Small ERs are shuttering across Canada. Is this really such a bad thing?

Small ERs are closing from coast to coast to coast. Chesley, a small town 175 km north of London, Ont. has recently had to close its ER for months due to staff shortages. Paris, Ont., 10 minutes from me in Cambridge, where the first long-distance phone call was made by Alexander Graham Bell (it was a telemarketer) closed its ER and made it into an urgent care centre decades ago. The Paris Willett Hospital Urgent Care Centre is open from 9 a.m. to 9 p.m. weekdays and weekends from 10 a.m. to 6 p.m. My patients love it because it’s way faster than the big ERs that are backed up with true emergencies. Also, the family doctors love not having to be up at nights. The tiny number of patients can be taken by paramedics to nearby Brantford General Hospital with shift-working emergency physicians onsite. Plus, Brantford General has CT, blood bank, internists, pediatricians, ob/gyns, ENT, anesthetists and surgeons readily available. Closing ERs is a really inflammatory topic because the public is rightfully afraid of losing ERs near them and eventually afraid of losing their hospitals. Small hospitals are not only there for care but are major employers with good, well-paying jobs. I consulted many years ago on small ERs trying to stay open. I used to hear that babies would be dying in the streets if the ER was closed. I would ask: What babies and what streets? Give me names and dates and locations. Give me data. The answer is to look at the cold hard data and not the emotional side. We would start by looking at the number of patients coming into the small ER after midnight and before 8 a.m. for the previous 365 days. You need a year because there is seasonal variation especially if it’s a resort area. Ski injuries in winter and car and farm accidents in summer. Usually, it was zero or one patient. The number of true emergencies (ABC, or Airway obstruction, Breathing problems or Circulation issues) is tiny, thank goodness. But even one patient with a life threatening condition ever is unacceptable and they need optimal care. But what can a small ER do for a true emergency? The exhausted family doctor is usually home after a hard day at work and has to work the next day. She has to get over to the ER and may not have the training or experience that comes from seeing a high volume of emergencies. An emergency physician sees these things all the time and has the skill sets to deal with them. I know because I was an emergency physician for 20 years and a family doctor for 30. Also, for a car, snowmobile or tractor accident, you might need a surgeon to take out the patient's ruptured spleen and the delay of coming first to a small ER can be fatal. Paramedics can start an IV and drive right to the big regional hospital and be met by a trauma team and go right to the OR. I worked at the Wrinch Memorial Hospital in tiny Hazelton in northern British Columbia, so I know what it is like to be in a small town alone in winter. My cottage is on southern Georgian Bay near Penetanguishene, Ont., 130 km north of Toronto. Years ago, I had lunch with some family doctors from there. I asked them why they had to staff the ER when there was a shift-working emergency physician five minutes away in Midland. They said they had always done it, and after our chat they thought it was a good idea to close the Penetanguishene ER. If I have a heart attack or fell off my deck at my cottage, I would be transported by paramedics past this closer hospital to Midland. I believe in closing small ERs and turning them into urgent care centres 12-hours a day for me, my family, my friends, my neighbours and everyone. I have skin in the game. Shelbourne, Ont., a small town 80 km north of Toronto (which we drive by every weekend going from Cambridge to our cottage), also closed its ER. I dropped in one day during a blizzard and asked them what happens in bad weather if they can’t transfer to a bigger ER. They said everyone stays indoors and they have had hundreds of years of coping with whiteouts and bad weather and it wasn’t a problem. Years ago, I also went to the two hospital cities Chatham, Sarnia (my hometown), Pembroke and Brockville to help the local family doctors close one ER and staff the other one with on-site doctors. A brave CEO in Chatham asked me to help, and he could have lost his job over closing one ER. He knew this would save lives because there was no doctor in either of their two ERs, so we closed one and had a family doctor onsite in the other one. Before that, they were trying to cover two ERs from home or office. Not the best care. And stressful for the docs. I helped the Hotel Dieu Shaver Hospital in St. Catharines, Ont. keep its ER open because it had enough patients to justify doing so. Also in Petrolia, a small town between London and Sarnia, I recommended its ER stay open because it was too far away from Sarnia General Hospital (now Bluewater Health) 21 km away. What do you think? How do we save our small ERs. Throwing money at the problem doesn't work. Turning them into 12-hour urgent care centres can help patients get fast, good care and not burn out the doctors, nurses and staff. Win, win, win. If you are struggling with ER staffing in your area, drop me a line. Don’t reinvent the wheel. It’s good to have a neutral outsider cut through the emotions and take the blame.

Small ERs are shuttering across Canada. Is this really such a bad thing?

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