Patients in N.B. face even longer waits in emergency rooms, report says

CBC

2 days ago

New Brunswick emergency room patients faced a typical wait of about four and a half hours in 2024-25, according to a new report by an independent public-policy think-tank.
That median wait — the length of stay from arrival in the ER to discharge or admission to hospital — increased by nearly half an hour over the previous fiscal year and by nearly an hour over 2020-21, the report by the Montreal Economic Institute, known as MEI, says.
"The situation is getting worse," said MEI economist Emmanuelle Faubert, who wrote the report, titled Canadians Are Waiting Too Long in the Emergency Room.
"And that is a trend that we see all across Canada."
Although the report indicates median waits last year ranged from two hours and 45 minutes in Newfoundland and Labrador to five hours and 23 minutes in Quebec, comparisons between provinces should be taken with a grain of salt, Faubert said, because of potential differences in the way they each collect and measure their data.
Nova Scotia and Saskatchewan aren't included in the report because they did not provide the requested data, she said.
WATCH | 'All across Canada, the situation is getting worse,' says report's author:
Stuck in the ER? Wait times are up across N.B., report says
3 hours ago
Duration 2:37
A report from the Montreal Economic Institute, a think tank in Quebec, found New Brunswick emergency room patients faced a typical wait of about four and a half hours in 2024-25. That's nearly an hour over 2020-21 wait times.
The New Brunswick median wait is based on about 490,000 patient visits to Horizon and Vitalité emergency rooms and represents the middle value of the lengths of stay of all patients, meaning half waited longer, and half less, Faubert said.
The median is considered a better statistical measure than the average, she said, because it's less affected by extreme cases and more likely to represent a typical visit.
Faubert attributes the increase in waits to a shortage of primary-care providers and a lack of options to deal with minor emergencies.
France model could help address 'missing middle'
She encourages the New Brunswick government and other provinces to adopt a new model being used in France — immediate medical care centres.
These independent clinics, which are generally privately owned by the health-care providers who operate them, specialize in handling non-life-threatening emergencies, such as bone fractures, wounds that require stitches, and infections, Faubert said.
This helps reduce the pressure on ERs and fill the "missing middle" when it comes to urgent care.
"They fall into a sphere where there's less bureaucracy, there's more place for innovation and less having to ask the government for anything anytime they want to implement a new strategy," she said. "That is what is currently happening in the public sector."
Privatization 'a terrible recommendation'
Dr. Fraser Mackay, an emergency physician in Saint John and chair of the rural, remote and small urban section of the Canadian Association of Emergency Physicians, calls that "a terrible recommendation."
"It's an ideological approach that promotes privatization of health care, siloing of health care, lack of accountability and basically taking us in the wrong direction."
Mackay said there's no denying wait times are getting worse across New Brunswick and across the country, and are "terrible almost everywhere you go," particularly in bigger centres. He supports making that data public and making citizens aware.
But the MEI report is "impressively off the mark" in terms of its conclusions and advice, he said.
Mackay contends the main driver of emergency department waits "has nothing to do with" access to primary care or the acuity of the patients in the waiting room.
"People with low acuity problems, I can see them really fast, but I need a place to see them … and available nursing staff," he said.
The problem is ER patients who have been admitted but can't be moved to a hospital unit because no beds are available, so they're tying up ER space and resources, said Mackay.
"It is an outflow problem … not an inflow problem."
While the French model might sound good on paper, it doesn't recognize our finite pool of doctors and nurses either, Mackay said.
"If you're staffing that clinic, where are you getting that staff from? Because we have trouble staffing our emergency departments as it is."
Hybrid system best, author says
Faubert could not immediately say what would be required to set up such centres in New Brunswick or how much it might cost, but did say patient services should still be covered by provincial health insurance.
"Of course if we plan to turn this into a reality, we need to dig deeper into how it would work," she said. "But as a concept it has shown that it does work in France, and we think that if it can be adapted to the Canadian environment then it could be beneficial."
Asked if she and MEI are pro-privatization, Faubert did not answer directly.
"The thing is, we've been putting more money into health care, more and more every year, and what we're seeing is that it's not working," she said.
"When we look elsewhere in the world, in some of the most efficient countries with the best health-care systems, essentially all of them are hybrid.
"They do have a public system, but they also have private, independent providers, and they work together to make sure that the population gets access to the care that they need."
Health department works to expand collaborative teams
The Department of Health is still reviewing the report but does "recognize that some New Brunswickers have struggled to access services in a timely fashion at hospital emergency departments," said spokesperson Sean Hatchard.
It's working with Horizon and Vitalité, who are responsible for day-to-day operations, to make improvements, including filling health-care positions as quickly as possible, he said in an emailed statement.
It's also working to expand family health teams across the province to improve access to primary care and ease pressure on the ERs, Hatchard said.
While Premier Susan Holt pledged in last year's election campaign to open 30 collaborative care clinics over four years, existing community care clinics that adopt the family health team model are now being counted among them. So far this year, teams have been announced in Fredericton, Lamèque, Tantramar, and Carleton North.
Some other initiatives that divert patients away from ERs include NB Health Link, eVisitNB, and expanded roles for pharmacists, who can now prescribe for 12 common ailments, Hatchard said.
Vitalité works on patient flow
Improving access to primary health care and optimizing patient flow are two of Vitalité's strategic priorities, according to an unsigned emailed statement.
Since 2022, Vitalité has established 26 local family health teams, enabling the regional health authority to care for nearly 32,000 additional patients and divert some non-urgent demand away from hospitals, the unidentified spokesperson said.
Vitalité has also implemented a number of initiatives to expedite discharges and reduce occupancy rates, which in turn shorten emergency department stays by increasing access to acute care beds, according to the email. These include discharge planning upon admission and the integration of tracking tools.
Horizon did not provide comments Tuesday.
More New Brunswick numbers
Horizon hospital patients faced the longest ER waits, with a median length of stay of four hours and 51 minutes, compared to three hours and 21 minutes at Vitalité hospitals, the MEI report says.
Horizon's Moncton Hospital had the longest median ER visits in the province at seven hours and 22 minutes, followed by the Saint John Regional Hospital at six hours and 37 minutes, and the Dr. Everett Chalmers Regional Hospital at six hours and 25 minutes.
The Sussex Health Centre, which lost its overnight ER services in 2022, was a clear outlier, with a median wait of only 18 minutes, according to the report.
Among Vitalité hospitals, Hôtel-Dieu Saint-Joseph de Saint-Quentin patients had the shortest median wait, at one hour and thirty-five minutes, while patients at the Dr. Georges-L.-Dumont University Hospital Centre in Moncton had the longest at five hours and 54 minutes.