Health minister considers Ontario pilot that sees some ER patients waiting at home

New Brunswick’s health minister is eyeing a Northern Ontario pilot project that allowed eligible non-urgent ER patients to wait in the comfort of home and receive text messages when it was the best time to go in.

The virtual home waiting room was tested at Sault Area Hospital in Sault Ste. Dr John Dornan says Mary could reduce “unacceptable” waiting times and improve the patient experience.

Asked about such a project for New Brunswick, Dornan said, “It’s something we can, should and will consider.”

Dornan suggested a plan could also be coming “within weeks” to reduce crowding of hospital beds by people waiting for nursing home beds or other long-term care placements.

This comes as both Horizon and Vitalit Health Networks say their ERs have completed lack of leisure resources Without any major problems, thanks in part to patients with non-urgent illnesses avoiding ERs whenever possible.

Now, faced with one increase in flu cases And ongoing overcapacity issuesHealth officials continue to encourage non-urgent patients to consider other options, such as tele-care 811, after-hours clinics and virtual care.

under Ontario PilotLaunched in August, patients with certain non-urgent medical complaints, such as a cough, minor injury, or needing a prescription renewal, will have to fill out an online form detailing their situation.

If hospital staff determine they meet the criteria, patients can wait in a location of their choice rather than sitting in a busy, crowded waiting room. They will receive hourly text messages advising them of their place in the virtual queue and when they should proceed to the ER to be triaged and registered to see a care provider.

“Our team will text you to come to the emergency department at the optimal time depending on how busy the department is,” the hospital’s website says.

Wait times and walkouts are reduced

Wait times overall dropped by more than 25 percent during the three-month pilot, according to a December report from the Sault Area Hospital Board.

For most “low acuity” patients, the time until initial evaluation by a physician decreased from 5.8 to 2.7 hours or less, while their length of stay decreased from 7.7 to four hours or less.

Hospital spokeswoman Brandi Sharp Young said those figures do not include time spent waiting at home by the 350 pilot participants.

Including that time, the reduction was closer to 22 per cent, he said, with 90 per cent of low-acuity patients waiting a maximum of six hours to see a doctor and seven-and-a-half hours to be discharged.

The rate of patients leaving the ER without being seen dropped by almost half to about five percent.

Additionally, 87 to 89 percent of users reported being satisfied with the virtual waiting room, and more than 90 percent said they would use it again.

According to Dr. Stephen Smith, the hospital’s vice president of medical affairs, the staff response has been positive.

Nurses, who are responsible for running the virtual queue, “have enjoyed a great deal of autonomy in accommodating lower acuity patients and keeping them waiting less time in the department,” she said. “Their job satisfaction has increased.”

The pilot has now expanded to accommodate 21 patients per day, up from 10, and Smith said they are working on “full implementation in the near future.”

Eventually, he hopes the virtual queue will also include access to primary care providers, he said.

‘Good idea’

Dornan thinks Salt Pilot is “a great idea.”

He recently fulfilled a promise to spend 24 hours in the ER waiting room of a Moncton hospital to find out what patients were facing – an experience he described as “difficult”, even when he was not sick.

“Even if you can get in your car or go for a walk somewhere, even in the common areas of the hospital — the cafeteria, the coffee shop — I think if people don’t have to spend that time sitting there because of fear (they’ll miss their name being called), I think that would go a long way.”

Smith believes the pilot could work in other areas and at larger hospitals.

Sault Area Hospital is already talking to some interested hospitals, he said.

‘Waiting for an urgent patient is a big concern’

According to one, only one-third of patients in New Brunswick ERs are seen by a doctor within a reasonable time. Recent report of the Provincial Auditor General.

Paul Martin found that even among patients who most needed to see a doctor immediately, only 56 percent of the cases were evaluated quickly.

Dornan argues that patients who are “very sick” – known as Level 1s and Level 2s – are seen within a reasonable amount of time.

But Level 3s – “people we’re not sure how sick they are” – are people who are spending excessive amounts of time in emergency departments.

Based on national guidelines, Level 3s should be seen within 30 minutes. “And they’re not,” Dornan said. “So that’s a big concern for us.”

According to the guidelines, patients evaluated as Level 3 “have conditions that could potentially develop into a serious problem requiring emergency intervention.” These conditions can include everything from head injuries and chest pain to asthma and vomiting.

up to six and a half times the national target

According to Horizon’s website, Level 3 patients represent the majority of ER patients.

Its Shows performance dashboard Level 3 patients in regional hospitals face an average wait of about three and a half hours between being tested and being seen by a health care provider.

At Vitality hospitals, these patients wait for about two hours, according to the network’s quarterly reports.

Patients rated Level 4, or less urgent, and Level 5, non-urgent, wait longer.

As of Monday, according to The province’s MyHealthNB websiteER patients faced waits of up to an estimated 16 hours between registration and discharge at some hospitals.

“We used to say how terrible it was when people were waiting eight hours, and now we’re looking at 12 hours, now we’re looking at 16 hours, and it’s barely raising an eyebrow anymore,” said Dr. Fraser MacKay, an emergency physician in the St. John’s area.

“It’s kind of taken for granted now.”

‘Bed block’ is the biggest challenge

Mackey, a board member of the Canadian Association of Emergency Physicians, is interested in the Sault Area Hospital pilot and hopes the data will be discussed at an upcoming national forum on the future of emergency medicine.

But Mackey said, “wait times are ultimately driven by bed constraints.”

Letting patients wait at home may make the ER appear less busy, he said, but “does nothing for the root cause of downstream overcapacity,” alternating levels of care to patients who are in hospital beds while they await placement elsewhere.

Up to 40% of Horizon beds are occupied by ALC patients

Horizon and Vitality executives also say these patients, known as ALCs, are putting a strain on their hospitals beyond capacity.

Greg Doiron, vice president of clinical operations, said in an email that they had 40 percent of Horizon’s beds occupied before the holidays.

This impacts emergency departments, he said, which are filled with patients who are waiting for hospital beds.

Horizon’s website shows As of Jan. 4, its hospitals are operating at a combined occupancy of more than 108 percent, with Upper River Valley Hospital in Waterville ranking highest at more than 167 percent.

At Vitalite hospitals, the overall occupancy rate is more than 96 per cent, with hospitals in the Acadie-Bathurst region exceeding 100 per cent, said Jenny Toussaint, vice president of clinical logistics.

“The region also has the highest proportion of beds filled by alternative level of care patients,” at more than 45 percent, Toussaint said in an email.

A call to exclude long-term care from social development

Mackey is calling for long-term care to fall under the Department of Health rather than social development.

As things stand, there is a “huge impasse in effective planning” for ALC patients, he said.

He is “silent on funding allocations and government planning and the ministers who oversee them… and that makes no sense to me.”

Dornan acknowledges the need to tackle the ALC issue but argues that this can be accomplished by departments working closely with the minister responsible for seniors and women’s health.

A plan that will “help get people out of our hospitals into the community” is coming “within a few weeks, certainly this quarter,” he said.

Dornan said the government is also working with regional health authorities to assign ALC patients to vacant nursing home beds within a 100-kilometre radius of a hospital.

Meanwhile, the government is trying to expand access to primary care through collaborative clinics, which should help ease pressure in ERs, he said.

“People who are really sick, we want to see them quickly” in the ERS. “For those who are perhaps less urgent, we would like them to be able to be seen through collaborative care clinics, 811, eVisitNB, their pharmacists and others in our communities.”