Better emergency health care may mean big changes to current system

Modernizing the way emergency health care is delivered in Nova Scotia may mean overcoming traditional expectations of how the service should look, and a "frank, honest conversation" about the need for change, the CEO of the provincial health authority says.

"We have done a lot of really creative change in this province," Janet Knox said in a recent interview. And more is expected.

The introduction of nurse practitioners in communities that couldn't attract or keep family doctors and the creation of collaborative emergency centres, or CECs, in communities plagued by emergency department closures, are some of the changes, Knox said.

Those models of care are different from what people might traditionally expect, but in many cases they ultimately led to improved and more consistent care for communities, she said.

And that continues to be the goal, Knox said, which is to give people dependable care and get them what they need,  regardless of where they live.

"It's getting the patient to the right place with the right practitioner," she said, adding that goal may require introducing new ways of doing things."It can be so much better."

The challenges are coming at a time when closures continue to rise and some communities are hit especially hard. Continued discussions with local providers about what does and does not work, as well as open public consultation, will happen in the new year, Knox said.

"It can't be that the system just creates a solution and says, 'this is going to work for us.'"

CECs being explored for some sites

More collaborative emergency care centres — staffed by a doctor by day and a nurse and paramedic with telephone access to a doctor at night — are being considered. 

The health authority's 2017-18 business plan includes exploring the possibility of a primary health collaborative emergency centre at Lunenburg's Fishermen's Memorial Hospital, upgrades to the existing CEC at Twin Oaks Memorial Hospital and design work for New Waterford Consolidated.

Dr. David Petrie, the senior medical director of the emergency program of care, said better integration of all the emergency departments to create a single network will also help. 

It's time to have a conversation about how best to use the 36 emergency departments across the province so they are serving their communities in the most effective way, he said.

"It is an ongoing conversation that we must have with some honesty and candor."

Patient outcomes will continue to help define what's working and what's not, as will community input, he said.

Dr. Rick Gibson, the health authority's senior medical director of primary health care, said the province's emergency system begins as soon as EHS arrives at a call, a system that remains in place whether an emergency centre site is open or not.

And when a site is closed, it's almost always due to the unavailability of a doctor.

He said many of the doctors staffing community emergency departments are family doctors so the lack of doctors also affects the primary health-care system.

Improvements could have other benefits

The ability to attract and retain doctors to smaller communities outside urban centres continues to be a struggle,

"One of the things we find is a barrier to recruiting physicians in smaller communities ... is that there's only three or four doctors in town, that they're expected to be on call 168 hours a week, that they're expected to be able to staff that emergency department and deal with the heart attack when that patient walks through the door," Gibson said.

"We do hear, for some of the smaller communities, that expectation that you be all things to all people and you be an expert in everything is terrifying to some people coming out of their training."