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ER closures: Not everything is black and white


Roseway Hospital in Shelburne. (Tina Comeau)
Roseway Hospital in Shelburne. (Tina Comeau) - The Chronicle Herald

When it comes right down to it, the emergency room departments at Roseway Hospital in Sandy Point and Digby General Hospital in Digby are never truly closed.

But in a true emergency, the first call should be to 911 regardless if the local ER is open or not.

“Our department, even though it’s called closed, it’s never locked,” said Jodi Ybarra, site manager for Roseway Hospital, in an interview.

“Sometimes when people hear ‘closed,’ they think it’s locked, lights are out, that sort of thing. That’s not the case. What happens is there’s still one registered nurse downstairs or in the department because there are still scheduled procedures that occur,” Ybarra says. “Although limited, there are still some people who come in for scheduled IV therapy or dressing changes, rechecks, those sorts of things that don’t require a physician to be there because it’s a standing order. So if someone presents and are not aware that we’re closed, they’re given the option to be triaged by the nurse.”

If someone is triaged when the ER is closed and it is urgent, the ambulance is called, and they are transferred to the nearest hospital, says Ybarra.

“So, the initial assessment is done, 911 is called and they get an ambulance from here. If it’s a true emergency, they say we’re calling 911. If it’s one where they could go by car, they’re given that option.”

In non-emergency situations the nurse on duty would recommend making an appointment with a care provider or going to the nearest outpatient department.

“We’ve had a number of people who we have had to ship when we were closed. It’s not an unusual occurrence,” Ybarra says. “We wouldn’t encourage someone to come in here if they really think they need urgent care and the reason is if you have someone having a chest pain and not feeling very well, you don’t want to waste the time to come in here to be assessed and then shipped. In those kinds of circumstances, you should be calling 911 from home regardless, whether we’re open or not.”

The same situation is true for Digby General Hospital, says Fraser Mooney, the Nova Scotia Health Authority (NSHA) public engagement and communications officer for the tri-counties.

“In Roseway and Digby, we still have nursing staff working from the emergency department when it is closed due to physician availability,” says Mooney. “However, this is not necessarily the case in all hospitals across the province. I understand some hospitals and collaborative emergency centres (CECs) may re-assign nursing staff to other units or departments during a physician-related closure. In these cases, the emergency department would be truly closed. It likely depends on the staffing model of each particular hospital or CEC.”

Mooney says the NSHA really doesn’t want people experiencing a medical emergency to show up at a closed emergency department.

“Staff are still working, and there is activity, but they are not able to treat patients without the full team present,” he says.

STAFFING A CHALLENGE

The predominate reason for ER closures is physician availability, and on a rare occasion it could be a nursing staff problem, as there are limited resources there too, says Ybarra.

The task to fill all the shifts can be 24/7 and come right down to the wire, as it did on Jan. 16 at Roseway Hospital, when coverage for the night shift wasn’t secured until 1 p.m. that same day.

“We had the closure notices all set up, and ready to hit send” when administrative assistant Collette Perham-Seaboyer heard back from a physician willing to cover, Ybarra says.

Ybarra says, generally speaking, Roseway Hospital has about 12 locums from throughout western Nova Scotia, as well as Halifax Bedford, to draw from to cover the ER shifts at the hospital. There are no local doctors in Shelburne County who practise emergency medicine anymore.

“We’re very fortunate to have the locums we have. We have a lot of great experience and a great group of locums that provide coverage here,” Ybarra says, noting these are independent practitioners who “have the choice of where they go to work.”

“There’s lots of places across the province that are closed and the fact that they chose to come here when they do is a huge bonus, but I can also tell you it’s a deterrent for them when they hear the negative press because why would you come to an area where you don’t feel appreciated.”

All staffing arrangements are done onsite by Ybarra and Perham-Seaboyer.

“It’s not people who are in other places doing the staffing. We do the staffing from this site. It’s not somebody from away that doesn’t care if we’re open or closed. Because it’s done locally we have a vested interest,” says Ybarra. “We are members of the community and we have families in the community. It’s not something we want to see happen ourselves. It’s not a good feeling when you live in town and hear an ambulance going and you know we’re closed.”

Finding doctors that do ER work is challenging, as it does require additional training.

“Not just anybody can be plunked down there and see everything that comes in nor would you want them to,” says Ybarra. “You wouldn’t want someone with no cardiac training seeing someone with a cardiac event, or a sick child to see a doctor with no pediatric training. The reality is there are closures in other places. We’re not unique. We’re doing what we can to get it covered.”

A busy day at the Roseway ER would see between 30 and 35 people registering for emergency visits, not counting the people who are coming in for scheduled treatments or people who might be admitted, says Ybarra. “The staff that do work down there do a great job.”

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