Backlogged ER at Cape Breton Regional Hospital becoming more common

A backlogged emergency department is becoming more common at the Cape Breton Regional Hospital, the physician in charge of emergency care says.

Last week, a code census was declared at the hospital, which happens when an ER becomes so full patients can't get admitted to hospital.

"It gets to the point where somebody arrives in an ambulance and we're really struggling to find a space for them," said Dr. Chris Milburn, chief of emergency care. "We have had several episodes over the past few months."

Milburn said he sees two causes for the backlogs.

One is patients who could be discharged to a nursing home but there is no space for them there. The other is patients who don't have a family doctor, or their family doctor doesn't do hospital work.

"There's been a change over time where more family doctors are not looking after inpatients any more," he said. "They're confining their practice to the office."

Empty beds in Glace Bay, North Sydney

Milburn said the Cape Breton Regional has developed a hospitalist service with doctors who exclusively look after patients in hospital. Now he said the health authority is trying to establish that service model in North Sydney and Glace Bay.

"On numerous occasions we've had empty beds in Glace Bay hospital or North Sydney hospital," he said. "Patients from those communities [are] coming to Sydney and having to wait in our ER because there's no beds in Sydney. But there's no doctor to look after them in their home community."

Milburn said sometimes emergency department physicians are not able to see patients waiting in the ER due to space.

"There is no place to put them, so it's really distressing for us," he said.

Brett MacDougall, the director of emergency care for the eastern zone, said when a code census is called, it triggers action such as contacting community partners, home care and VON.

"We get into a whole review of the patient population to see if there are any barriers to discharging patients," he said.

As well, there are a number of inpatient units that have over-capacity beds so patients are moved into those areas, he said.

MacDougall said it's difficult to predict how often code census will be called in the future, especially in Cape Breton with its growing elderly population with more multiple conditions.

Both Milburn and MacDougall asked that people going to the emergency departments be patient.

"When you work in the system," said Milburn, "you realize that the problems in ER are a reflection of other problems in the system."