Thread by @Brent_Thoma

Beds in Saskatoon's overnight EDs (JPCH, RUH, SPH) last night: ~70. Consulted/admitted patients in our EDs: 73. Total # of patients in our EDs: ~155.
"That can't be possible, where are the emergency patients seen?" Good question. 1

First, not all admitted people get a bed. Our consultants also admit patients from the waiting room or a hallway. This gives emergency very few beds that are only used by really sick patients. Second, we maximize our space however we can. For example, at RUH: 2

We put a stretcher behind triage to see the 30-40 waiting room patients. It's in the main hallway behind a curtain so not ideal. People get assessed then sent back to the waiting room. Some meds are provided by already overburdened triage nurses. Many get discharged from here. 3

We have a 'treatment room' where multiple people can sit in chairs while getting IV fluids and meds if they don't need monitors. We pull patients out of that room to a repurposed tiny room for their assessments. Unfortunately, this was closed last night due to a lack of nurses.4

We have also repurposed a storage area off of a hallway by adding a bed and curtains. Patients sit in chairs in the hallway and get pulled there for assessments then sent back to their hallway chair. This was also closed last night due to a lack of nurses. 5

And of course, there is the paramedic hallway. Paramedics line up their stretchers with patients that there isn't space/staff for in the department. They can be there for hours (full shifts, even). Sometimes we assess and manage their care entirely on those stretchers. 6

Sometimes we get even more creative. For example, last night my boss Dr. Smith saw a patient outside:

https://twitter.com/Joanna_jds114/status/1432752386590793734

. Often, people just leave without being assessed because they have been waiting for so long (some lower acuity patients waited >6 hours last night). 7

"But the sickest patients get a bed, right?" We try. But it depends on your definition of sick. Possibly dying (Triage 1)? We'll find somewhere. Potentially very sick but not dying now (Triage 2)? Sometimes they are triaged to the waiting room to await the next open bed. 8

"Hasn't it always been like this?" We’ve had worse nights in the last few months, but never before then.

"Other places are worse." Yes, probably. Not something to aspire to though, is it?

"It’s not all #covid19sk though." No, it isn't. But covid takes space others could use. 9

“Isn’t the department brand new? Why isn’t it bigger?” It would be more than big enough if we used it for emergency patients (remember all those admitted patients filling every one of our beds?). 10

Also, the new building didn’t come with extra staff and the pandemic hasn’t been kind to the ones that we have. Many have left. Despite this, we never close our doors to a patient. 11

No matter what brought you to our department, we will try to help. We’ll continue to try to make things work. Because that’s what we do. But every day we work like this will cost us more skilled staff as they leave due to burnout. 12

And I’m going to be honest, we are running out. Being understaffed is now the norm. At some point, we'll need to create more capacity. That will likely require cutting other services to redeploy their staff. Nobody wants to do that, but we also don’t want this. 13

You deserve better, Saskatchewan. And I’m sorry that we aren’t delivering it right now. I hope this helps clarify where we are at and why we can’t accommodate a raging virus right now. If it is unacceptable to you, please call your politicians and ask them to help us. /end