No need to rely on a leaked report - health care workers have been sounding this alarm for years - and especially the past few months. This is the worst I have seen in my 19 years in emergency medicine. So why is this happening? 1/
https://twitter.com/TorontoStar/status/1580265839315804160
Inflow >> Outflow. #s of patients waiting for transfer from our hospital to a LTC (full), repatriation back to a hospital in their home region (full), or to home (no home care available) FAR EXCEEDS #s of patients waiting in the ED for a bed on the ward 2/
Yet those waiting fill all the ED beds as beds on the ward are full. We play ED "musical beds" in order to assess patients and often care for new patients in suboptimal spaces - hallways, waiting rooms, quiet-ish corners. The inflow will always continue - we do not close. 3/
Outflow is difficult on weekends and especially on long weekends when many LTC facilities aren't resourced to accept new residents - thus the patients stay in hospital and the back up into the ED increases. Mon and Tues after a long-weekend are notoriously bad. 4/
The math is clear: outflow needs to equal or exceed inflow every day - provide safe places to transfer to or discharge to and we will have the space we need to see patients quickly and safely. 5/
This is compounded by major Health Human Resources challenges - many HCW are not being paid enough for the highly-skilled work that they do and the risk they are faced with. Their wages have actually decreased relatively due to inflation and #Bill124. 6/
But HHR is also affected by the moral injury that comes from not being able to provide the care to people in the beds you know they need to be in, nor at the standard you have been trained in, nor that you expect for your fellow humans. It weighs you down patient by patient. 7/
We work in our hospital with EMS, colleagues throughout the hospital to flow patients through as safely as possible - but we all being asked by our system to do the impossible. 8/
Family MDs are working harder than they ever have. Complexity has increased greatly. There continues to be a shortage and when people have nowhere to go, they come to us in the ED. 9/
Add to this the ongoing decimation of resources for those who are most vulnerable. Today's announcement of shutting down a shelter hotel in Toronto is devastating. Their health will suffer further. They have nowhere else to go. These humans will be in our ED this winter. 10/
There is always more to do in hospitals - and we work passionately to try new ideas; but they are small compared to the big changes that must come from our government. Improve the outflow now - not a decade from now, #RepealBill124, match resources across ON to the demand. 11/
I work with passionate and skilled people in our ED, hospital and system. I witness brilliance, advocacy and teaching every day among people who care for each other in addition to the patients in front of them. And so I go back each day and fight along side them... until... 12/
... Until one of us will leave or take rest .. usually quietly- as we feel guilty... like we are letting others down. But we must rest - especially when we read of the decreased life spans for those in EM and ask how many more years do I have? 13/ onlinelibrary.wiley.com/doi/full/10.10…
Our government cannot continue to ignore the devastating health care crisis that we are in... Emergency Departments are only the canaries in the coalmine. 14/
PS - if you know an Emergency Department Nurse - reach out and thank them. It is #EDNursingWeek - they deserve far more than a week - but please let them know how truly amazing they are. 15/
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