North Cumberland Memorial Hospital in Pugwash.

The Nova Scotia Health Authority is hoping to clear up some confusion regarding to the Collaborative Emergency Centres and the services offered.

Barbie Cook, the site manager for the Lillian Fraser Memorial Hospital in Tatamagouche and North Cumberland Memorial Hospital in Pugwash, said the document was put together following a community meeting in Pugwash in March.

“There were four things we had as topics of conversation at the meeting,” said Cook. “Primary health care, recruitment of doctors and retention, and ER closures.”
The meeting, which saw about 70 people in attendance, had presenters from the authority on those topics, and there were question and answer sessions for each.

“One of the most heated conversations and where people are most concerned are the ER closures. There is still a lot of confusion as to what is being offered at the Collaborative Emergency Centres, more so than we realized.”

The document states no doctor is in the building overnight at the CEC, however the staff at the facility can call a doctor on the phone after assessing a patient. They’re able to come up with a care plan for the patient.

“These are not local doctors doing this on-call service, so it frees up the local doctors to be more available in the daytime when volumes are higher,” the document reads. It also states the frequent daytime closures are continued to be addressed.

During the day, unscheduled patients at the CECs are assessed by a registered nurse before being seen by a doctor or most appropriate provider. The team includes dieticians, nutritionists, mental health professionals, and occupational and physiotherapists. Diabetic education, addiction and mental health services, palliative care, and respiratory therapy are also available.

Overnight, beginning at 8 p.m. for most CECs, registered nurses and or paramedics with Emergency Health Services assess patients before calling an offsite emergency doctor for collaboration on a care plan. Patients could be treated and released with advice on self-care. They may be recommended to follow up at a clinic or CEC the following day. Patients may also be sent to a larger hospital by ambulance (at no cost).

Anyone to call a CEC during the overnight hours will be reminded no doctor is on site. Patients can choose to attend for assessment and treatment by the overnight team.

During overnight hours, paramedics aren’t allowed to bring patients by ambulance to the CEC, however taken to the most appropriate regional or tertiary facility.

When a CEC is closed due to lack of physician coverage, no doctor is available to respond – in person or via phone – to urgent or unscheduled visits.

“Even though we strive to make sure there is always a doctor available during daytime hours, there are still times when we have to make a decision to close the CEC due to lack of resources,” reads the document, noting ambulances don’t transport patients to the CEC when it is closed.

If a patient attends the CEC when it is closed, the nursing staff can assess the patient and respond according to protocols available. Nurses are limited in being able to treat patients independently, however will do what they can. A number of minor ailments can be treated without a doctor present, such as minor abrasions and scratches, minor burns, head lice, ring or single fish hook removal, tetanus administration, and suture and staple removal.

If emergency situations present themselves, there are some protocols in place, however nursing staff may not have the staff or equipment to treat a potentially life-threatening illness or injury as efficiently as possible.

In these cases, calling 911 is advised, or visiting another emergency department

Information on when CECs are closed can be found online at www.nshealth.ca under the ‘news’ tab, by calling 811 or the local facility, or listening to daily radio announcements.

Statement from Nova Scotia Health Authority on Collaborative Emergency Centres

At a community meeting held recently in Pugwash, we heard that it is confusing to know when people should go to their local health care facility and for what reason. Nova Scotia Health Authority (NSHA) is working very hard to make this easier for the public.

The rural health care facilities with emergency departments in Nova Scotia Health Authority’s Northern Zone moved to a Collaborative Emergency Centre (CEC) model in 2011 and 2012. The emergency departments in Pugwash, Springhill, Parrsboro and Tatamagouche are now referred to as CECs. NSHA’s Northern Zone includes the Municipality of East Hants, as well as Colchester, Cumberland and Pictou counties.

The CEC model means that a doctor is not in the building overnight, but the staff at the facility can call a doctor on the phone after they assess the patient to come up with the plan of care for that patient. These are not local doctors doing this on-call service, so it frees up the local doctors to be more available in the daytime when volumes are higher. This helped address increasing doctor resource issues, as most sites had been experiencing more closures, and we continue to address challenges.

The following information is to help clarify the difference between the daytime and nighttime model of care at a CEC.  It will also clarify what it means when the CEC is closed due to lack of doctor coverage.

Most importantly, people need to know where to go for help when they need it, and what to expect.

We cannot overemphasize enough that if you need immediate assistance regardless of whether the CEC is open or closed – call 911.

