HALIFAX – Nova Scotia’s innovative approach to dealing with chronic, unplanned closures of rural emergency rooms is showing dividends, but a new study says the province’s collaborative emergency centres are being used by very few people in the overnight hours.
The study, released Wednesday by health-care consultant Mary Jane Hampton, says the eight centres – all of them in largely rural areas – have been achieving what they set out to do after the first one opened in Parrsboro in 2011.
“It was really an innovation for the Canadian health-care system,” she told a news conference. “This model is working really well. But the numbers overnight are really small.”
The centres offer patients same-day or next-day appointments with physicians and nurse practitioners who can handle most medical problems that aren’t life-threatening. They are open for extended hours during the day and most have paramedics and registered nurses working overnight with support from physicians over the phone.
The study says that since 2011, there has been a significant drop in unplanned closures at emergency departments inside rural hospitals, achieving the main goal of the project.
The model has since been adopted by P.E.I. and Saskatchewan. A Health Department spokesman said Alberta, Ontario and New Brunswick have each expressed an interest in the project.
Despite its success, Hampton submitted 18 recommendations for improvement, including a suggestion that providing overnight services may not be the best use of resources.
She said each of the six centres that operate 24 hours a day usually see only one patient in the overnight hours, if not less.
The problem is that the centres have become victims of their own success, the study says. By relieving local doctors of their on-call emergency duties, the physicians have had more time to see patients during the day, easing the overnight burden at the hospitals.
Hampton said it might be a good idea to have the paramedics at the centres respond to house calls for non-emergency care.
The study says paramedics work well with nurses when patients are coming into the centres, but they have nothing to do with inpatient care, mainly because of union restrictions.
“Paramedics find the CEC environment quite quiet,” Hampton said. “It’s a challenge to find paramedics who would thrive in that environment.”
Health Minister Leo Glavine said he recognizes there have to be changes.
“We can’t ignore the information that has been provided on the extremely low utilization during those overnight hours,” he said.
However, the minister said the overall success of the program has provided incentive to open at least six more centres, as suggested in a 2010 report by Dr. John Ross, the provincial adviser who drafted the original plan for the previous NDP government.
As for paramedics making house calls, Glavine said some are already doing that in a few locations.
“These are people who like to be busy,” he said.
NDP health critic Dave Wilson, a former paramedic, said the Liberal government has failed to capitalize on a program that works.
“We’re into the second year of their mandate and they have sat on their hands, not expanding a model of care that has been successful,” he said.
While the number of emergency room closures has dropped, there are ongoing problems at hospitals in Cape Breton and along the province’s South Shore, he said, adding that the number centres should be doubled over the next three years.
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