A recent article published in the Chronicle Herald highlighted the chronic difficulties of staffing Nova Scotia’s rural emergency departments.
Unanticipated closures exposed Nova Scotians to thousands of hours of emergency service disruptions. That is to say a community suddenly and often unexpectedly found itself with closed emergency department doors. I can think of nothing worse than for an individual and their family to experience a medical emergency and their expectation of timely care is thwarted by a closed sign on the ER door. This, in my mind, undermines the confidence of Canadians in their health care system at a time when their need is most critical. It makes a lie of the much vaunted Canadian values of universal access to quality health care (unless of course you are a rural Canadian!)
It is unreasonable to expect that every Canadian community can expect to maintain a full service emergency department. Simply not possible and given the realities of current health human resources not likley to get better any time soon.
Are Nova Scotia’s collaborative health centres the answer? Certainly many provincial premiers and health ministers seem to think so. But even in Nova Scotia these centres have also had service disruptions because of nursing shortages.
I think the answer is in managing expectations and embracing our ruality as a nation. In rural remote or isolated communities, clearly the nursing station or first aid post, integrated with regional or district resources, may be all that we can hope to achieve. In rural communities in more populated regions of Canada (hugging the US border) then we need to think of a more regionalized system of care. Better to know that you can expect a half hour car or ambulance ride to a regional center of excellence with guaranteed continuous access than a sporadically available and unreliable service.
Regionalization will involve some consistently unreliable ERs closing or having reduced hours of service. While this might be perceived by municipal leaders to be a “loss”, it might be better seen as a regional “gain” in guaranteeing access to consistent quality care.
Whatever one’s feelings about health care regionalization, I think we can all agree that unexpected service disruptions are a bad thing with the potential for patient harm