Paramedics push a gurney toward an ambulance outside a Toronto hospital on Jan. 5. Chris Young/The Canadian Press
The health-care staffing crisis and a new wave of COVID-19 are pushing Canada’s emergency rooms to the brink, with wait times reaching new highs and several hospitals recently being forced to temporarily close their emergency departments.
The Canadian Press spoke with emergency physicians across the country, who discussed what patients should consider before seeking emergency care and why, for some patients, the emergency room is still one of the only options available.
What should patients consider before seeking emergency care?
Despite the pressures hospitals face, it’s critical that no one feels dissuaded from visiting the emergency department when they need urgent medical care, said Dr. Lucas Chartier, associate medical director of the emergency department at the University Health Network at Toronto.
There is no blanket guideline of when and when not to go to the emergency room, as each patient has their own unique considerations.
Doctors usually say to seek emergency care for acute conditions, such as severe shortness of breath or severe uncontrollable bleeding. Mild aches and pains or a fever and sore throat can often be referred to less urgent care, doctors said.
The emergency department will treat the most urgent problems first, Chartier said, meaning that “some patients who perceive their illnesses as significant may be out of touch with the other problems we need to deal with, leading to more longer than expected waiting time.”
“People’s understanding, understanding and empathy is really important here,” he said.
Dr. Tanya Munro, chief of emergency medicine for the northern zone at the Nova Scotia Department of Health, said schools can provide more effective health literacy education so that people ultimately feel more confident. that they manage their own fortunes.
“That being said, if you are seriously ill, injured or very, very concerned – we will always be there to see you,” she said.
What are some alternatives if a trip to the emergency room can wait?
Dr. Bill Sevcik, chair of the department of emergency medicine at the University of Alberta, encouraged patients who are unsure where to seek help to call a telehealth hotline, which can be done in several provinces by calling 811 Helplines are often staffed by nurses who can provide health advice and connect patients to other services.
Some patients also have access to urgent care centers, which are designed to provide same-day care in urgent but non-life-threatening situations.
And then there are the “lucky ones,” Shevcik said, who have easy access to a primary care provider.
Canada ranked last when it came to timely doctor appointments among a survey of 11 countries, including parts of Europe, the United States and Australia. About 41 per cent of Canadians said they could make a same-day or next-day appointment with a doctor or nurse, according to a 2020 Commonwealth Fund survey. Only Sweden ranked lower at 38 per cent, while the Netherlands and Germany led the list .
In Nova Scotia, where about 100,000 people are waiting to see a family doctor, Munro said she has interacted with patients who have sat in emergency rooms for 18 hours with a minor illness or chronic condition because it would take six weeks for to see their family doctor.
“There is absolutely no way” to solve the problems in emergency rooms, Munroe said, “unless we can improve patient access to all types of care.”
What about virtual care options?
The pandemic has seen a spike in interest in virtual care options.
A group of Toronto hospitals, led by the University Health Network, teamed up in December 2020 to launch a virtual emergency room service for adults in Ontario with non-life-threatening injuries, such as rashes or sprains.
It’s the same emergency doctor the patient would otherwise see in the hospital, except it’s via video call or over the phone. A virtual call works much the same as a regular emergency room visit: the doctor can send prescriptions to the patient’s pharmacy, schedule an appointment with a specialist and, if necessary, refer the patient to an in-person emergency room.
The virtual platform helps increase access to emergency care, including for immunocompromised patients seeking to avoid overcrowded emergency rooms, Chartier said.
And while Chartier said it’s a system worth expanding, he said it needs to be integrated with primary care providers to ensure patient care extends beyond the virtual emergency room.
Telus, Tia Health and Rocket Doctor are among a growing list of virtual care platforms that offer free doctor appointments for those covered by public insurance in a number of provinces, including British Columbia, Ontario and Alberta.
But while virtual platforms have been touted by some as a useful stopgap for primary care backlogs and access issues, family physicians have also criticized them as a poor substitute for consistent, long-term relationships with family physicians.
When should patients seek emergency care?
Chartier said there are a number of obvious reasons to visit the emergency room, such as broken bones or uncontrollable bleeding. But in general, patients should consider emergency care when symptoms become severe — whether it’s severe shortness of breath or severe dehydration or excruciatingly severe headaches.
He said patients should also be aware of any major change in the ability to speak or move, as well as sharp changes in their level of consciousness.
But all three doctors stressed the importance of not judging patients who arrive at emergency rooms with seemingly non-urgent conditions.
“We are the safety net for a range of people: those who don’t have access to care, those who don’t have any insurance, those who are vulnerable and marginalized, those with substance use and mental health disorders who are otherwise not followed by teams or may not have access to them for a number of reasons,” Chartier said.
“We are proud to play this role. These are patients that we know are not being served in other ways. And we’ll always welcome them with open arms because that’s what we do.”
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