Canadian Emergency Doctors Urge Solution of Staffing Crisis

Overcrowding of patients and staff shortages are causing conditions to worsen in emergency departments across Canada, and the crisis requires immediate action, according to the Canadian Association of Emergency Physicians (CAEP).

“Governments and hospital leaders must be accountable and responsible now; They must use their authority to stabilize and rebuild the capacity of our emergency medical safety net before we effectively do not have one,” the association warned in a statement.

Record-high hospital occupancy, patients’ inability to find care in the community, and a critical shortage of healthcare personnel are “evidence of a severely stressed [healthcare] system that is only exacerbated by the COVID-19 pandemic,” according to the CAEP.

The organization calls on governments, hospital administrators, physicians and healthcare personnel, their unions, and associations to work together to provide Canadians better emergency department care.

Emergency Departments Closing

The situation in emergency departments “is continuing to worsen in a dramatic way across the country, and the CAEP is asking all leaders — administrators and healthcare worker associations — to come together urgently to start improving it,” Atul Kapur, MD, CAEP’s co-chair of public affairs, told Medscape Medical News.

“We need to start stat,” stressed Kapur, an emergency physician at the Ottawa Hospital in Ontario. “We’ve seen that nationwide in the last couple of weeks, a number of emergency departments are closing.”

Hospitals are overcrowded in large part because there are no places for patients to go when they no longer need acute care, Kapur explained. In addition, more patients are showing up in the emergency department because they do not have a family doctor and have difficulty getting outpatient diagnostic tests or home care service.

Patients in the emergency department who are to be admitted to the hospital might be waiting for a bed to become available, and the patients who no longer need acute care might be waiting for a place to be discharged to.

Under these stressful working conditions, “we’re losing staff in record numbers across the country,” said Kumar. The emergency department “is a tough place to work, especially for our nurses, compared to other places.” The difficulty has been heightened by the COVID-19 pandemic.

The CAEP has been calling for solutions to this critical situation for decades, he said. “The best time to fix this was 10 years ago, and the second-best time is today.

“If you don’t start on the solutions,” Kumar noted, “things are just going to get worse. You need to start on solutions [such as] training more workers and finding ways to perhaps improve recognition of credentials of those who’ve trained elsewhere.”

Many emergency department workers have been leaving their jobs recently for various reasons. “Emergency nurses, more than anyone else, are subject to verbal and physical abuse from patients and families and don’t always get the protection and support they need from the hospitals,” Kumar noted.

“And in Ontario, the government has legislation to limit their wage increase to 1%. All of that adds up,” he said. “So, nurses are not only feeling stressed, they’re also not feeling recognized for what they’re doing, other than occasionally being called heroes.”

The CAEP statement describes the following factors as contributing to the current situation:

  • People may not have timely access to primary care, community-based specialty care, and diagnostic testing.

  • Patients are arriving in the emergency department in record numbers with more advanced disease.

  • The crowding of patients in emergency departments causes long waits and delays in hospitalization and has adverse effects on quality of care; the effects are more pronounced for vulnerable patients (eg, those with mental health problems or addiction).

  • Offloading patients from ambulances may be delayed, which ties up ambulances that could be going to their next call.

  • Staff are experiencing more burnout, moral distress, and absenteeism.

  • Emergency departments are closing across the country. Closures primarily have been in rural regions, but even urban centers are now affected because of staffing shortages.

To solve this crisis in emergency departments, the CAEP is asking governments and administrators to implement policies to achieve the following goals:

  • Improve community and long-term care.

  • Develop a hospital bed capacity to better meet current needs (Canada has one of the lowest beds-per-capita ratios among member countries of the Organization for Economic Cooperation and Development).

  • Develop a national human health services strategy.

  • Manage the health and well-being of emergency department frontline workers.

  • Address escalating workplace violence.

Policy Recommendations

The Canadian Medical Association, in partnership with the Canadian Nurses Association and the College of Family Physicians of Canada, issued a joint statement in May in which they offered solutions to immediately address the healthcare crisis in Canada.

“With more health workers burning out and leaving their professions, the system has reached a point where immediate action is needed to prevent total collapse,” the organizations said.

The joint plan “offers immediate, medium, and long-term policy recommendations for the federal government to adopt and collaborate with its provincial/territorial counterparts.”

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