A spokesperson for Southern Health-Sante Sud says hospitals in the region continue to handle a lot of cases that do not need to be seen at an emergency room (ER).
Dr. Aly Dhala is Chief Medical Officer. He says it has been a fairly busy summer at their emergency rooms, particularly at the regional centres like Boundary Trails Health Centre. He notes the uptick in volume is related to closures and service disruptions at some smaller sites. As a result, patients then tend to go to the larger regional centres that are open 24 hours a day, seven days a week.
Dr. Dhala says when an individual presents to an ER, they are triaged based on the severity of their condition. This is done by using the Canadian Triage and Acuity Scale (CTAS). This scale uses five levels of severity with CTAS I being the most severe and CTAS V requiring non-urgent care.
"We see CTAS one to five across the board at regional centres," he says.
According to Dr. Dhala, cases of CTAS IV and V are generally less urgent and can probably be managed without presenting to an ER. This could include a minor illness, such as a cough or cold, skin rash or ankle sprain. It can include lumps and bumps, as well as prescription refills and vaccinations. He notes ideally these should be seen at a clinic or through a family physician.
At the opposite end of the scale is CTAS I, II and III. Dr. Dhala says these are more severe conditions where an individual needs emergency and critical care services. For example, this can include symptoms of a stroke, such as facial drop or loss of function in a limb. It can include signs of a heart attack, such as crushing chest pain that is going to the jaw or shoulder. Other examples of CTAS I, II and III are the sudden onset of a severe headache or confusion, a traumatic fall where a limb might be fractured, significant bleeding and an allergic reaction.
"When I say allergic reaction; tongue and lip swelling, difficulty breathing and someone who has a known allergy and they've been exposed," he explains. "We'd want to see those people in a more acute setting like an ER."
Dr. Dhala reminds the public that when it comes to emergency rooms, patients are not treated on a first come first served basis. He notes the wait time for a patient is determined based on when they showed up but also the severity of their condition.
"You might present to the ER with a rash, and you might have a three to four hour wait time in the waiting room," he explains. "If someone comes in with a heart attack or a concern for a heart attack, that person is going to be seen before you and you are going to be bumped."
Dr. Dhala says non-urgent conditions are best treated at a primary care setting in order to give capacity to the really urgent or sick patients who need to be seen.
"If you present to the ER with a less acute condition, you might not necessarily be turned away, and you won't be turned away, but you could face a very long wait time," he says. "And that wait time might not be acceptable to you."
Dr. Dhala says emergency rooms across the region see a lot of cases of CTAS IV and V. And though it is tough to estimate the percentage of these cases, compared to CTAS I, II and III, Dr. Dhala says at the hospital where he works, they could easily have one-third of visits fall into this category.
Rather than visit the ER for cases not considered urgent, Dr. Dhala suggests trying a quick care clinic or trying QDoc, which is virtual health care.
"I'd encourage patients to try to connect to those types first before running straight to the ER," he says. "At least try to connect and see what options are available in terms of getting a visit in to be seen for those lower acuity conditions."
Dr. Dhala says ideally, they want to get to a place where patients are connected with a family physician or other type of primary care provider, such as a nurse practitioner. He notes there are many benefits in having continuity with your care provider, because they are the ones who know your chart and history, leading to better outcomes and fewer errors.
Dr. Dhala says there is a lot of work underway to improve primary care access. He says the regional health authority realizes that good primary care can lead to decreased visits to the ER.
"It is something that we are actively working on," he says.