On New Year's Eve, the ER is
one room that's pretty much guaranteed to be packed. While
there's no velvet rope to cross, there'll surely be a
long, anxious queue. And for these patients who find themselves
in the ER during the festive season, wait times for seeing
a doctor make the other headaches of the season —
like finding a babysitter — seem most trivial indeed.
So how does the ER staff hold up,
when they have to work like mad on days much of the
country spends either resting or revelling?
Dr Steven Friedman, who works in
the ER at Toronto General and Toronto Western Hospitals
and is a member of the Department of Family and Community
Medicine at the University of Toronto, takes this holiday
pandemonium in stride. "It's kind of nice to work during
the holidays because it's quite a festive atmosphere,"
he says. "The staff brings in food and chocolate, although
we'd all prefer to be at home with our families."
SEASON
OF THE STITCH
But Dr Friedman knows the holiday season isn't always
fun for patients. "[ER overcrowding] is clearly impacting
the delivery of health care in a negative way," says
Dr Friedman. As for why the year-round overcrowding
problem only gets worse during the holidays, he feels
it's the little things like family doctors closing up
for the holidays and the lack of support staff that
really fill an ER. And seasonal factors such as colds
and flu, road accidents, slips and falls certainly don't
help.
"The number one cause of ER overcrowding
is a lack of hospital inpatient beds, which causes patients
to back up into the emergency department," says Dr Friedman.
"A lot of people come to the ER with things that can
be treated elsewhere — they're not the cause of
the problem because they consume a tiny percentage of
the department's resources, and these patients are just
waiting for treatment — not tying up beds. The
jams are caused by those who require a prolonged workup
in an ER bed."
SHOT
TO THE HEART
Patients needing timely treatments like thrombolysis
are the ones truly done dirty by ER congestion. A recent
study published in the Annals of Emergency Medicine
showed the average Ontario door-to-needle time was well
above the recommended 30 minutes.
But our ER wards are working to
mitigate this. "We do our best to defer what can be
done in the community, outside the hospital," says Dr
Friedman. "If patients can follow up with their family
doctor, we will push back a treatment. For example,
if a CAT scan doesn't need to be done today, we'll defer
it."
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