As the number of emergency room (ER) closures across Canada continues to climb, a sense of urgency and concern has swept through the nation. The grim reality of these closures was recently underscored by a troubling incident in Clinton, Ontario. On July 30, 2023, after a triple stabbing at a house party, a frantic driver rushed wounded teenagers to Clinton Public Hospital, only to find the emergency department shuttered after 6 p.m. The youths, aged 15, 16, and 17, had no choice but to embark on a 20-kilometer journey to another hospital. This poignant incident illuminates the dire consequences of rural hospital closures and the potentially devastating impact on patients’ lives.
Rural ER Closures Surge in 2023
The closure of the Clinton hospital’s emergency room is just one piece of a much larger and likely record-setting puzzle of temporary ER closures across Canada in 2023. CTV News has identified more than 1,284 instances where hospital emergency units, predominantly in rural communities, have been unavailable for hours or even days. It’s worth noting that this number is an approximation, and the actual count could be even higher.
While some provinces provide transparency by posting closure details online, others have failed to offer concrete numbers or have not responded to inquiries from CTV. Data was often gathered from health authority websites or news reports documenting ER service interruptions.
Rural emergency physician Alan Drummond emphasizes the gravity of the situation, stating, “There is absolutely no doubt that this is the most closures we have EVER seen.” The growing prevalence of these “service interruptions,” as hospitals term them, is a stark contrast to past years when such closures were rare and confined to specific regions.
The Social Contract and Assured Access to Quality Care
Dr. Drummond stresses the failure to take these closures seriously, stating that they represent a breach of the social contract between the government and Canadians, ensuring assured access to quality emergency care. These closures are not mere inconveniences; in certain cases, they can mean the difference between life and death. Minutes can be crucial when dealing with conditions like strokes or heart attacks, and the closure of an ER can have life-threatening consequences.
A Minister’s Perspective
Rev. Craig Bartlett, a minister residing near Chelsey, Ontario, has been without a family doctor for over two years since returning from work in South Korea. He criticizes the situation in his area, where the closest emergency unit in Chesley, run by the South Grey Bruce Health Centre, has been closed an estimated 157 times in the current year. Bartlett underscores the need to maintain or expand services in the region until a sufficient number of doctors can be recruited.
The Domino Effect on Primary Care
Emergency physician in Thunder Bay, Ontario, explains the broader impact of ER closures, stating that in small rural centers, when an ER closes, access to both emergency care and some primary care is severed. This interruption in healthcare services can have far-reaching consequences for the health and well-being of residents.
Tracking ER Closures and Their Impact
Dr. David Savage, a professor at the North Ontario School of Medicine, started tracking emergency room closures in Ontario after the Red River ER closed for 24 hours in 2022. He counts every instance of an ER opening and closing as a separate closure. In 2022, he tallied 848 closures across the province. As of August 31, 2023, the figure stands at 498, including the permanent ER shutdown in Minden. Dr. Savage expresses concern about the lack of examination into the harms inflicted on patients who must travel for urgent care.
In Northern Ontario, where the average distance between ERs can exceed 100 kilometers and sometimes even more than 200 kilometers, the burden on patients traveling for care can be substantial. Dr. Savage hopes to track the closures and their potential impact on health outcomes, emphasizing that this is a significant access-to-care issue.
Unprecedented Challenge in 2023
Dr. Drummond, with 45 years of experience in medicine, characterizes this year as the worst for emergency medicine. He highlights the disparity between the healthcare professionals’ concerns and government responses, with governments treating this crisis as a temporary glitch while patients’ well-being hangs in the balance.
Possible Solutions
Experts predict that ER closures may persist due to staffing challenges, primarily related to a nursing shortage. Addressing this issue is complex, as there is a considerable lag between training and practicing for healthcare professionals. The nursing shortage, as well as a shortage of doctors, was predicted long before the COVID-19 pandemic.
A 2018 analysis predicted a shortage of 117,600 nurses in Canada by 2030. Dawn Peta, a registered nurse and co-president of the National Emergency Nurses Association of Canada, questions why these shortages were not addressed earlier, given the predictions.
In 2008, the Canadian Medical Association estimated that Canada needed 26,000 more doctors to reach the Organization for Economic Co-operation and Development’s average of four to five doctors per 100,000 people. Currently, Canada stands 17th on the OECD list, lagging behind countries like the United States, France, and Norway.
Rev. Bartlett, who experienced prompt access to healthcare in South Korea, expresses bewilderment at the Canadian system’s functioning. He questions the lack of forward planning to address the healthcare worker shortage.
Retention as a Solution
One consensus among experts is the importance of retaining existing healthcare professionals, both in rural and urban areas. “Retention is a bird in the hand,” says Nova Scotia-based doctor Tania Sullivan, emphasizing the value of retaining current healthcare workers.
Creative planning is deemed necessary. Sullivan’s team is working on a strategy to increase availability from three to seven days a week. They are also focusing on boosting training, using simulators to keep rural health workers’ skills up to date, and considering deploying doctors and nurses to multiple sites to expand coverage.
Retaining healthcare professionals will also require improving working hours and conditions and offering retention bonuses. These measures are expected to keep nurses, both rural and urban, in the healthcare workforce.
The Ominous Future Without Immediate Changes
Despite the urgent need for solutions, the future remains uncertain for hard-hit rural areas. Dr. Savage foresees a potential continuation of closures if staffing challenges are not addressed promptly.
Tracking ER Closures by Province/Territory
The article concludes by providing a breakdown of ER closures by province and territory, highlighting the varying degrees of data availability and the extent of the crisis across Canada. Many provinces face significant challenges in managing ER closures, further emphasizing the urgency of addressing the issue.
As the crisis of ER closures intensifies in Canada, it is imperative for governments, healthcare authorities, and the public to recognize the gravity of the situation and work collectively to ensure that all Canadians have reliable access to quality emergency care, regardless of their geographic location.