N.S. doctor prescribes fixes for ER system

A doctor asked to examine Nova Scotia's troubled emergency departments says there are 14 smaller hospitals across the province that should look at closing their ERs overnight.

In releasing his final report in Halifax on Tuesday, Dr. John Ross said he found emergency rooms at the smallest hospitals are seeing as few as one patient a night, and only one in 1,000 of those patients has a life-threatening medical problem.

"Patients are mostly actually coming during the daytime that's when they want to see someone and if we're losing part of our staff to the night shift when no one is showing up, then again, I think there's a mismatch there," Ross told reporters.

Ross said there were more than 795 days worth of closures across emergency departments in Nova Scotia last year. These unplanned, last-minute closures due to lack of doctors or nurses was one major reason why Ross was picked to review emergency care.

"Certain centres, they need to be open 24/7 for sure," he said.

"There are other places where I think we can offer some different options. Variable hours, different types of on-call systems through 811 and 911 to get people to the right place at the right time."

Ross said close to 90 per cent of visits to small emergency departments in rural areas involve health problems that can be treated in one-stop clinics, which can see patients through same-day or next-day appointments.

For that reason, the 85-page report recommends that 14 hospitals in Nova Scotia should look at a collaborative practice model, which would put doctors, nurses, nurse practitioners and paramedics, all under one roof.

Those hospitals are:

• Fishermen's Memorial Hospital, South Shore Health.
• Annapolis Community Health Centre, Annapolis Valley Health.
• Lillian Fraser Memorial Hospital, Colchester East Hants Health Authority.
• All Saints Springhill Hospital, Cumberland Health Authority.
• North Cumberland Memorial Hospital, Cumberland Health Authority.
• South Cumberland Community Care Centre, Cumberland Health Authority.
• Eastern Memorial Hospital, Guysborough Antigonish Strait Health Authority.
• St. Mary's Memorial Hospital, Guysborough Antigonish Strait Health Authority.
• St. Anne Community and Nursing Care Centre.
• New Waterford Consolidated Hospital, Cape Breton Health Authority.
• Northside General Hospital, Cape Breton Health Authority.
• Victoria County Memorial Hospital, Cape Breton Health Authority.
• Twin Oaks Hospital, Capital District Health Authority.
• Musquodoboit Valley Memorial Hospital, Capital District Health Authority.

Ross said the process toward a collaborative practice model is already happening at six of the 14 hospitals.

"As long as we can kind of give them a decision-maker and provide the emergency care, it's not necessarily through a doctor or a building," he said.

Reaction to report

Critics said the report is a way out of a promise made by the province's NDP government during the 2009 election campaign. At the time, Premier Darrell Dexter said he would keep all emergency rooms open around the clock.

"[Dr. Ross] has given them his seal of approval to close some of these smaller ERs on a regular basis," said Progressive Conservative health critic Chris d'Entremont.

The 26 recommendationsin Ross's reportalso focused on the need for better primary care, solutions to improve patient flow at larger hospitals and better service for seniors.

It was well received by others attending the news conference.

"Patients in this province need to have the access where they need it," said Doug Clarke, CEO of Doctors Nova Scotia. "That does not necessarily mean emergency rooms all over the province."

Joan Jessome, the president of the Nova Scotia Government and General Employees Union, said she was impressed that Ross advocated for solutions that do not involve job loss.

"I'm quite impressed with it, to be honest with you," she told CBC News.

"Whether [the ER] is closed or whether you're actually just reassigning the hours if you've got people working at night and there's no patients, why do you have it open?"

Health Minister Maureen MacDonald said she agrees a new model is needed, but the only promise she would make it to read the report carefully and consult with health authorities, doctors and other medical staff.