Overall N.S. emergency department closures double what they were 3 years ago

Nova Scotians who live in rural communities continue to bear the brunt of emergency department closures primarily because of a lack of doctors, nurses or paramedics, according to a new accountability report issued Thursday.

Overall, 15 hospitals outside metro Halifax recorded what the government calls temporary closures. These are times when hospitals are forced, because of a lack of staff, to close their emergency departments unexpectedly or at the last minute.

According to the report issued by the province's Health Department, those 15 emergency departments across the province were closed temporarily a total 15,056 hours, or 627 days, in the year ending March 31.

Seventeen of the province's 38 emergency departments were able to remain open 100 per cent of the time, but EDs were open about 9,000 hours less this past year than in 2019-20.

Scheduled or planned closures were much more common last year. Those shutdowns accounted for 54,272 hours of closure, more than triple the unplanned hours people would have been forced to seek help elsewhere. 

Health Minister Michelle Thompson said the pandemic would have played a part in that.

"Part of those closures were a reallocation of staff. Certainly COVID has impacted the amount of scheduled closures that we've experienced," said Thompson. "Reallocating staff to perhaps regional centres or into a COVID response team has contributed to that.

"I also think that when we lose primary-care providers, physicians in communities, we are better able to anticipate when emergency rooms will be open or closed."

Fewer facilities providing after-hours care

Four facilities that provided emergency after-hours care in 2019-20 did not last year, including All Saints Springhill Hospital, South Cumberland Community Care Centre in Parrsboro, Northside General Hospital in North Sydney, and New Waterford Consolidated Hospital.

The hospital in Springhill provided some walk-in care, but hours were reduced in the fall when staff was redeployed to COVID-19 response.

The facility in Parrsboro became a family medicine/general practice clinic and stopped overnight care. The Northside General Hospital became an urgent treatment centre providing care for those with unexpected, but non-life-threatening injuries. That care was not available overnight or throughout the weekend.

All four facilities had serious issues with unplanned closure in 2019-20. Together, they racked up a total of more than 7,200 hours of unplanned closures.

Smaller EDs struggle to stay open

While larger regional hospitals were able to keep their emergency departments open, several smaller community hospitals and collaborative emergency centres struggled. The emergency department at the Musquodoboit Valley Memorial Hospital, in particular, was open for 56 per cent of its expected operating hours.

Other facilities that struggled include:

• Victoria County Memorial Hospital (73 per cent).

• Eastern Shore Memorial Hospital (76 per cent).

• Strait Richmond Hospital (84 per cent).

The report blames the closures on "a combination of factors, including staff shortage, difficulty in recruiting in rural Nova Scotia and occupational health and safety, infection prevention and control and public health measures, resulting from the COVID-19 pandemic." 

Thompson said while there was no single solution to the problem, she believes Nova Scotians are ready to talk about might need to change.

"I think Nova Scotians know that we need to deliver care in a different way," she said. "I don't know what the future brings, but what I can commit to is that we are going to work with front-line health-care workers. We are going to work with community and we want to create those local clinical services plans that make sure people have access to the care they need, when they need it.

"And if it isn't offered in their community directly that we have very clear sightlines for them to understand how they access that care."

That's not to say Thompson has any plans to close any of the province's 38 emergency departments.

"No, I can't tell you that I have three or four emergency rooms in my mind that we are going to close." 

The report draws its data from records compiled by the Nova Scotia Health Authority and the IWK Health Centre. The emergency department closures occurred between April 1, 2020, and March 31, 2021.