Westover: Surely we can make hospital emergency departments work better

While we try to untangle the Gordian knot of the training and hiring of more family doctors, can't we make the current situation in the ER more palatable for all?

Published Sep 05, 2024  •  Last updated 0 minutes ago  •  3 minute read

More and more, Canadians are forced to go the emergency department, thanks to the family doctor shortage. Photo by Ashley Fraser /POSTMEDIA

A little over two years ago, or was it three — how time flies — my husband was doubled over with stomach pain. He was pretty sure the verdict was kidney stones, but was hoping for a definitive diagnosis and some pain relief.

Instead, he spent nine hours in the emergency room, gave up hope of being seen or provided pain management, and returned home with nothing but a back ache from an uncomfortable chair and a giant question mark about our promise of universal health care.

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Fast-forward to last weekend, and a neighbour’s experience was doubly bad.

Same health concern, same hospital, but this time an 18-hour wait to see a doctor (he didn’t quit midway), before being diagnosed and discharged with not much more than, “this too shall pass.” Literally.

Emergency rooms are no longer exclusive to matters of life and limb. New data released this month by the Canadian Institute for Health Information shows that ER visits shot up from 15.1 million in 2022-23, to 15.5 million in 2023-24.

This shouldn’t be surprising, given some 6.5 million people are unattached to family doctors. ERs are now also purveyors of primary care, with the same CIHI report showing the most frequent reasons for visiting include pain in the throat and chest, pelvic pain and abdominal pain.

Take my mom as an example. When her colitis acts up, she needs to make her way to an ER. She hasn’t been able to find a family doctor since hers retired five years ago. (She was informed via a letter in the mail. “It felt like a divorce,” she said.)

She’s tried walk-in clinics, but you need to arrive at sunup to be registered before the cut-off, usually at 8 am. Many such clinics are in strip malls, and offer no seating or protection from the elements before the doors open — not ideal for someone whose age begins with 8. Often, they only connect patients with doctors virtually, which means in addition to being inaccessible they provide limited diagnosis and prescriptions.

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Understandably, the ER becomes the de facto best (only) option.

Surely while we try to untangle the Gordian knot of the training and hiring of more family doctors, we can make the current situation in the ER more palatable for all involved — including the over-stretched health-care providers.

Shouldn’t there be a means for people to register their symptoms and get triaged online, via an app or health portal, and then be messaged or texted when their appointment time is approaching — let’s say within the next two hours? That’s a generous window to afford people time to arrive, while ensuring plenty of buffer so doctors and nurses aren’t left waiting on patients.

This would minimize viral contagion in the ER, it would allow people to arrive for their allotted time less frustrated, and it would create a generally better atmosphere in which to provide and receive care.

I realize that there are still lots of cases where people need to show up physically without a pre-check in.

Actual emergencies, for example. People who arrive by ambulance. Those without access to phones or with limited transportation.

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But surely the brightest minds in health care working together with tech-savvy coders could build a predictive algorithm that would allow people to sign up for care, wait for it patiently, at home, and make their way when it’s their turn.

(My husband’s barber shop does this. So do restaurants that give you a buzzing coaster. I feel like it’s within reach, you know?)

At the very least, we should provide online wait-time trackers, like the one launched in 2019 by St. Joseph’s Healthcare Hamilton and Hamilton Health Sciences. Researchers found that when the average wait time increased by an hour, patient volume would drop by 10 per cent. And that’s because ERs are no longer purveyors of exclusively urgent care.

Maybe it’s time to meet the moment, rather than keep wishing things were different.

Suzanne Westover is an Ottawa writer.

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