St. John's ERs failing to hit targets

Barb Sweet
Published on November 26, 2013

At the city’s two hospital emergency rooms, Eastern Health is hitting wait-time targets only about a quarter of the time for most of its patients, according to numbers obtained by The Tele­gram.

Patients who show up at emergency rooms are triaged into five levels of urgency — triage Level I being threat to life or limb or imminent risk of deterioration  — and Level V being the least urgent. The health authority — as do others — follows benchmarks, which are the targets it hopes to hit in order to give patients the nationally recommended level of care.

About 90 per cent of patients requiring triage Level III are supposed to get a first assessment by a doctor within a half hour. But during the time period April to October, that only happened for 25 per cent of the Level III patients at the Health Sciences Centre and St. Clare’s emergency departments. For Level IV patients, who are supposed to be first seen within an hour, the compliance rate for the target — which is 85 per cent — dropped to 23 per cent.

Patients falling into the triage Levels III and IV currently make up 91 per cent of visits to emergency departments at St. Clare's Mercy Hospital and the Health Sciences Centre.  

Level V patients did better in the waiting room.

According to benchmarks, 80 per cent of those cases are supposed to be initially assessed by a doctor within two hours. That happened for 40 per cent of Level V patients over the seven-month period.

For the triage Level I — needing immediate attention — and Level II — potential threat to life or limb or in need of quick medical intervention  —  Eastern Health says it monitors compliance with those benchmarks differently and  hasn’t had a problem hitting the benchmarks. Only seven per cent of ER visits fall into those triage categories. According to bench­marks, nearly all Level I patients are to be seen immediately and Level II are to be seen within 15 minutes.

The Telegram requested the statistics from Eastern Health last week, after the the Canadian Association of Emergency Physicians (CAEP) re­leased a new position paper on benchmarks and called for the public reporting of wait times as a way to tackle overcrowding in emergency rooms and the jam it causes for patients accessing care and hospital beds.

When it comes to getting people in and out of the ER — arrival to discharge — within the targeted five hours for 90 per cent of patients, Eastern Health achieved the goal in 74.6 per cent of cases.

For patients who are so sick a decision is made to admit them to hospital, 85 per cent are supposed to be placed in an inpatient bed within four hours. But during the time period April to October, that happened only 60.2 per cent of the time.

There are also goals for ensuring patients don’t leave the ER without getting seen by either a doctor or nurse practitioner.  

In all hospitals, Eastern Health aims for a target of only 3.5 per cent leaving because they don’t want to wait.

But in the city hospitals over those seven months, 6.8 per cent of patients did not stick around.

Pamela Russell-Mayo of Deer Park was one of those patients who got fed up, when she went to the Health Sciences ER one Friday evening this month. She’d fallen down an embankment while chasing after her puppy, which had sprung off the leash and bolted to a neighbour’s yard.

Russell-Mayo called her husband, a contractor, and they made the 40-minute drive to St. John’s. At 5:30 p.m. that day, the waiting room was crammed with patients and, Russell-Mayo said, she was in such discomfort, she kept standing up to try to relieve the pain in her ribcage.

She said she was triaged, sent for an X-ray after a few hours and eventually sent to the fast-track area — which is supposed to move certain patients through the system quicker — to await the results.  While there, she had to catch a nurse’s attention after feeling faint. But midnight came and the nurse told her the clinic was closed for the night, and she and another patient were sent back to the ER waiting area, according to Russell-Mayo.

Knowing her husband had to rise early the next morning for work and frustrated with the wait, she decided to leave.

“It was a complete waste of time for me to go in there,” Russell-Mayo said Monday.

“I don’t even know what they got (fast track for). And you always hear how good the Health Sciences is supposed to be.”

She eventually found out from a medical appointment that her ribs weren’t broken, but likely bruised.

At rural Avalon hospitals — Carbonear General Hospital, Dr. William H. Newhook Community Health Centre, Placentia Health Centre, Dr. A.A. Wilkinson Memorial Health Centre — 7.1 per cent of patients leave the ER  without seeing anyone.

But the ERs at the peninsula sites —  Bonavista Peninsula Health Centre, Burin Peninsula Health Care Centre, Dr. G.B. Cross Memorial Hospital, Grand Bank Health Centre and U.S. Memorial Health Centre — are beating the targets when it comes to getting patients to wait; only three per cent leave without medical attention.

Eastern Health bases its benchmarks on guidelines recommended by CAEP and National Emergency Nurses Affiliation.

According to CAEP, there’s no excuse for continued inaction on emergency room congestion.

Last week, CAEP released a paper that proposes hospitals should strive for the target of a median ER wait of one hour before initial assessment by a doctor, and that 90 per cent of the patients would wait no more than three hours for that initial assessment by a doctor.

Eastern Health has improved wait times at the Health Sciences Centre from a few years ago, cutting the average wait for an initial assessment by a doctor in 2012-13 by 17 per cent over 2010-13 and seven per cent at St. Clare’s.

The health authority said it’s like other hospitals around the country in its challenge to meet benchmarks. Some of the steps it has taken to improve the situation include hiring nurse practitioners for larger ERs, extending doctors’ hours at the city ERs, adjusting nurse and doctor scheduling to match peak demand and expanding the emergency department at St. Clare’s.

But when Russell-Mayo turned up at the Health Sciences Centre, she said, there as no option to see a nurse practitioner, and once midnight came, she was told there was just one doctor on for a room packed with patients.

According to Eastern Health, if patients cannot be seen in the fast track by the time the fast-track area closes — it operates 12 p.m. to 12 a.m. — they will continue to be seen in the emergency department based on their level of triage, so all patients who are waiting to be seen in the emergency department are waiting in the same area.

Health Minister Susan Sullivan told The Telegram in a statement last week the province has paid a lot of attention to improving the performance of emergency departments, and has received a copy of the position paper. Officials are currently reviewing it.