ER spillover into hallways creating patient risk at Halifax hospital: study

Code census hits all-time high The NSGEU says emergency room code census is putting patent safety at risk. CTV’s Sarah Ritchie reports.

HALIFAX -- Staff at Atlantic Canada's largest hospital has had to perform CPR in elevators and hastily erect brown paper room dividers due to spillover from a crowded emergency department, says a union study.

The Nova Scotia Government and General Employees Union released the report on Monday tracking a rise in so-called code census incidents at the Halifax Infirmary, when the emergency department declares the ward is "unsafe" and starts sending patients to in-patient units.

Last year, the Infirmary had 146 code census incidents, up sharply from the 87 times the rapid transfer system was enacted seven years earlier, though the figures have fluctuated.

In January, there were 23 code census calls -- a new high for a single month.

"Code census only moves the problem of overcrowding onto in-patient floors," said Jason MacLean, the union president, during a news conference in Halifax.

"It's not safe for code census to be called virtually every day in a one-month period."

MacLean said he couldn't comment on whether there have been deaths or injuries directly related to the overcrowding.

However, the union report includes several anonymous accounts from senior nursing staff who allege patient safety was harmed as a result of the influx of ER patients, as backlogs emerged between units and patients are left in hallways.

In one account, a nurse told researchers the sudden arrival of emergency patients meant patients in intensive care couldn't be transferred into regular beds when they were improving.

This in turn led to long waits for acutely ill patients who needed to go into intensive care, leading to heart attacks in elevators when last-minute transfers to the ICU were attempted.

"It can take an hour or up to five hours to get the patient into intensive care units ... and we have had some very critical incidents like doing CPR in the elevator and so on," the staff person said, referring to incidents in the last two years.

"We gave the patient a cell phone and our number and said 'call us if there are any concerns,"' said the account from an unnamed registered nurse.

In another recent incident, "two patients were placed in a private room separated by a sheet of brown paper," says the 66-page report.

In another case in February, the hospital had to put a patient in a family waiting room for the night, according to the report.

The union also released statistics obtained through freedom of information that documents the growing use of the ER and longer wait times for patients.

According to the report, slightly over 72,000 patients turned up at the Halifax Infirmary's emergency department last year, about 14,000 more than in 2008-09.

The union made 15 recommendations to the Nova Scotia Health Authority and the Health Department, including the need to publicly document code census calls and treatment wait times, and to revisit policies on staffing levels when overcrowding occurs.

It suggests the health authority conduct an automatic review when any long-term care patient -- usually people awaiting care in nursing homes -- has been occupying a hospital bed for more than four months.

The employees' union is also calling on the province to study the underlying causes for the sharp increase in the number of patients showing up at the Infirmary's emergency room since 2009.

Health Minister Leo Glavine sent an e-mail thanking the union for its "long and detailed report," and said his staff will be reviewing it.

NDP Leader Gary Burrill said the health authority has neglected primary care in recent years, as it focused on a complex restructuring to create a single health agency in the province.

He also criticized the Liberals for failing to move more rapidly on opening new nursing home beds, leading to more hospital space being used by elderly patients who can't find a spot in a long-term care home.

Health authority spokeswoman Kristen Lipscombe said the authority "has established an action team aimed at improving patient flow across the province's health care system."

"The recommendations in the union's report highlight a number of factors that are already areas of focus for NSHA. We welcome the collaboration of unions in addressing them," she said.

MacLean said the union plans to continue doing freedom of information requests and releasing monthly statistics on wait times and the frequency of the code census calls.

"Government is accountable for this problem. They've ignored it so far because they've been allowed to ignore it this far," he said.