What can you expect when you visit the emergency room? Listen to Dr. Alan Drummond, a rural Emergency Medicine physician, explain what measures are in place to keep patients, Doctors and staff safe.
What can you expect when you visit the emergency room? Listen to Dr. Alan Drummond, a rural Emergency Medicine physician, explain what measures are in place to keep patients, Doctors and staff safe.
OMA Podcast Season 2, Episode 2 - Visiting the Emergency Department with Dr. Alan Drummond
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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan, and I’m the Director of Media Relations and Social Media at the Ontario Medical Association.
Dr. Drummond: Hi, I'm Alan Drummond. I am a family and emergency physician in Perth, Ontario.
Flanagan: And we're here today to talk about when to go to the emergency room.
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Flanagan: As an emergency doctor, I'm sure you get a lot of people coming into the emergency department. It's, sometimes, what people see is the quickest way to get care. When should a patient visit the emergency room versus calling their doctor?
Dr. Drummond: That's a good question. I think it is the birthright of every Canadian citizen to have timely access to quality emergency care—and more than a birthright, in fact. Access to emergency care is a basic human right.
It is the patient that declares their individual emergency; it's not for us to judge the appropriateness of the visit. We, in fact, encourage people that, if you have a concern that can't be addressed in the usual manner—either through telehealth or family physician, or there is an acute change in your medical status and you're worried about yourself or your loved one, and you can't get answers—we are there.
Five million Ontarians come to the emergency department on a regular basis. And they do so because, crowding aside, the reality is that we provide excellent care.
There's a lot of talk in the media, from time to time, about inappropriate visits and people over-utilizing the emergency department when it can be better seen, but a lot of that stuff is judgmental. Nobody should be discouraged from coming, particularly now I think, at a time of COVID and increased media attention on crowding hospitals and crowded ICUs.
About two months into the onset of the pandemic, emergency physicians noted with alarm both across Ontario, urban and rural, as well as across Canada, that emergency department patient volumes were dropping significantly, by as much as 40% in some occasions.
I think there's several reasons for that. One was the media attention on crowded hospitals. The other was concern that people, if they came to the emergency department, might catch COVID from a fellow patient. Or quite often there was a sense that they didn't want to give COVID to somebody.
So, people stayed away from accessing the services that they required, and to their detriment. Now, we're in the second wave. One lesson that we learned from the first wave is to encourage people not to delay seeking care.
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Flanagan: One thing we've heard a lot is that people are afraid, sometimes, about going to the emergency department—they're afraid they might catch COVID. But really, outcomes could be significantly worse if people delayed treatment of something that's serious. Is that true?
Dr. Drummond: That is actually entirely true. People had delayed seeking care for such things as heart disease, heart attacks, strokes, pneumonias, fractures. I don't think it was so much of people being afraid of coming, so much as it was people are afraid of contributing to the perceived chaos in emergency departments. And, uniquely, the emergency departments have never been so quiet, so wait times dropped dramatically.
So yeah, there are a lot of time-sensitive conditions. And yes, we respect and acknowledge Ontarians’ desire to be good citizens, and to preserve hospital resources. But, now is not the time to delay seeking care.
We really need to keep emphasizing the fact that Ontario emergency departments are as safe as they have ever been. We have adapted well to the reality of the COVID pandemic, in terms of our screening mechanisms, our approach to the patient, who can wait, where they should wait so that we don't congregate a waiting room full of people with somebody who's really sick with a high transmission of COVID. So, those patients are screened for, segregated, and more often than not are directed quickly in the emergency department for a full and thorough assessment.
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Flanagan: One of the things we're hearing about a lot in the media right now is the rising number of people in hospital and ICUs with COVID and how that impacts everybody. And, I think the general public doesn't have a great understanding about beds in hospitals and the staffing that goes with it and what all that means. Would you have an example or be able to talk a little bit about what it does mean?
Dr. Drummond: The principal reason that we have a crowded emergency department is in fact a crowded hospital. What is defined as a safe hospital is a hospital where the occupancy—the number of beds actually occupied by patients—is only 85%. That allows us to have beds free and available on the wards to accept large influxes of patients.
Most Canadian hospitals haven't seen 85% occupancy in decades, and they usually function at around 100-110, and even as high as 120% capacity, which means that admitted patients are occupying every bed in a hospital. Sometimes they're being placed in sun rooms and utility rooms.
