MEDIA RELEASE: Working Group Releases 15 Recommendations to Improve Patient Safety

Today, the NSGEU released a report outlining a number of serious concerns our members have regarding patient safety as a result of a continued year-over-year increase in the number of patients registered at the Halifax Infirmary Emergency Department (HI ED).

This report, entitled, Code Critical, was developed by a working committee comprised of NSGEU staff, legal counsel and health care members in response ongoing Code Census calls at the hospital, which has led to patients being placed in hallways or being double- and even triple-bunked, in order to create capacity in the Emergency Department.

“Code Census only moves the problem of overcrowding onto in-patient floors. It does nothing to address the underlying problem of an overall lack of capacity and resources that are needed to deal with the growing demands on our health care system,” said NSGEU President Jason MacLean.

“When Code Census was created in 2009, it was used seldomly. Now, Code Census calls have reached all-time high numbers. In fact, the Halifax Infirmary saw a record of 23 Code Census calls in just 31 days in January 2017.”

Through conversations with frontline health care workers, as well as a series of Freedom of Information requests, we discovered some disturbing statistics and trends, all of which align with the concerns our members have raised.

Highlights of the report include:

  • There were almost 14,000 more patients showing up to the HI ED in 2016 than there were in 2009, the year Code Census was created – this represents a 23 per cent increase;
  • The average number of patients showing up daily at the HI ED has grown from 161 to 204 in the last eight years. Staff say they routinely get up to 250 patients per day. Moreover, they report these patients are sicker and have more complex needs than in the past;
  • Record numbers of patients also mean record wait times. In 2016, an average of 161 patients per month waited more than 24 hours in the HI ED. Staff say it is not uncommon for people to wait over 100 hours between registration and discharge or transfer to a floor;
  • From September 2014 to August 2016, wait times from triage to admission at the HI ED were almost always at least three times and sometimes four times higher than the NSHA’s own eight-hour target.

The problems at the HI are having an impact on services throughout the province:

  • The number of ambulance arrivals at the HI ED has steadily increased since 2014, with more than 1,500 arrivals in December 2016 – which is the highest rate in two years;
  • During that same time period, 90 per cent of ambulances had to wait almost three hours before they could discharge their patients;
  • Sometimes so many ambulances are lined up waiting that paramedics will double up patients so that one can leave for another call. While ambulances are waiting to offload patients, ambulance coverage around HRM and the province suffers.
  • Other facilities are also feeling the burden. Registration numbers at the emergency department at Cobequid Community Health Centre are growing at a faster rate than the HI: they’ve increased by 21 per cent from 2012 to 2015;
  • When the Cobequid emergency department closes at midnight, stats show the vast majority of unseen patients will go to the HI ED for treatment.

“This issue has culminated in problems throughout the system, like patients being treated in hallways and family waiting rooms on in-patient floors, and surgeries being cancelled,” said MacLean.

On the in-patient floors, there are a number of factors causing delays, as well:

  • There are more patients than ever awaiting discharge to Alternative Level Care (ALC) and Long Term Care (LTC) facilities. In fact, staff say it is not uncommon for ALC patients to have extended stays of up to a year or longer while they wait for a bed to open up at a facility;
  • The Veteran’s Memorial Building is housing Long Term Care patients from Dartmouth General while that facility is under construction, which means they can no longer help alleviate overcrowding from the HI;
  • Patients from other Atlantic provinces, specifically PEI, are often kept at the HI for extended periods of time before a bed at a hospital in their home province opens up, or they are able to access home care services.

Ultimately, only increased capacity will truly fix this growing crisis. But the 15 recommendations that are outlined in this report are certainly a step in the right direction. They are relatively inexpensive, and can be implemented quickly.

“Too often, governments try to fix problems by bringing in high-paid consultants. This report, which was authored by the real experts – the people working on the front lines of health care -makes reasonable suggestions for changes that employees believe will help make the problem more manageable and ultimately make their patients safer,” said MacLean.

Read the full report.


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The Nova Scotia Government and General Employees Union represents over 31,000 women and men who provide quality public services Nova Scotian’s count on every day.

For more information, please contact:

Holly Fraughton, NSGEU Communications Officer

902.424.4063 (office)

902.471.1781 (cell)

One Response to MEDIA RELEASE: Working Group Releases 15 Recommendations to Improve Patient Safety

  1. Dr. John Ross March 29, 2017 at 10:41 am #

    I have managed to read and scan through your report. It appears well researched and presented. The recommendations are very reasonable. Sadly, this same situation is playing out at other large hospitals across the country. Contrary to the comment about it being an issue since 2009 – emergency care access block has been going on since the late 1990’s.

    Big changes across in-hospital care disciplines with improved regular communication and collaboration are needed. Acute care hospitals must be able to focus on that role – acute care. Primary care needs more creative delivery options. Post acute care, convalescence, rehabilitation, home care, and long term care each require improvements, smooth hand-offs between them and overall ‘system’ integration. THAT requires functional leader and manager teams with the broad competencies to understand, respond to, and drive complex adaptive systems.

    Furthermore, funding decisions should all be made using the ‘value’ lens where VALUE = OUTCOMES/COST. Sometimes more expensive ideas are high value whereas cheap solutions are a waste of money.

    ‘Disease care’ in 2017 is ALL about patient flow through a system. The system needs to functionally integrated, interdependent, and closely managed by experts. That requires FAR more complexity savvy engineers in day-to-day operations as well as grander system planning, industrial economists, behavioural psychologists who understand change and human behaviour AS WELL AS care providers who truly care. The current non-system has become extremely complex, but solutions are not. We need fresh perspectives, far fewer sacred cows, risk takers and room to make mistakes.

    Thank you for challenging the status quo.


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