Paramedics push a stretcher towards an ambulance outside a Toronto hospital on January 5. Chris Young/The Canadian Press
A health-care staffing crisis and another wave of COVID-19 are pushing emergency departments across Canada to the limit, with wait times reaching new highs and several hospitals recently forced to temporarily close their emergency rooms.
The Canadian Press spoke with emergency physicians across the country who discussed what patients should consider before seeking emergency care and why, for some patients, the emergency room is still a the only options available.
What should patients consider before seeking emergency care?
Despite the pressures hospitals face, it’s critical that no one be deterred from visiting the emergency department when they need urgent medical care, said Dr. Lucas Chartier, assistant chief medical officer for emergency departments at the Network of University of Toronto Health.
There is no one-size-fits-all guide to when or not to go to the ER, as each patient has their own unique considerations.
Doctors generally say to seek emergency care in acute conditions, such as severe shortness of breath or severe uncontrollable bleeding. Minor aches and pains, or fever and sore throat, can often be directed to less urgent care settings, doctors said.
The ER will deal with the most pressing issues first, Chartier said, meaning that “some patients who perceive their illnesses as important may not be relevant to the other issues we need to deal with, which leads to time longer waits than expected.”
“This is where people’s understanding, understanding and empathy is really important,” he said.
Dr. Tanya Munroe, head of emergency medicine for Nova Scotia Health’s northern region, said schools could provide more effective health literacy education so people can feel safer d ‘self-manage your conditions.
“That said, if you’re really sick, hurt or really, really worried, we’ll always be there to see you,” he said.
What alternative options are there if a trip to the emergency room can wait?
Dr. Bill Sevcik, chair of the department of emergency medicine at the University of Alberta, encouraged patients who are unsure where to seek care to call a telehealth hotline, which can be done in several provinces by calling to 811. Telephone hotlines are usually staffed by nurses. who can provide health advice and connect patients to other services.
Some patients also have access to urgent care centers, which are meant to provide same-day care in urgent but non-life-threatening situations.
And then there are the “lucky ones,” Sevcik said, who have easy access to a primary care provider.
Canada ranked second for timely doctor appointments among an 11-country survey that includes parts of Europe, the US and Australia. About 41 per cent of Canadians said they could book a same-day or next-day appointment with a doctor or nurse, according to a 2020 Commonwealth Fund survey. Only Sweden ranked lower at 38 per cent, while the Netherlands and Germany topped the list.
In Nova Scotia, where about 100,000 people are waiting to find a family doctor, Munroe said he has interacted with patients who sat in emergency rooms for 18 hours with a minor illness or a chronic illness that would take six weeks see your family doctor.
“There is absolutely no way” to address the problems in emergency departments, Munroe said, “unless we can improve patient access to all types of care.”
What about virtual care options?
The pandemic has seen increased interest in virtual care options.
A group of Toronto hospitals, led by the University Health Network, joined forces in December 2020 to launch a virtual emergency department service for Ontario adults with non-life-threatening injuries, such as rashes or sprains
It’s the same emergency doctor that a patient would otherwise see in the hospital, unless it’s by video call or phone. The virtual call works the same way as a regular ER visit: the doctor can send prescriptions to the patient’s pharmacy, make an appointment with a specialist and, if necessary, direct them to an in-person emergency room.
Chartier said the virtual platform helps increase access to emergency care, including for immunocompromised patients looking to avoid crowded ERs.
And while Chartier said it’s a system worth expanding, he said it should be integrated with primary care providers to ensure patient care extends beyond virtual ER
Telus, Tia Health and Rocket Doctor are among the growing list of virtual care platforms to offer free doctor appointments for those covered by public insurance in several provinces, including British Columbia, Ontario and Alberta.
But while some have touted virtual platforms as a useful solution to primary care access and access issues, family physicians have also criticized them as a poor substitute for consistent relationships and long term with family doctors.
When should patients absolutely seek emergency care?
Chartier said there are a number of obvious reasons to visit the ER, such as broken bones or uncontrollable bleeding. But in general, patients should consider emergency care when symptoms become severe, whether it’s shortness of breath or severe breathing, severe dehydration, or an excruciatingly severe headache.
He said patients should also be aware of any serious changes in the ability to speak or move, as well as acute changes in their levels of consciousness.
But all three doctors stressed that it was important not to judge patients who arrived in emergency rooms with seemingly non-urgent conditions.
“We are the safety net for a range of people: those who can’t access care, those who don’t have any insurance, those who are vulnerable and marginalized, those who suffer from substance use and mental health disorders that d ‘otherwise they are not tracked by teams or you may not be able to access them for various reasons,’ said Chartier.
“We’re proud to play that role. These are patients who we know are underserved in other ways. And we’ll always welcome them with open arms, because that’s what we do.”
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