A crowded hospital means that a patient seen in the emergency department, who is deemed to require admission can't be transferred, there's no place for them to go. And so, they end up occupying hallways in the emergency department, and, in some dire circumstances, even end up occupying bathrooms and closets in emergency departments. It'd gotten that bad over the years.
And so, a crowded emergency department is not a reflection of inappropriate use by the public, it's rather a reflection of an overcrowded hospital. Care needs are barely met or medical needs was certainly not met. And so, we think it's a unique tragedy that in a country as wealthy as ours, and in a province as wealthy as ours, that that situation is allowed to continue.
Another thing's happened. There is an increased risk of medical error, there’s an increased risk actually of more medical complications, including death.
So, this chronic situation of a crowded hospital, a crowded emergency department, has existed clearly for 20 plus years, and the problem is exacerbated or worsened around this time every year with the onset of flu season.
So, in dealing with the convergence of the COVID pandemic and influenza, it is particularly important, with the very fragile resources we have in the healthcare system on a good day, that we all do our best to lessen the burden on hospitals. That does not mean—that does not mean—don't come to the emergency department. But what that does mean, is that do your best to be a good citizen, and to follow the advice of our public health officials—appropriate physical distancing, washing our hands, mask wearing—because
we want to have more surge capacity available for COVID patients. That means we would like to see less people admitted with influenza.
So, if you have access to a influenza vaccination, a flu shot, then you should get it. If you have hesitated in the past, I understand how that happens, but this is the year if you're going to be a good citizen, even a good patriot, that you actually roll up your sleeve, get the flu shot.
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Flanagan: So, it's interesting that you brought up surge capacity, because I know that's something that has been in the news just over the last couple of days as hospitals have been asked to get their surge capacity ready, clearing out that 10-15%, so that there's room for more patients if there's a large influx.
Dr. Drummond: That's entirely true. Every government in this country has been told for the last 20 years that running a hospital at a hundred percent occupancy rate is dangerous and allows no surge capacity in a case of a natural disaster or infectious disease pandemic.
So, they've had no excuse. We've gone through very many infectious disease outbreaks over the last 20 years. The reality of pandemics and widespread infections now needs to be incorporated into our thinking process. We've gone through SARS, H1N1—so there's no excuse anymore to allow hospital occupancies to creep back up.
Now, the downside to that was that, in order to achieve safe occupancy rates, surgeries got cancelled, procedures got delayed, patients got discharged to, you know, less than ideal circumstances. And that is something that we really must strive to avoid. We don't want to come out of this pandemic with a tsunami of cancer patients who have not been appropriately assessed and treated.
So, we need to prepare, and whether that's freeing up hospital beds, or whether that's developing alternate sites for care—such as field hospitals, hockey rinks, taking over hotels, that kind of thing. But do we have the staff? Do we have the nurses, the lab technicians, the radiology technicians, the nursing staff, the respiratory technologists, and even the physicians to staff those beds?
Being a physician does not mean that you won't get COVID, particularly in smaller hospitals where human resources are scarce. Even one or two physicians having to be quarantined for a couple of weeks can have a profound impact on a community's ability to staff their hospitals.
We've asked that you spare the thanks, actually, and just make sure that you follow public health guidelines to the best of your abilities to minimize the risk, not only to our patients, but to us as well, so that we can maintain the integrity of our healthcare system under what will be most certainly challenging times over the next three months, until vaccination uptake reaches a satisfactory level.
Ontario citizens should be proud of their emergency healthcare teams, in terms of physicians and nurses and paramedics.
When this arrived, nobody ran away. Health care providers have got sick. Health care providers have died.
So, I'm proud of them. And I hope that everyone Ontario is. But manifesting that pride needs to be something more than a free coffee at the coffee shop. It needs to be widespread adoption of public health measures, no vaccination hesitancy with respect to flu, or any of the COVID vaccines that are coming down the pipe.
And it has also forced us, as especially, to look at what we do and have less tolerance for the crowded hospital and the crowded waiting room. And we've adapted. We've adapted extremely well. And we're starting to see virtual access to patients by emergency physicians. It has forced us into the future.
And thankfully, I think our specialty is an enthusiastic, socially responsible, innovative group. We all understand that Ontarians place great faith in us, and I can let you know that we're not going to let them down.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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