
Increasingly, we feel a sense that we don’t stand a chance of catching every warning sign before disaster strikes. Imagine a surgeon without a scalpel or a microbiologist without a microscope. Emergency doctors are being stripped of the tools we need to do our job. Delivering excellent emergency care to every patient who needs it is becoming impossible to do.
If we were pilots, we’d refuse to fly a plane under such dangerous conditions. But unlike flights, emergency departments can’t be cancelled.
It doesn’t have to be this way.
The Canadian Association of Emergency Physicians (CAEP) has provided clear scientific recommendations for a fundamental redesign of the system. Emergency physicians have done the research, appealed to policymakers and provided solutions. A coordinated system, government leadership and investment in frontline workers is needed.
Politicians must demonstrate the resolve to fix this crisis. Until governments act on our scientific recommendations and commit to meaningful system change, Canadians will continue to wait in dangerous conditions – and more families will face tragic, preventable loss.
The authors refer to “policymakers.” In my experience they are fairly easy to identify. It’s much harder to identify and therefore to influence “decision-makers” in relation to the health system. My sense is that many policymakers often do lots of work to create plans that are never enacted–and I sometimes wonder how carefully they are even considered–or are directed to do the detailed policy work necessary to implement the decisions others have made. It’s telling how often and how quickly people with impressive job titles seek to assure groups of patients, clinicians, and researchers that they are not the real decision-makers.
I am lucky to be a patient of a family health team that has a week-day after-hours clinic (5-8pm) and a Saturday clinic open for a few hours. But over the years it’s become very clear how few options other than the emergency department there are in what are still the majority of hours of the week when urgent care is required but when no one in our family health team can be contacted. Even in the middle of Toronto late on a Sunday afternoon we were told by the person on the call we made to the number listed on our FHT’s website that our only option was to go to a hospital emergency department.
Decades ago SickKids had an urgent care centre, clearly distinct from the emergency department. Being referred there was itself a very clear and useful signal that the problem did not appear to be an emergency. I’d be interested to know why it disappeared.
I understand why ED staff are reluctant to tell patients who are seeking care why there are long delays. But there should be mechanisms to make it clear to patients (perhaps when they are being discharged from the ED or when they are accessing information via the portals they are being urged to use or even, depending on circumstances, while they are killing time in a waiting area) why the waits are what they are. We really do wonder whether we are waiting because our problems are really not emergencies–which, of course, is sometimes the case–or because there are too few nurses, doctors, or technicians. Nearly every staff member I have encountered in EDs has been great, but I think they could use some help in identifying the best ways to let patients know why they are experiencing what they are experiencing.
Thank you for your continuing advocacy for all of us working in the emergency departments across the country.
We are all doing the best we can every day and we all appreciate the support CAEP provides.