Inside ERs at a breaking point, staff provide care while juggling shortages and closures

It is 6:30 am and part of the Emergency Department at Kingston General Hospital will be closed for the day. The lights go out so the patient can sleep, but one by one, they wake up and say they’re being moved.

Monica Griffin, a nurse in charge at the Ontario hospital, the trauma center for about 500,000 people in the area.

Reason? There are not enough staff to keep Area C – reserved for the least ill patients – open for day shifts. They lack two nurses, so the patient needs to be transferred elsewhere in the ward.

“It’s always been like this – or worse,” says Griffin.

Persistent and pervasive staff shortages in the healthcare sector mean that even a large urban hospital like Kingston is affected. Many doctors and nurses across Canada have been calling for help for months, as the COVID-19 pandemic overwhelmed resources they say have been stretched – leading to an unprecedented wave of staff shortages. which they say is reaching a breaking point.

According to Ontario Health, 18 hospitals in the province have had their emergency services interrupted since the end of June, most often on night shifts due to a shortage of nurses.

About 46,000 additional hospital workers need to be hired in Ontario just to address staff turnover, hospital hiring, as well as the impact of the pandemic and the growing needs of an aging population and increasing, according to Ontario Hospital Union Council/ Cup.

VIEW | A hospital in Kingston, Ont., addresses staff shortages:

The juggling act of a hospital that takes care of patients with insufficient staff

Widespread healthcare staff shortages have forced the Kingston Health Science Center to shuffle patients between departments, sometimes closing an area of ​​the emergency department and treating people. in the hallway. CBC News chief correspondent Adrienne Arsenault witnesses the damage it has done to staff and patients at the Ontario hospital.

Meanwhile, the average waiting time of the emergency department in the province is currently 20.7 hours for hospitalized patients.

When Nation visiting, Missy Calbury, 27, has spent about 20 hours in the hallway in Block C and is awaiting surgery for her broken ankle. She said she didn’t realize how busy the hospital would be, until she came and witnessed it with her own eyes.

“I really couldn’t sleep, people walking by, always getting in people’s way…. I like being in a room, that’s for sure,” she told CBC News. “They definitely need more people.”

Hospitals of all sizes impacted by staffing challenges

Kingston Health Science Center is the largest acute care academic hospital in southeastern Ontario, consisting of two hospitals (including Kingston General), a cancer center and two research institutes.

Dr David Messenger, chief of emergency medicine at KHSC, notes that despite the hospital’s size, it is not without its staffing challenges facing hospitals across the province and Canada. face.

“A nurse sometimes makes the difference to our ability to operate,” Messenger said.

Image of a man in scrubs and mask in a hospital corridor.
Dr David Messenger, head of emergency medicine at the Kingston Health Science Center, is pictured last month in the emergency department. He noted that there are backlogs for patients throughout the healthcare system that all culminate in the hospital emergency room. (Yanjun Li / CBC)

Rural hospitals, where staffing margins are often thinner, may be hit harder by this shortage.

In Chesley, Ont., a small community in Bruce County, the local hospital was forced to indefinitely close its three-room emergency department overnight, from 5 p.m. to 7 a.m., due to medical staff shortages. dozen. Sometimes, the emergency department is also closed for the day.

When the hospital is closed overnight, any patients inside who need emergency care will be seen. But as emergency and family physician Dr. Jacquie Wong says Nationunfortunately at 5 p.m., “anyone who goes to the emergency room for care won’t get it.”

The hospital provides a list of emergency departments closest to Chesley to residents. The nearest facility is in Hanover, 19 km away.

“If it’s urgent, we’ll call an ambulance for them,” Wong said.

But she says the need to access 24-hour urgent care is especially important in a small community like this, because people can’t plan for emergencies.

Two women stand outside a hospital.  One is exfoliating.
Jacquie Wong shows Adrienne Arsenault a sign to close the emergency room overnight in Chesley, Ont., in August. (CBC)

“We’re a big community of farmers, so there’s a lot of machinery involved, so you can have a big accident. Plus, you know… heart attack or stroke or problems. about breathing,” she said. “If you can’t breathe and you have to go another half hour, that’s horrible.”

Although local nurses have had to work more shifts since the start of the pandemic, over time, “that will take its toll,” Wong said, and then they “can’t afford to continue.” close to those people.”

Amid the pressure, Wong said, “we care, we want to provide care and we’re doing our best.”

