Healthcare has become an essential area of focus worldwide. In Canada, Medicare refers to the public funded care system involving thirteen provincial and territorial health care insurance programs. Under the Medicare system, all Canadian residents have reasonable access to medical and physician services without paying out of their pockets. Unlike other nations such as the United, States Canadians seem satisfied with their government-funded healthcare system (Oviatt & Hollingsworth, 2015). However, the long wait to see a health specialist or get treatment has become a defining characteristic of the Canadian healthcare system and a source of dissatisfaction to the residents. In fact, Canada has one of the longest waits for medical care among the developed nations where a same-day or next-day appointment with a physician is nearly impossible. The wait for emergency department care, elective surgery and referrals to specialists are some of the services which are often painfully long. Therefore, this paper will discuss the primary cause and measures which can be taken to reduce the long wait time to see a specialist in the emergency department (ED) in Canada.
The Causes of Long Emergency Department Wait in Canada
Canadians wait longer in the emergency rooms than other patients in developed nations. For example, 27% of Canadians have been reported to take more than four hours in the emergency department (ED) in comparison to only 5% and 1% in the Netherlands and the United Kingdom respectively (Saint-Laurent, 2017). According to Canadian Institute for Health Information (CIHI), the number of people who visited the ED in the year 2016 was approximately sixteen million and more than one million patients were admitted to various hospitals nationally (Ubelacker, 2017). Nevertheless, over 90% of those admitted the patients took over thirty-two hours to secure a bed in the hospitals. Likewise, in every ten people visiting the ED, nine of them left within eight hours. Therefore 10% of the patients had longer wait. Over the last ten years, this has been the challenge in the Canadian healthcare system, and the wait is still getting longer (Ubelacker, 2017). Some of the factors contributing to extensive wait time in ED include
Overcrowding in the Emergency Department
The congestion in the emergency department is a national problem to the Canada healthcare system. In fact, it is becoming a chronic state even in other sections in the health organization. Typically overcrowding refers to a state in which demand for service exceeds the ability of physicians and nurses to provide quality care to their patients and within a reasonable time interval (Affleck et al. 2013). According to a joint survey by Canadian Association of Emergency Physicians (CAEP) and Royal College of Physicians and Surgeons of Canada (RCPSC), the number of patients in the emergency room out-weighs the available physicians. The shortage of physicians is a primary cause of overcrowding. In fact, there is a shortfall of 478 emergency physicians, and the number is anticipated to rise to 1071 by 2020. Therefore, the deficiency leads to extended wait time in the ED with doctors feeling the increasing pressure from the rising volume of patients. Unfortunately, Canadian aged sixty-five and above wait longer in the ED despite the fact that older adults do not fare well in the emergency rooms. In fact, some older patients are vulnerable to delirium and deconditioning worsening their condition and ability to return home whenever their needs are not addressed in time.
Lack of Resources for the Admitted Patients
Similarly, lack of adequate resources such as acute care beds also contributes to increased waiting time. For example, over the five years, the hospital beds have reduced by almost 40% nationally. The dynamics aimed at equipping home and long term care centres. Consequently, it has become increasingly difficult for one to secure an inpatient bed. Hospitals and other health centres also find it challenging to timely admit patients from the emergency rooms. According to doctors the shortage of essential equipment has resulted in strikes, unnecessary investigations, walkouts and finger-pointing destabilizing their ability to offer quality health services (Sutherland & Crump, 2013). The limited resources have made the ED one of the frustrating work environment and have failed to attract new graduates to work in this sector. As a result, patients continue to languish in stretchers and in the wait rooms expecting to be served.
Limited Community Care Resources
In some cases, patients with minor illness take up the limited emergency room resources creating a backlog and leaving those suffering from acute diseases at risk of waiting unreasonably for life-saving care. However, with limited community care resources, every person would rush to seek medical attention in hospital leading to an increased volume of patients and service delays. Also, lack of alternative and advanced diagnostic testing facilities in the communities health centres continue to discourage people from seeking medical attention in some of the local amenities. For example, lack of computerized axial tomography scan and magnetic resonance imaging in some of these health centres forces patients to visit the ED in major hospitals in the hope of having their scans done quickly. Likewise, the healthcare system lacks interconnection between local health centres to the provincial hospitals. Therefore, those who seek medical attention at the community level but might require specialized treatment always find it challenging secure a referral to the primary hospitals.
