Where is your emergency doctor? Clean the rooms; there’s no one else to do it

Exhausted and with his N95 strap marks still etched on his face after a recent weekend shift, the ER doctor’s quiet desperation is palpable as we speak.

We won’t use his name because he’s not authorized to comment publicly, but emergency room care in Canada is life support, and he thinks Canadians should know why.

While you wait for help, the ER doctor waits for someone else to do their job so the doctor can reach you. These tasks, he says, are either falling more and more on him or not being done at all, despite the obvious and overwhelming need.

This doctor has been trained for 11 years to learn how to save lives in an emergency. He tells me that his emergency department treated 95% of patients in less than four hours before the pandemic. In the last two months, it regularly takes 14 hours. The average waiting time to be admitted to hospital in Ontario is currently the highest on record — about 20 hours.

There are many reasons for backups — pandemic protocols, an aging population, more people without a family doctor, burnout and illness — and many solutions, all of which require more spending.

But some expenses Safe silver.

These days, the ER doctor says he increasingly finds himself cleaning rooms, entering data, booking diagnostic tests, sterilizing and finding parts for equipment, as he there are not enough people to do this work.

“I’m going to look in your ear with the light, and the light is burned out. It’s mind-boggling how often that happens. If they just spent money…to make sure these things are in place in case if necessary, we could all work much harder and faster.

He tells me he doesn’t understand why there aren’t more workers to provide basic supports.

“You would think they would spend more money to make us work more efficiently and faster. Instead, they spend more to make us work less efficiently and more slowly.

The emergency department sees about 240 patients a day on average, he says, up slightly from the pre-pandemic average of 230 patients a day.

Typically, ER doctors here see about 1.8 patients per hour. This is down from 2.2 patients per hour on pre-pandemic days, but not primarily because of COVID-19.

Much of it is also due to technology.

Perhaps his biggest problem is the time he says he should now spend interfacing with a screen rather than patients.

The hospital fired the clerks who used to enter this data instead of turning them into medical assistants and assigning them to 24-hour shifts.

“It is now up to me to put this information in the system. Before, it was someone else’s job.

The new electronic medical record and computerized order entry system routinely malfunction, he says.

In a emergency department.

He’s also baffled by the lack of cleaning staff, even as he rushes to make sure a room is open as quickly as possible.

“A maid waiting to clean the room is considered too expensive. Instead they have a doctor waiting for the room. How is it cheaper? »

When he goes ahead and does the work – wiping things down, disinfecting – he does it at an hourly rate of pay 10 times or more that of the cleaner.

Then there is patient care. On a recent night shift, he sent six patients home and rescheduled diagnostic tests for daytime hours because, despite a decade of advocacy by the ER group for full night X-ray coverage, they only treat life-threatening cases overnight.

Each time a patient who has registered to be seen in the ER leaves and returns, they must re-register, at a system cost of around $400 each time – even if they receive no service.

One night, one doctor, six patients with unresolved issues, $2,400. Wasted.

This week, the Financial Accountability Office revealed that Ontario underspent its 2021-22 budget by $7.2 billion (3.9%)but exceeded its health budget by $4.1 billion, including $3 billion for hospitals.

Have we been better cared for?

Last week, Canada’s provincial and territorial premiers asked $28 billion more per year from the federal government for health care, without conditions. That’s to say 65% more that the federal government currently transfers to the provinces and territories for health care.

Not only is there no plan to fix the ER doctor’s light bulb, reboot his computer system, or clean up his exam room so he can do his job; there is no plan, period.

The cult of efficiency that has plagued all utilities since the 1990s has rendered the system incapable of dealing with surges.

We are using the most expensive workers in the most expensive part of our health care system to do the work that other types of workers could and should do, at a much lower cost.

It’s not a new idea. When I wrote a report for the federal government in 2006 on how to use international assistance to achieve better health care outcomes, I tapped into stories how people without medical experience were trained to provide simple health care to their peers in their communities.

This thought is regularly used in the distribution of malaria prevention tools around the world. We trained thousands of dental therapists to provide primary dental care to children in their schools in Saskatchewan and Manitoba in the late 1970s, using dentists only as needed. During the pandemic, we trained people with little medical experience to become vaccinators in 8 to 10 hours.

Modular training, or “badging,” is used in the skilled trades and the military to increase the supply of particular skills and reduce bottlenecks. Why not in the field of health?

There is no quick fix for what ails us, but – as this doctor’s story shows – there are many things that can be done, intentionally, systematically, to pull us out of the hole.

Hiring more lower-paid workers to help higher-paid workers put their skills to full use is a small step that could bring big change for patients and healthcare workers alike.

More money without a plan is not a sustainable path forward.

Comments are closed.