VIEW | In Chesley, Ont., ER struggles to stay afloat:

Rural ER is struggling to stay open 24/7 and the staff doesn’t stop caring

The overwhelming staffing pressure on Canadian hospitals has forced some hospitals to temporarily close their emergency rooms. National spent a day with staff at Chelsey, Ont., hospital until the point they had to close the emergency room overnight because of staff shortages.

‘We knew this was coming’

Messenger says there are backlogs for patients throughout the healthcare system that all culminate in the hospital emergency room.

“There’s really nowhere to take (patients) because all the beds upstairs are full and many of the beds upstairs are full because people need to go elsewhere for care in the community with no space left. . So everyone wait and have this series of progressive barriers to move efficiently and effectively through the system.”

The current situation, he said, has been going on for a long time.

“We knew this was coming… emergency doctors and nurses and organizations across Canada were warning that this was coming,” he said.

“The system has not provided the necessary resources for a long time”

Messenger points to the fact that patients are getting older, which means they have more complex medical needs and people are getting sicker. Many people may not have a family doctor. And, he notes, the mix of what they’re seeing in the emergency department is changing — including mental health needs and an increase in patients with substance use disorders.

“We’ve really become the door to healthcare for a lot of people who can’t get to it any other way,” Messenger said.

A man and a woman stand in the hospital corridor.  The man is exfoliating and talking to the woman.
Messenger talks to Arsenault at the emergency department in Kingston. According to him, the current health care situation has existed for a long time. (Yanjun Li / CBC)

A whole system is under stress

Dr David Pichora, president and CEO of Kingston Health Science Center, says a combination of several factors – including staffing shortages, unmet need for care in the community community and deferred care due to the pandemic – which means the entire system is under strain. .

“Our ICU was packed for months, months and months,” he said.

ICU program director Julia Fournier says her stressful staff often have to look for opportunities to try and “double” patients, a nurse-to-two patient ratio . Sometimes they “triple,” which, she said, is unheard of in intensive care, where the ratio is often one patient to one nurse.

Right day Nation visited the unit, it had about half of the staff they needed.

Kingston General Hospital is seen from a drone on December 15, 2021. The hospital’s intensive care unit has been ‘packed for months, months and months’, Dr David Pichora, president and CEO of the Kingston Center for Health Sciences, said. (Patrick Morrell / CBC)

“I know nurses who provide great care, but it’s stressful for them,” says Fournier. She worries to see her team struggling “because of the emotional trauma and moral stress. They’re tired. They’ve been through a lot with the pandemic.”

In addition to the occasional and temporary closure of a section of the emergency department, KHSC also had to limit the number of patients they see at the Urgent Care Center at the nearby Dieu Hotel Hospital to ensure there is no shortage of patients. enough doctors and nurses. keep their emergency department running.

Pichora notes that their Urgent Care Center is popular because people can come in without an appointment, see a doctor or nurse; and if blood tests, X-rays or CT scans are needed, it’s done right away. Many people go to their Urgent Care Center who has a family doctor in the community, but can’t get an appointment in time or need testing sooner than they can get them into the community, he explained.

Pichora says the Urgent Care Center is “a bit of a victim of its own success,” Pichora says it’s pretty busy because it’s efficient and convenient for patients. This is a model to consider expanding further, he said, as governments consider how to redesign care in community health groups in the province.

‘We’ll take care of you’

Organizations like OMA and CMA are calling for systemic solutions to ease the strain on hospitals.

These include increasing the number of healthcare workers through strategies such as licensing more overseas-trained doctors and creating national physician licenses.

They also want to improve access to primary care, centers for patients with less complicated surgery, better long-term care and home care systems for the elderly, more More hospice and palliative services, more resources for mental health needs and substance abuse issues, and continued work on digitizing health data and facilitating epidemics more virtual care.

Messenger said that while it has been working to find efficiencies in hospitals, at this point the problems are so large that they really need broader system-level solutions, and “the change in legislation will enables an enhanced range of practice for different types of care providers.”

“We’re emergency doctors, aren’t we? We’re action-oriented people and we like quick solutions, and we want to move on to the next thing and solve the problem,” he said. .

However, Messenger wants to reassure people that despite the challenges, they will be there for those in need.

“People need to be aware that it’s not like the system of 10 years ago…. There will be less urgent incidents. But we’ll take care of you. We’ll take care of you.”


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