The Canary in the Coal Mine
- Coralee Sonnenburg
- Jul 17, 2018
- 4 min read
Future Trends in ED Nursing
Throughout this course I have learned about foundational principles of the Canadian healthcare system. I have taken the to opportunity to learn about how these principles apply to my practice as a nurse in the emergency department. Reflecting on what I have learned, I examined the future directions of healthcare in Canada and questioned what issue would have the most profound impact on my practice in the ED. Does fear of mass shootings make exciting advances in combat medicine to future of ED medicine? Or perhaps technological innovation in medicine like portable ultrasound diagnostics or the use of wearable personal health technologies are the future. Will advances in paramedicine in Ontario with outreach paramedicine programs play a key role in my future practice as an ED nurse? As a registered nurse, perhaps the development of RN prescribing legislation will have an impact on my future practice within the healthcare system. What about the Local Health Integration Networks and their ability to improve access to care and efficiency in Ontario? Upon reflecting on all of these different future trends in my practice, I realized that the future health trend in Canadian healthcare that will have the most direct impact on myself, my workplace and my clients is the management of overcrowding in the emergency room.
The Canary in the Coal Mine
Emergency department overcrowding is the canary in the coal mine of our healthcare system. Over the last seven years the number of visits to emergency departments in Ontario has increased by 13%, with a population growth of only 6% (Health Quality Ontario, 2016) demonstrating that people in Ontario are using the emergency room more frequently. At the same time the complexities of patient’s medical conditions and the length of time patients spend waiting for hospital admission is also increasing (Health Quality Ontario, 2016). By 2031 it is expected that 25% on Ontario’s population will be over the age of 65 further increasing the demand on emergency room visits as currently those over 75 account for 50% of ED visits (Ontario Hospital Association, 2006).
The implications for emergency room overcrowding cannot be ignored. The consequences of ED overcrowding include increased wait times, loss of patient privacy, increases in medication errors, and multiple studies have also linked ED overcrowding to increases in patient mortality and ultimately contributes the staff burnout (Moskop et al, 2009).
The causes of ED overcrowding are not primarily linked to increase in volume or “unnecessary” patient visits, but studies have repeatedly demonstrated that the majority of ED overcrowding occurs when patients who are seen, treated and admitted by ED staff are unable to move off of the unit to inpatient beds (Moskop, Sklar, Geiderman, Schears, & Bookman, 2009).
So What is Ontario Doing?
In 2006 the Ontario Hospital Association in collaboration with the provincial government published Improving Access to Emergency Care, highlighting what needs to be done to address ED overcrowding in Ontario. This reports emphasis the importance of planning for the future as the population of Ontario ages, increasing the demand on the healthcare system. It gives recommendations for involving key partners both in hospital, in long-term care settings and community care in order to address the ways the entire healthcare system must respond to fix overcrowding.
In 2009 the Ontario Ministry of Health and Long-Term Care government took some of these recommendations and Ontario’s Emergency Room Wait Time Strategy. This multisystem approach focuses on creating more alternates to the ED in communities, faster discharge of alternative level of care patients from hospital, increasing community supports and measuring of ED performance standards (Ontario Ministry of Health and Long-Term Care, 2009).
What Does the Future Look Like?
Working on the frontlines in the emergency department, overcrowding in the ED continues to be a constant battle. There are more and more patients, who present with increasingly complex medical histories, demanding more resources from the department and increased daily pressure from boarding inpatients for days on end. Ontario appears to have taken a broad systems approach, engaging community partners and addressing ED overcrowding at multiple layers within the healthcare system.
Perhaps one of the most profound effects on ED overcrowding will be ensuring that as our population ages, we create policy and supports that allows the population to maintain their health as they age. Addressing one of the primary causes of ED overcrowding, the boarding of admitted patients should be seen as a priority. Having all levels of healthcare involved in ensuring there are appropriate facilities and supports for housing, and the appropriate number of inpatient hospital beds regionally will be key. This also highlights the importance of demonstrating hospitals efficiency in terms of length of stay and discharge of patients to the appropriate level of care.
References
Health Quality Ontario. (2016). Under Pressure: Emergency Department Performance In Ontario. Retrieved from http://www.hqontario.ca/portals/0/Documents/system-performance/under- pressure-report-en.pdf
Moskop, J., Sklar, P., Geiderman, J. M., Schears, R. M., & Bookman, K. J. (2009). Emergency Department Crowding, Part 1—Concept, Causes, and Moral Consequences. Annals of Emergency Medicine, 53(3). 605-611. doi.org/10.1016/j.annemergmed.2008.09.019
Ontario Hospital Association, Ontario Medical Association, Ontario Ministry of Health and Long-Term Care. (2006). Improving Access to Emergency Care: Addressing System Issues. Retrieved from http://www.health.gov.on.ca/en/common
/ministry/publications/reports/improving_access/improving_access.pdf
Ontario Ministry of Health and Long-Term Care. (2009). Ontario’s Emergency Room Wait Time Strategy. Retrieved from http://www.health.gov.on.ca/en/pro/programs/waittimes/
edrs/strategy.aspx
Comments