Thursday’s article by Savannah Awde presented great news for Fredericton; Urgent Care in the greater Fredericton area finally! I have been envious as I travel to visit family in the US and see that they can access Urgent Care in minutes and be in and out with treatment and prescription in an hour or less. All right, it is not a socialized system but surely the principles of innovation and meeting public need must rank somewhere in public policy priority even in socialized systems.
The saga in Fredericton has been a long story and I commend the Horizon officials for getting to it. Those who experience those long waits in Emergency Departments for an intervention that sometimes may take 10 minutes may be able to breathe a sigh of relief. But let’s give them time to work out the wrinkles that inevitably will be there.
Emergency Departments have been compromised for decades by public policy allowing them to become the centre of the community for all things health care in non-business hours or for those who do not have a family doctor. For 30 years, the typical answering machine in physician’s offices has said “if your situation is urgent, we suggest you go to the Emergency Department.” My family has had many experiences with the 811 number giving the same direction.
The truth is that the predominant old tradition of family doctors being available 24/7 disappeared decades ago and rightly so. Doctors are human and need family time, too! But in our socialized system, public policy did not keep up and in the late 1980’s and early 1990’s the system began to show long waits in the Emergency Department. I remember as far back as 1991, one of our hospital board members, a very prominent citizen, arrived late for a board meeting with the story of a several hours wait with his son in Emergency with a non-life-threatening injury.
As far back as the early 1970’s, the consultants who were preparing plans for the Chalmers Hospital had a design proposal that included a space for Urgent Care in the hospital. The intent of the consultants, who had much planning experience with hospitals on the continent and the world, was that there would be a separation of Emergency Department Care from Urgent Care. At that time, the prevailing definition of Emergency was: “imminent danger to life or limb”. That definition was prevalent in the health planning and regulatory sector for decades at that point. Using that definition, there would be no room for treating what is reported to be up to 80% of the volume of traffic in emergency departments.
Urgent Care, by definition, was at that time applied as meaning that treatment is needed but the patient is not about to expire or lose a limbo or have permanent damage to their health if treatment is not administered immediately.
By 1990, Urgent Care Centres were springing up in some centres across the continent, more so in the US, and in 1991 a small group from DECH visited the Eastern Maine Medical Centre in Bangor where the then Medical Director of the Emergency Department stated categorically: “patients will not wait in my emergency department.” When our team visited that hospital in 1991, we learned that the organization was pretty advanced, that nurses, nurse practitioners, physician assistants were trained to work at full scope of practice so that physicians could intervene after much of the preliminary diagnostic work had either been ordered or completed. The department could function as a pure Emergency Department because the non-life-threatening patients were looked after in the Urgent Care Centre located in a separate area and staffed by physician assistants, nurse practitioners, and supervised by a physician.
After a few conversations in Fredericton, the enthusiasm was not felt widely so the department continued to function but with much-needed expansion to the physical space to accommodate growing volumes of patients.
Since those days the long-anticipated “aging of the population” has come on with a vengeance! The predictable increases in fractures, cardiac issues, strokes, and chronic disease crises have grown exponentially as anticipated with an aging population. Combine those factors with general population growth as well as the serious growth in mental health crises and drug dependency problems and the Emergency Department has had challenges that result in the much-publicized long waits to “be seen by a physician.” In addition to all that, the growth in physicians operating practices with limited office hours further contributes to the problem.
To their credit, physicians in several New Brunswick communities established “after hours clinics” which provided some measure of relief to those who could get to them. The issue has been, from a public service perspective, that they have not been functioning as extensions of the hospital but have been independent with hours of service and service organization quite inconsistent.
The growing ALC (alternative level of care) problem has come to crisis proportions in which emergency departments and acute care beds often appear overloaded with patients who can and should be in some form of long-term care situation be it home care, special care, nursing home care. The absence of a provincial plan and strategy for long-term care exacerbates the issue in which there is capacity in the long-term care system but organizational hurdles represent major obstacles to implementing essential reforms.
Meanwhile, on a visit to the US, should you experience a serious chest infection or have some other urgent but not emergent problem, an Urgent Care Centre will look after you in moments; no 17 hour waits for non-life-threatening issues to get attention.
Recommended by consultants some 50 years ago, think of the many, many people who have suffered serious hardship and suffering in the meantime. Why was it not enacted when recommended? Apparently, there was need for the space to be used for other purposes such as Endoscopy Clinics, Cardiology Clinics and such. And these are legitimate needs as well. But one would think that in that time it would be possible to find solutions to what has been a growing, now crisis, problems with Urgent Care.
South of the border where the system is not socialized, solutions have sprung up. It is simply jaw-dropping that it has taken this long for government, physicians, nurses, health authorities to get it together. The health authority deserves a salute for taking this step and one can only hope that this is the beginning of a process of getting primary care structured in such a way that serious consumer issues are given priority.
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at email@example.com or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.