'It's hallway medicine': Horizon CEO promises permanent ER closures 'not on the agenda,' solving offload delays a priority

Derek Cassista says a day-in-the-life of a New Brunswick paramedic is far different than what it used to be.

He says it’s become common for them to be off the road entirely, waiting outside a hospital or in a hallway with a patient – sometimes, for their entire shift.

“You ride a taxi up to the hospital. You enter the hospital, you encounter me, Derek, the paramedic and you say, 'Hey Derek, I'm here for the night shift,’” Cassista describes. “And you take over from me. I'm going to get in the taxi, go to the station and go home. And then you, as the paramedic, quite foreseeably could spend the entire night sitting with a patient in the hallway.”

Cassista, the president of the Paramedic Association of New Brunswick, said Tuesday one ambulance waited at the Moncton Hospital for 13 hours, 50 minutes with a patient, while another waited 12 hours.

He says they call it "hallway medicine."

Offload delays, where paramedics are unable to transfer a patient at the hospital because there are no beds or not enough health-care workers to staff those beds, have become more of an issue in New Brunswick this year.

The issue was only made worse by the pandemic, with ongoing staffing shortages and summer vacations.

“We are concerned that the next few weeks are going to be insanely difficult for us as paramedics,” Cassista said.

According to data from Ambulance New Brunswick (ANB), the number of collective hours ambulances are waiting outside hospitals isn’t exactly improving.

CTV Atlantic compared offload delays between the time period of June 27 to July 11 and March 15 to March 29. While there were days where there were no delays, on average, the total time ambulances experienced offload delays had increased.

Of Moncton, Fredericton and Saint John hospitals, the Moncton Hospital has the highest number of offload delays.

On June 27, ambulances spent a collective 127.62 hours waiting to offload a patient at that hospital.

However, Horizon Health Network CEO Dr. John Dornan says he also receives data from ANB and believes there’s been a small improvement since the winter.

“The numbers that I’m seeing hasn’t shown a huge drop but the numbers are moving in the right direction and some of the things that we’ve put into play will take some time to bear fruit,” he said Wednesday morning. “I don’t think it’s appropriate to have any offload delays. Every time there’s an offload delay, it’s taking a part out of our system that’s needed elsewhere.”

Dornan says Horizon has hired a "flow coordinator" who’s working evening shifts, to help move people into the hospital itself so there’s more room in the emergency department for ambulance patients. He also said patients arriving by ambulance who are not considered urgent are “sometimes put in waiting rooms.”

“They’re mobile, and so the ambulances can get back on the street again. And people who are more sick, we try to get them a bed as soon as possible,” he said.

New Brunswick Premier Blaine Higgs added his voice to other premiers this week, asking Ottawa to reevaluate its health transfers formula. But he acknowledges more money isn’t the only answer.

“A new formula is required and a discussion is required and we need to have that long-term sustainable commitment,” he said in an interview from Victoria, B.C. on Tuesday. “Yes, more funding is required but it's innovation in health care that's going to really save health care at the end of the day.”

Dornan maintains Horizon’s biggest hurdle is staff. He says continuing to get support in recruitment efforts from the province is critical.

“Maybe, continuing to support our new initiatives to bring staff in, nursing staff, other staff from alternate sources,” he said. “Like India, like nursing schools out of Maine that are coming here, like Oulten College, like our traditional universities. I think ongoing efforts in these areas will solve our problem.”

CLOSING, CUTTING ERs NOT ON AGENDA

In recent weeks, the ongoing staffing shortages has created, what Dr. Dornan calls, a "perfect storm."

Vacations and COVID-19 infecting doctors and nurses have impacted the health network’s ability to staff some emergency departments, forcing them to temporarily close.

Sackville, Sussex, Oromocto and the Upper River Valley hospitals have all been impacted.

Vitalité Health Network also warned Tuesday that it’s experiencing ongoing shortages of medical and nursing staff, which has them asking “the public to avoid our emergency departments for all non-urgent health problems.”

“This hits home very closely to me. I had a member of my family who waited 10 hours last night in an emergency room,” said Cassista on Tuesday.

Cassista warns the public should find a different way to get help, if their needs are non-urgent.

“If you haven't been involved with calling 911 or going to a hospital in the past few months, it's a bit of a culture shock when you walk in and somebody meets you and says, ‘Hey, do you have a pillow? Do you have a bottle of water? Because you're going to be here a long time,’” he said. “That's the reality of the situation we're in.”

It has some community residents and leaders fearing about the future of their rural emergency departments, but Dornan says any permanent closures are not their goal.

“We are working hard to prevent that, in fact, it’s not on our agenda. We have nurses coming to work for us in Sackville. The drain to Nova Scotia is starting to reverse so that we see nursing staff that are coming there from Nova Scotia and the Moncton area,” he said.

“We feel very strong that we need to support our rural, community ERs. We need to have them adequately staffed by competent, rested nurses in Perth-Andover, in Sussex, in Sackville. That is not what we see in our future.”

Average Ambulance Offload Delays between June 27 and July 11:

Average Ambulance Offload Delays between March 15 and 29: