N.S. health minister looks to maximize services for rural communities

With recent changes related to available services in North Sydney and Parrsboro, Nova Scotia's health minister says consideration must be given as to how best to meet the health-care needs of communities.

The Northside urgent treatment centre has been operating in North Sydney for a little more than a month and a similar facility is scheduled to open soon in Parrsboro. The centres replace models that struggled to stay open and provide same- and next-day appointments for unexpected but non-life-threatening conditions.

In a recent interview, Health Minister Michelle Thompson said she and her team are watching early results to see if similar models could help other communities that are underserved. She noted that early reviews from Northside are positive.

"I think we have to be agile. We're not used to that," said Thompson, who worked as a nurse and an administrator in long-term care before entering politics.

"I think we've kind of had a way of moving forward and I think that's part of the challenge that we're facing."

Small patient turnout at many EDs at night

Challenges abound in Nova Scotia's health-care system, as they do across the country. Of note in rural communities is service availability, something that can be affected by a provincewide issue: staff availability.

It's for that reason Thompson and officials from her department and the provincial health authority are taking a look at data for community hospital emergency departments.

From April 2018 to this past September, half of the community emergency departments in Nova Scotia averaged fewer than two patient visits while open between the hours of 7 p.m. and 7 a.m. The information was provided to CBC News by Nova Scotia Health.

The sites in question are:

• All Saints Springhill Hospital — 1.7 visits.

• Annapolis Community Health Centre — 1.6 visits.

• Buchanan Memorial Community Health Centre — 1.5 visits.

• Eastern Memorial Hospital — 1.5 visits.

• Eastern Shore Memorial Hospital — 1.5 visits.

• Guysborough Memorial Hospital — 1.8 visits.

• Lillian Fraser Memorial Hospital — 1.4 visits.

• Musquodoboit Valley Memorial Hospital — 1.2 visits.

• North Cumberland Memorial Hospital — 1.4 visits.

• Northside General Hospital — one visit.

• South Cumberland Community Care Centre — 1.4 visits.

• St. Mary's Memorial Hospital — 1.5 visits.

Some of the 24 community hospitals on the list, such as the Northside General Hospital, no longer function as traditional emergency departments or no longer offer after-hours services. Others are subject to regularly scheduled and unscheduled closures because of staff availability.

Understanding why people go, what they need

Only four sites — Queens General Hospital (8.8); Digby General Hospital (9.1); Hants Community Hospital (11.6); and Soldiers' Memorial Hospital (13.7) — averaged about nine or more patient visits during the period in question.

Thompson said that as the information is being evaluated, it must be placed in context beyond visit numbers. It's important to understand why people are attending the emergency department in the first place, she said.

"When people don't have any alternatives, we know that the emergency rooms is where people have to default to," she said.

"There may be 20 people that use those every night, but does that mean that we actually need more primary care in the community at different times of the day?"

The provincial government recently expanded access to virtual care to everyone on the wait-list for a family doctor or nurse practitioner.

The best use of workers

Nova Scotia Nurses' Union president Janet Hazelton said the early reports she's hearing about the urgent treatment centre model are positive. Nurses enjoy working there and patients are thankful not to have long waits for treatment, the way they might in a traditional emergency department.

Hazelton said keeping non-emergencies out of emergency departments is an ongoing challenge and options such as the urgent treatment centre are one way to do that, as long as the necessary staff are available.

Because there's a finite amount of people to draw from, there needs to be a critical look at utilization, said Hazelton.

"If there's only two people or no patients being seen, is that a good use of our resources?" she said.

"We do know we have a nursing shortage and so we need to be using nursing personnel to the best of our ability. We need to make sure we're utilizing all health-care workers, for that matter, appropriately."

Consultation, communication key

As options are considered, Thompson said communities must be kept informed and involved from an early stage so they understand what's happening, why it's happening and what it means. That includes helping communities understand how they'll continue to be able to access emergency services when they're required.

"It's really important that as we move forward, we do community engagement sessions so people can understand, one, what the data is and what it's telling us, and two, how do we change systems so that they're responsive to the needs of the community," she said.

"I feel that if we are very transparent and we include people in those discussions and give people some agency over some of the services they have in their community or surrounding areas, it will help us move forward."