Halifax Infirmary using conference room for emergency patients ‘to help relieve some of the pressures’

The Halifax Infirmary’s emergency department is so clogged with people seeking treatment, doctors and nurses are now seeing patients in a former conference room, says one insider, who compared the scene to a sinking ship.

“It’s basically adding more deck chairs to the Titanic,” said the staffer, who spoke on condition of anonymity.

“It’s almost like frontline medicine in a war zone.”

The hospital started using the former conference room last week.

“It’s not like a patient care room. It’s got no oxygen; it’s got no monitors or anything. They put a whole bunch of chairs in, and they put a partition in so you can do gynecological examinations behind a screen,” said the staffer.

“It’s in a room where they used to have conferences, and now they have a nurse and six chairs, and patients who don’t need to lie in a bed are pushed into the chairs.”

Pilot project 

Nova Scotia Health confirmed Tuesday that patients are being seen in a former conference room at the Infirmary.

“This is a pilot project to help with access and flow through the emergency department,” said Brendan Elliott, who speaks for the health authority.

The changes involve more than just a conference room, said Joanne Dunnington, interim executive director for the QEII Health Sciences Centre.

“There was a very large area that was just off the emergency department that we have been looking at to see how we can re-purpose it to help relieve some of the pressures both within the emergency department and the in-patient units,” Dunnington said.

“I don’t think it’s any surprise to anybody that we have a large number of patients in the emergency department and wait times to be seen can be quite lengthy, and we also have a lot of admitted patients that are waiting for beds in the hospital that are kind of backing things up.”

‘Quick treatment area’

The former conference room is being used as a “quick treatment area” for patients who likely won’t need admission to the hospital, Dunnington said.

In the first week, it was open for 12-hour days, and about 30 patients were seen in the area daily, she said, noting the idea is to treat folks, then send them home.

“That’s about 20 per cent of the patient volume that we would have had in the emergency department that we’ve been able to see in that space,” Dunnington said.

The hospital plans to open a large space adjacent to the former conference room on Wednesday that contains 16 beds, she said.

“That will actually house patients that are either requiring admission and waiting for that bed, to free up some emergency department space to continue to see those patients that need emergency care, or it could be an area where we know patients are getting ready to go home where they can be cared for,” Dunnington said.

‘Absolutely optimistic’

She’s “absolutely optimistic” the change will take pressure off the emergency department.

“I think this is very progressive and very patient-centred,” Dunnington said, noting it’s a “temporary solution.”

During initial discussions about the plan to use the conference room to treat patients, “there was a bit of skepticism and reluctance” among physicians and nurses at the emergency department, Dunnington said.

“But I think now that people have actually seen the space and seen it functioning, people are really pleased,” she said.

“People have been walking through it and are quite amazed at the transformation of it and how great it actually looks.”

Most Canadian hospitals are looking at using “unconventional spaces” for patient care, Dunnington said.

“I think that we’ve just seen the burden of disease and population growth – that it’s happened far faster than I think anybody had expected it to, and the pressures are being felt across the country.”

‘The crisis is constant’

Using the conference room “would be a brilliant idea to manage through a crisis,” said the emergency department staffer who didn’t want to be identified. “But the crisis is not a one off. The crisis is constant.”

The Infirmary’s emergency department has 44 beds.

“The beds are so full of admitted patients that there’s essentially no emergency department,” said the staffer.

“If you call an ambulance, you’ll either get seen in an ambulance hallway or you’ll be seen in a conference room because most of the beds are blocked with admitted patients.”

On Monday at about 4 p.m., the emergency department had 29 admitted patients and another 24 that had been referred for admission, said the staffer.

“There are nine in the ambulance hallway. So, there’s nowhere for the paramedics to offload their ambulances to. The patient who has waited the longest for admission has waited for 113 hours and 39 minutes.”

‘Disaster mode’

On Monday, the Halifax Infirmary’s score on the National Emergency Department Overcrowding Scale – a formula that takes in the number of emergency department patients, the number of emergency department beds, the number of hospital beds, the number of ventilators in use in the emergency department, the waiting time for the longest admission, the waiting room time of the last patient called to a bed, and the number of admits in the emergency department – was 354, “which is disaster,” said the staffer.

“It’s been in disaster mode for the last few months.”

There were 104 people in the emergency department on Monday at 4 p.m., “of which 44 are waiting to be seen and the longest wait has been six hours and 41 minutes,” said the staffer.

The first patient a doctor working Tuesday morning would see arrived at the hospital Monday night, said the staffer.

“People die in the ambulance hallway. Not every day.”

‘Disfunction in the emergency department’

One man died recently after waiting five hours in an ambulance hallway, said the staffer.

“And then the paramedics realized how sick he was. They moved him to the department and then he died, and the quality review is saying, ‘Well, it took them five hours to get his blood transfusion.’”

It took 40 minutes for the blood to get from the blood bank, said the staffer.

“It wasn’t 40 minutes; it was five hours and 40 minutes because they didn’t realize he needed it for five hours because of all the disfunction in the emergency department.”

The Infirmary’s emergency department used to empty by around 4 a.m., said the staffer, who has worked there for more than a decade.

“Now at four in the morning, there are usually 15 or 20 people waiting. The waiting room is completely getting overcrowded. If you try to walk into the waiting room, you’d just see it completely blocked up.”

‘Nurses have resigned’

As many as 60 doctors work at the Infirmary’s emergency department, as well as about 100 nurses, said the staffer.

“A lot of the nurses now are travel nurses because the vast majority of regular nurses have resigned.”

The backups place a strain on doctors as well, with many decreasing the amount of work they’re doing at the emergency department and trying to find other places to work.

The hospital has been trying to get in-patient floors to take patients in the hallways, said the staffer.

“And they are doing it. The pushback is that it’s not safe. And we’re saying it’s a hell of a lot safer than the people on the ambulance stretchers that haven’t even seen a doctor yet. At least the patient who is upstairs in a unit has seen a doctor, they have had their treatment started, (and) they’re stable enough that they’re not in (intensive care).”