Unplanned ER closures spiked in Nova Scotia in 2022-23: report

Nova Scotia emergency departments were closed for more than 79,000 hours collectively in 2022-23, and over half of these closures were unplanned, according to a new report.

The Health Department’s annual emergency department accountability report for the fiscal year was released Thursday, providing detailed metrics about each hospital in the province and how their ERs performed.

The results show closures, both scheduled and temporary, increased across the province over the previous year, as hospitals continue to grapple with physician and nursing shortages.

There were a total of 79,813 closure hours in Nova Scotia’s 31 emergency departments between April 1, 2022 and March 31, 2023.

Just over half, 53 per cent, were temporary or unplanned closures, which happen when a facility suddenly does not have enough health-care professionals to remain open.

Nineteen of the province’s 31 ERs had to close their doors temporarily for a total of 41,923 hours due to lack of available staff. This represents a 32 per cent increase in unplanned closure hours compared with the previous year, although the department cautions against comparing the two years’ closure data due to the fact some emergency departments have been shifted into urgent treatment centres. The urgent treatment centres data is not included in the report.

Health Minister Michelle Thompson said the main culprit for closures is staffing. Nova Scotia hospitals, like health facilities across the country, have been struggling to recruit enough health workers to keep ERs open and wait times down.

However, unlike some other provinces, there were no closures of the larger regional or tertiary hospitals in Nova Scotia, Thompson noted.

In communities where closures have been necessary, types of staffing shortages can vary, which is why each community requires a tailored response, she said.

“Perhaps it’s a physician shortage in one community, perhaps it’s a nursing shortage in another community, so we were working very, very intentionally, in communities, working with community recruitment groups.”

Wait times in emergency departments were also up, the report shows.

Overall, the average emergency department wait time was 2.8 hours, which is a 22 per cent increase from last year’s average time of 2.3 hours.

Waiting times at the IWK children’s hospital emergency department went up by over 33 per cent to two hours.

Increases were also observed in the number of patients who left emergency rooms without being seen by a physician. A total of 3,678 patients to the IWK, or 8.6 per cent of IWK emergency department visits, left without seeing a doctor. This is almost double the percentage from last year.

Of the 530,143 patients who visited all the other emergency departments in the province, 10.4 per cent left without getting a physician’s care, which is also up from last year’s 8.2 per cent.

The report also shows the children’s hospital saw a significant increase in overall emergency department visits. In 2022-23, there were 42,653 visits to the IWK, a 30 per cent increase from the previous year.

There were a total of 530,143 visits at all other ERs, which represents a 0.4 per cent increase from the previous year.

Again, comparison of these figures must be done with caution as the number of emergency departments decreased over these two fiscal years, with some being converted to urgent treatment centres, the Health Department warned.

Thompson said this shift in the model of care has been one step the province has taken to try to reduce pressures on emergency rooms.

The province has also expanded access to virtual care, opened mobile health clinics and established clinics run by pharmacists, who can treat and prescribe for minor ailments.

It is also working to address the growing number of elders in hospitals waiting for spaces in nursing homes, occupying beds needed for emergency patients who must be admitted.

“We’re looking first at ways in which we can provide access points for people across the province in order to access care that they would maybe typically seek in emergency room care,” Thompson said Thursday.

“(But) it really is not just one thing, we have to look at it as a system. We have to look at how all of the initiatives are leading to better experiences and wait times in our emergency departments.”

Nova Scotia NDP Leader Claudia Chender said the report highlights serious issues facing the province’s emergency care system that need urgent attention.

“The Houston government has chosen to focus on one-off announcements rather than making sure our health-care system works,” Chender said in a news release.

“People deserve to know that the emergency care they need is available when and where they need it.”