Emergency room doctors in Atlantic Canada say “bed-blocking” and patients presenting with advanced disease that wasn’t detected or cared for earlier are driving high numbers of deaths.

Nova Scotia’s health authority says emergency department deaths hit a six-year high in 2023, with 666 deaths compared with 558 the year before.

Newfoundland and Labrador recorded a slight drop in emergency department deaths, from a five-year high of 326 in 2022 to 297 in 2023, but last year’s figure is still higher than the years before and during the height of the COVID-19 pandemic.

Retired doctor Robert Martel, who worked in Nova Scotia ERs for decades, says many beds in emergency departments are blocked because they are occupied by patients who can’t get a spot in long-term care or who need community services.


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He says patients are also showing up at emergency rooms far sicker than they should be, because they don’t have a regular doctor who could have detected their illness earlier.

Dr. Stephen Major, president of the Newfoundland and Labrador Medical Association, says there is ample evidence that patients have worse outcomes when they are kept in an ER long after they require emergency care.

Major is a family physician in St. John’s who worked in emergency rooms before taking a break last year, and he says the concept of “bed-blocking” is also forcing doctors to compromise care, which affects their emotional health.

“There were times where there were 30 admitted patients, and you might have three to five beds that are free to try to cycle people through,” he said. “We’re seeing patients in a chair, in a corner, you’re putting patients wherever you can see them, because they need care.”

Dr. Mike Howlett, president of the Canadian Association of Emergency Physicians and an associate professor at Dalhousie University, says health officials in all provinces need to start long-term strategic planning to ease the pressure on emergency departments.

That planning, he said, must include doctors, heath-care workers, long-term care operators and others offering community care, such as home supports.

“What we really need is a decision by governments to make it a priority that these patients won’t stay in the (emergency) department as long as they are because we know that it kills people,” Howlett said. “By not addressing it, governments and planners are systematically aiding and abetting a service level that virtually guarantees people will do worse.”

This report by The Canadian Press was first published July 10, 2024.