“An emergency department that is patient focused should communicate to the patients who are waiting, as best they can, what their expected wait time should be.”
— From the provincial government’s
2012 Strategy to Reduce Emergency Department Wait Times
in Newfoundland and Labrador
Walking through a corridor in the Health Sciences Centre in St. John’s the other day, I saw a steady stream of beaming couples departing with tiny squirming infants in spanking-new strollers.
A happy sight, to be sure.
It got me thinking that hospitals are like airports — there are plenty of warmly received arrivals, some sorrowful departures and a whole lot of people just sitting around waiting.
Which brings me to the emergency department.
I was there to see my father, who was taken to the ER by ambulance Sunday night and, as a result, did not have to spend countless hours waiting in the crowded anteroom before being seen by a physician.
He’s doing much better now, thanks to the great medical care he received.
But not everyone fares as well.
Spend a few hours in the emergency department waiting room and you will witness human misery in many forms.
It’s a room full of dull-eyed, worried-looking, rumpled people in various states of discomfort.
A young woman sits holding her bandaged hand upright and leans against the wall, trying to sleep.
A young man limps through the double doors and eases himself gingerly into a chair.
A woman lowers her head in her hands despondently, wincing with every movement.
Another woman arrives with what looks like raw burns or fresh bruises across her cheekbones and the bridge of her nose.
The room is painted a listless blue and the air is stale. Despair seems to drift down and settle on the people waiting like dust motes. There is an anxious look about new arrivals, but that quickly morphs into slump-shouldered resignation. The space fills up quickly.
After a few hours shifting in hard seats under the fluorescent lights, we all look like we’ve slept in our clothes. Zombie-like, we stare at our cellphone screens and tap out text messages, some of us oblivious to the sign above our heads that asks us to please turn off our cellphones.
The scattering of magazines is dog-eared and thumb-worn. Someone has torn out a page containing recipes.
The wall-mounted television is set too high up to watch comfortably and the scrolling TV news is a mind-numbing murmur. Only the odd word or phrase penetrates the steady din of snatched conversation.
“Stittsville … grief counselling … young son and daughter … stay-at-home mom …”
Suddenly the dull TV drone is drowned out by a young woman’s loud moans. She is doubled over in pain and her moans soon turn to screams and anguished sobs. People shift in their seats uncomfortably, avoiding eye contact. The young man with her is frustrated by their long wait and his inability to comfort her and pounds on the windows of the information station.
You feel for the people working there, who can only do so much.
You also wonder what will happen to the young woman who is in so much pain, and to the other people waiting for care.
Later in the day, the number of people slumped in chairs remains about the same, though the odd face has changed, replaced by a new one.
At one point, a manager emerges to announce that the ER is over-capacity — that 24 people have been admitted and there are only 22 beds, and that no one else (pending an accident or disaster, presumably) could be admitted.
That news spurs a testy verbal exchange between the hospital employee and a woman who has been waiting to see a doctor since 9 p.m. the night before.
“That’s not my problem,” he says, explaining they are doing the best they can, but there are limits.
It was the emergency department at the Health Sciences Centre, but it could have been at just about any ER in the country. Health authorities in many jurisdictions are grappling with the problem. Long waits and frayed nerves are common.
Last year, in this province, the Department of Health released a five-year strategy to reduce wait times in emergency departments. It’s only a year old so we will have to wait (pardon the pun) and see if it succeeds.
I truly hope it does. Lord knows, it’s a problem that has been studied and tackled and analysed and measured.
Meanwhile, one thing is abundantly clear. Emergency departments are overcrowded, understaffed and under-resourced. And that’s not good for anyone — the employees working under extreme pressure or the sick and injured.
In July 2011, an article on the website Healthy Debate reported on an emergency department wait-time study by researchers in Ontario that was published in the British Medical Journal.
As the article noted:
“The study findings imply that when emergency departments are full or overcrowded, processes of care change and quality declines. Howard Ovens, an emergency medicine specialist and director of the Mount Sinai Hospital emergency department, says that the study findings ‘confirm what emergency department staff have always known, that an overcrowded, backed up emergency department is dangerous.’
“Ovens says that ‘doctors will spend less time with patients when there is a long queue, as they are trying to get caught up.’
“The authors of the study also speculated that spending less time with patients can mean time-consuming, but important tests may not be ordered, observation times may be shortened and arrangements for follow-up after discharge may be incomplete.”
Emergency departments where people are screaming in pain and have nowhere to lie down, where the wait time extends from one day into the next, and where even people who are admitted to hospital can be left for days on gurneys in noisy, busy corridors because there is a shortage of beds, are simply not working properly.
We need to solve this problem, stat.
Pam Frampton is a columnist and
The Telegram’s associate managing editor. She can be reached by email at