Halifax children’s hospital sounding alarm over its ER department ‘crisis’

As Nova Scotia’s health system continues to face strain from the COVID-19 pandemic, the emergency department at a Halifax children’s hospital is sounding the alarm.

Katrina Hurley, the chief of the IWK emergency department, says the hospital’s ER is in a crisis, seeing record numbers of patients for spring

“It’s nearly beaten a record level of ever, patient volume in a single day,” said Hurley.

“A lot of these patients are also acutely ill. So it’s a high level of acuity in addition to a high volume of patients.”

Hurley said there’s no one illness that’s dominating in the high patient volumes, something that’s unusual for this time of the year.

“In the past, when we’ve had a large surge, it’s been almost exclusively due to a single virus such as RSV or influenza.”

Nova Scotia continues to see hundreds of newly-confirmed cases of COVID-19 each week and restrictions — including wearing face masks — have been lifted since March 21.

But according to Hurley, it’s not just that everyone has COVID-19 without masks in place.

“(It is) masks are off and everyone has everything,” she said.

The IWK emergency department has been seeing patients with fever, cough, vomiting, diarrhea and hand-foot-and-mouth disease, among others.

“The masks protected the children from COVID, but they also protected them from all those other childhood ailments. And so removing the masks has brought all of those illnesses back, pretty much at the same time.”

6:48 New Emergency Department Taking Shape at IWK Health Centre

The ER at the hospital has been working at overcapacity for six weeks every day, said Hurley.

“Some days are better than others. But at some point during most days we become overwhelmed.”

According to Hurley, the previous single-day record for ER visits at the IWK was 180 patients. Last Monday, they saw 178. In previous years, the average would be about 100 patients a day during this time.

Because of overcrowding during a normal day at the ER, waiting rooms become full and some patients end up waiting for hours. In the past six weeks, Hurley said there have been 47 long waits, which exceed 12 hours.

“The fact that 47 people sat in our department and waited for 12 hours to me is a sign of a crisis in our department.”

View image in full screen

Pediatric emergency medicine is the most overcrowded, with the average child patient being under the age of five.

Hurley said she believes people come to the ER as a last resort.

“The epidemiology of illness in the community has changed and the health-care system has changed,” Hurley said.  “There are more patients than ever that don’t have a family doctor, and patients’ ability to access care in walk-in clinics appears to be quite limited — at least that’s what patients tell me.”

In addition to that, the pandemic has placed a lot of strain on staffing in Nova Scotia, so the department often needs to fill shifts on short notice.

And after spending hours in the waiting room, patients often become “verbally very upset with staff,” said Hurley.

“That can be difficult to face day in and day out, particularly when … the staff is working in triage.”

She also said it can be distressing for health staff to see people in need waiting for care. “I feel really badly. I feel that I haven’t maybe done my job well enough,” she said.

The department currently has vacancies, though they rarely work understaffed because people will work overtime, or assist from other units.

Health Minister Michelle Thompson said in a media availability Wednesday, there has been some work done to assist the IWK with staffing

“Nurse practitioners, as well as an increase in physician hours to assist with the increase in patients that they’re seeing,” said Thompson.

2:12 Halifax mom shares experience after infant contracts COVID-19

But the overcrowding can’t just be boiled down to issues within the emergency department, according to Hurley.

“We can’t control what’s happening in the community. We can’t control where and how people access health care… People decide what their emergency is. Some of those are things that I don’t consider an emergency, and some of them are things I wish they had come for sooner.”

Hurley said there’s no one solution to this problem.

“If we add more walk in clinics, does that mean people will use them? If we add more nurses to the emergency department, does it mean we can move patients faster when we don’t have enough beds?”

Heading into the summer, Hurley said July and August have in the past been the quietest months of the year in terms of patient volumes. But this year, that might not be the case.

When it comes to what the government can do, Hurley said she’s not sure as it’s a complex system. Data gathered now can inform decisions in six months, but not immediately.

“My biggest concern is that we don’t have the ability to respond to surges while they’re occurring,” she said.

“I can’t tell you how hard we’re trying. We meet all the time, we’re always strategizing.”

In the meantime, she wants families to be prepared when visiting the ER. The sickest patients are seen first, and others may have to wait so bringing toys, food and distractions is a good idea.

“I want them to know that we’re doing the best we can to provide them with the care they need.”

— With files from Alicia Draus.