Days after Premier Tim Houston held a health summit with senior health officials, the province announced changes to emergency care.
Among its main commitments, the province wants to have teams led by doctors focus on getting patients out of ambulances and into the emergency department faster.
Another priority for the province is to assign physician assistants and nurse practitioners to provide care in emergency departments.
The province is planning to add care providers and patient advocates to support patients in waiting rooms.
To free up beds, the province is promising to provide health care teams with real-time data on where beds are available across the system and what tests or other actions are needed to get patients home quicker.
Finally, the province wants to make virtual care available to more patients with less urgent needs.
Michelle DePodesta, executive director of Acute Health Services for the Eastern Zone, told The Reporter these initiatives are in the early stage, and although they’ve observed “great success and uptake,” they still need to figure what’s working and how they can work through any challenges.
Locally, DePodesta said a float physician started at St. Martha’s Regional Hospital in mid-December. Because offloading ambulances can add to wait times, she said the floating physician can help get patients who arrive by ambulance seen and triaged, which allows paramedic crews to respond to calls.
DePodesta said NSH will be posting positions for St. Martha’s and Eastern Memorial Hospital in Canso, and noted that Nurse Practitioners can assess and treat a wide range of patients. She said this idea is being tried out on the low acuity outpatient population to see if they can help with congestion in the waiting room.
DePodesta said they are also looking to fill positions at St. Martha’s and Inverness Consolidated Memorial Hospital (ICMH) with a focus on patient advocates to provide comfort for patients in waiting rooms.
The emergency department at ICMH has been swamped at times, leading to Inverness Municipal Councillors to complain to NSH.
Currently, the emergency department at Strait-Richmond Hospital is open between 48 and 72 hours per week, and DePodesta said they are trying to keep it open as much as possible.
For some time, DePodesta said the NSH has been working on filling positions at the Evanston facility.
In a press release issued on Jan. 18 the province announced they are working to ensure people with the most urgent needs receive care first, improve ambulance response times, and offer more places for people to receive care, which they said will ease pressure on emergency departments.
Michelle Thompson, Minister of Health and Wellness and Antigonish MLA, said the province has been making “record-high investments,” since forming government, and the recent tragic losses in Cumberland and Cape Breton have added to the sense of urgency.
To support paramedics, the province wants to make paramedic training at more Nova Scotia Community College campuses and provide a tuition rebate of $11,500 to paramedics who agree to work in the province for at least three years.
The province said it intends to add a second air ambulance to handle routine transfers for tests and treatment between Sydney and Halifax, as well as Yarmouth and Halifax, which they said will allow “ground ambulances to stay in communities more often.”
Another commitment from the province is funding to train medical first responders who sometimes arrive at an emergency scene first.
To give people more places to receive care and reduce pressure on emergency care, the province said it will: support new and existing collaborative family medicine practices; expand services in more pharmacies; enable out-of-province doctors licensed in Nova Scotia to offer virtual care; provide more mobile primary care, mobile respiratory care clinics, and urgent treatment centres; and offer a new phone app, known as a digital front door, that is intended to help people find the right services and where they are offered.
Karen Oldfield, President and CEO, Nova Scotia Health said the health care system was built during a different era, and aside from technological advances, “it has barely changed since.”
On Jan. 20, NSH announced training and retention initiatives for nurses in emergency departments across the province.
Spanning their careers working in emergency departments, NSH announced post-secondary programs focused on emergency care for nursing students, professional development opportunities, and a nursing innovation fund for practicing Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).
But in a press release on Jan. 17, the Nova Scotia Nurses Union (NSNU) said the actions don’t address the “staggering nurse vacancy rate and urgent and untenable pressures on nurses,” which they’ve been talking about for more than a decade.
Union president Janet Hazleton said she’s most concerned about initiatives that risk adding to the workload of nurses, if there isn’t a significant shift in filling vacancies, or at the very least, initiatives to retain existing nurses. Without more beds and professionally trained nurses in emergency departments, wait times will remain unacceptably long, she stated.
The NSNU said nurses need “non-nursing work such as administrative tasks and other duties” removed from their duties to “focus on timely and precise patient care.”
Although patient advocates may seem like a logical solution for anxious patients lingering in waiting rooms, “qualifications and boundaries must be very well-defined,” the NSNU said, noting “there is a significant distinction between a patient’s medical needs verses their comfort needs, and how the advocate is to intervene. “ In conjunction with the advocate role, NSNU is asking that “someone with medical expertise,” be present in waiting rooms to ensure patients are observed and assessed.
Hazelton says she would have liked to see nurse-prescribing as an action item considering many patients presenting at emergency departments are looking for prescription renewals.
Government must also provide consistent tuition relief for nurses who wish to work in areas like emergency departments, the union stated.
The NSNU predicts the plan will fall short of meeting the government’s goals.
And they are ambitious goals that contain different ideas, fresh perspectives, and new ways of doing things, but that alone will not ensure success.
It should not be forgotten that the main source of health care problems continue to lie with the lack of physicians, nurses, and other health care professionals. Without success in recruitment and retention, some of these plans amount to Band-Aid solutions without the people to lead them.
It was encouraging to hear last week’s announcement of provincial funding for groups and municipalities trying to recruit and retain health care professionals, and hopefully, that money spent now will pay off for years.
The announcement also underscored how important it is that vacant positions be filled.
In order to function properly, the system needs a sufficient number of qualified health care professionals to keep emergency departments open, attend quickly to those needing emergency care, ensure patients have the best care possible, and prevent staff burn-out.
Without proper staffing, some of these goals will continue to prove elusive.