Increased Acuity and Complexity of Illness
The lifestyle in the contemporary society has left people vulnerable to numerous forms of diseases. Additionally, with the ageing population, some chronic and terminal illnesses such as diabetes, emphysema and cardiovascular ailments are so common and requires emergency services. Patients suffering from these diseases needs compound assessment and advanced diagnostic technology for treatment and therapy. In most cases, those in the ED have the responsibility to develop an outpatient follow-up and management program for those patients with acute exacerbation of long-term disease. The different responsibility dispensed to emergency staffs also contributes to long waits in their work environment.
Measures to Reduces the Wait Time to See an Emergency Department Specialist in Canada
The string of high profile problems faced by the ED demands instant solution with a goal to enhance health and safety of patients and physicians. Initially, frequent ED users were considered as personalities of low socioeconomic status with limited access to primary care. However, the wealthy suffering from the complex medical issue is also frequent visitors to the emergency rooms. Likewise, the extent to which physician prioritize their patients care, therefore, face several shortcomings. An appropriate approach to address the problem should consequently consider all personalities and patients information. Some of the measures to reduce the wait time in the ED in Canada include
Increase Post-Acute Bed Capacity and Community Care Resources
After admission, it takes longer for patients to be discharged due to limited availability of post-hospital care at the community level and post-acute beds. Typically, only a few and financially stable Canadian can afford a family health specialist while majority relies on the services offered in the provincial hospitals. Therefore, a strategy to integrate provincial hospitals with private health centres, long term care units and family doctors at the local level would reduce the high demand for post-acute beds (Sutherland & Crump, 2013). Similarly, equipping the regional health centres with essential equipment would also provide an alternative source of care to patients, therefore, reducing overcrowding in the emergency rooms.
Expand the Role of Private Insurance in the Health Sector
Canada emphasis on equal health care services for its citizens but allowing a more significant role for privately funded medical care would reduce long waits in the public hospitals. The wealthy and employees benefiting from private insurance plans in their workplace would receive more timely care than those who rely firmly upon the public insurance scheme (Globerman, Esmail, & Henderson, 2013). Consequently, if some patients decide to access private health services, this would gradually reduce the queue for those relying on the public funded medical care.
Implement Overcapacity Protocols
Overcrowding is symptomatic of demand beyond capability in hospitals and requires a system-wide mechanism with an aim to improve patient flow. According to CAEP a rapid implementation of overcapacity protocol would assist hospitals in addressing issues of surplus demand (Erenler et al. 2014). The intervention would address issues related to patients in the ED whose conditions are already stable especially during the times of peak impatient pressures. The practice would decongest ED by provides equivalent services to the admitted in another environmental setting. Nevertheless, the mechanism would only temporarily decompress ED, but with different strategies, in place to address performance, the menace would gradually diminish.
Launching a Public National Benchmark for Emergency Department Experiences
By setting national standards and publicly expressing patients experiences within the ED in various infirmaries, this would promote transparency in the health sector. The long duration patients have to encounter to receive health attention have been a national issue. Therefore, instigating an accountable framework to assess and rank hospital performances would result in a universal standard of service in all health centres. Initially, the level of performance varies from one hospice to another based on the financial stability of the patients. As a result, the middle-class citizen who forms the majority of Canada population suffers in ED due to the large volume of patients visiting specific government hospitals (Alliance, 2014). Likewise, the strategy would enhance the working environment making it competitive. As a result, the health sector would attract more graduates, therefore, reducing the shortage of nurses and other specialists in the emergency rooms.
In conclusion, the long wait to see a doctor in the ED is widely contributed by the increasing number of patients seeking medical attention in the departmental hallways without getting the care they need. Consequently, increased overcrowding in Canada has a drastic impact on health care threatening the lives of patients. However, with the integration of several measures to address the menace the long wait time to see a health specialist would immensely reduce. Lastly, improving access to hospital care should be the responsibility of every Canadian and not a government obligation.
Affleck, A., Parks, P., Drummond, A., Rowe, B. H., & Ovens, H. J. (2013). Emergency department overcrowding and access block. Canadian Journal of Emergency Medicine, 15(6), 359-370.
Alliance, W. T. (2014). Time to close the gap: a report card on wait times in Canada. Ottawa: Wait Time Alliance.
Erenler, A., Akbulut, S., Guzel, M., Cetinkaya, H., Karaca, A., Turkoz, B., & Baydin, A. (2014). Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital. Elsevier. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909875/Globerman, S., Esmail, N., Day, B., & Henderson, D. R. (2013). Reducing wait times for health care: what Canada can learn from the...
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