The Collaborative Emergency Centre Daytime Model

If you present to an open emergency department during the daytime, unscheduled patients will be assessed by a nurse (RN) and then seen by the doctor or most appropriate provider.

Doctors, nurse practitioners, nurses, and other health care providers are working closely together as part of a team to provide care for you and your family. They are part of a broader local team that often works together outside the centre, but stay closely connected.

The team includes dieticians and nutritionists, mental health professionals and occupational and physiotherapists. Access to diabetic education, addiction and mental health services, palliative care, and respiratory therapy is also available.

The Collaborative Emergency Centre Nighttime Model

Every night between 8 p.m. and 8 a.m. (or 8:30 p.m. and 8:30 a.m. in Parrsboro), your CEC is staffed by registered nurses and/or EHS paramedics who will assess you and then call an offsite emergency doctor to collaborate on a plan for your care.

You may be treated and released with advice on self-care. It may be recommended that you have a follow-up appointment at the clinic or the CEC the next day. Or you may be sent on to a larger hospital by ambulance at no cost to you.

If you call the facility during these hours, you will be advised that there is a registered nurse and/or paramedic on site, but you will also be reminded there is no doctor on site. You can choose to come in to be assessed and treated by the overnight team.

Ambulances are not allowed to bring patients to a CEC during these hours, so if a patient is picked up by EHS, treatment will start as soon as they arrive and they will be taken directly to the most appropriate regional or tertiary facility.

What does it mean when a Collaborative Emergency Centre is “Closed due to lack of physician coverage”?

This means that there is no doctor on call to respond (in person or by phone) to urgent or unscheduled visits.

There are various reasons that could have caused this closure (vacancies, staff illness, weather, etc.).  Even though we strive to make sure there is always a doctor available during daytime hours, there are still times when we have to make a decision to close the CEC due to lack of resources.

During this time, the radio provides public service announcements that the facility is closed. You may also call the facility or 811, and you will be advised the facility is closed and to go to another open facility.  Note: EHS ambulances do not take patients to the CEC when closed.

If a patient, unknowingly, presents to the closed CEC due to no doctor available, the nursing staff will assess the patient and respond according to protocols that they have.  Without a doctor present, registered nurses are limited to what they are able to do independently for patients, but they will always do what they can to help.

It is important for patients to be aware that nursing staff will need to register patients regardless of whether or not they are being seen by a doctor, so patients should always bring their health card.

There are a number of minor ailments that nursing staff are able to follow specific protocols to do independently without a doctor present. These protocols include: minor abrasions and scratches, minor burns, head lice, ring or single fish hook removal, tetanus administration, as well as suture and staple removal.

Nursing staff also have protocols in place to deal with emergency situations if necessary, but they may not have the staff or equipment available to treat a potentially life-threatening illness or injury as efficiently as possible.

It is always advised to call 911 or visit another emergency department in these cases.

Ways to find out what CEC is open

1)      Visit the www.nshealth.ca website and click on the “News” tab: http://www.nshealth.ca/news;

2)      Call 81;1

3)      Call your local facility to ask;

4)      Listen to daily radio announcements.

Over time, there have been many adaptations in our rural hospitals in order to sustain the highest level of service possible with the resources that we have. Understandably, this lack of consistency causes confusion and frustration.

It is helpful for Nova Scotia Health Authority to hear from community members about things that may cause confusion and suggested ways to improve communication.

We encourage people to send their ideas and/or feedback to patientfeedback@nshealth.ca or call toll free: 1-844-884-4177

Know when to call 911

If somebody’s life is potentially in danger (chest pains, severe pain or trouble breathing) call 911 immediately – it is available 24 hours a day.

Nova Scotia’s highly trained paramedics will respond with emergency medical care you can trust and take you to the right hospital for the care you need. Treatment can often start immediately and sometimes a trip to the hospital can even be avoided.

Most Nova Scotians with a valid health card are charged $134.52 for emergency transport to a hospital from their home. This may be covered by personal insurance.

For more information, please visit www.gov.ns.ca/health/ehs/fee.asp or call toll-free at 1-888-280-8884.

Know when to call 811

If you have symptoms, you’re not sure what to do, or need health information, call 811 and talk to a registered nurse — also available 24 hours a day — for advice on the best course of action. ** Residents without a primary care provider are asked to call 811 to be registered on the Need A Family Practice provincial wait list **

Reminder: You can also try calling your primary care provider to see if they can fit you in to an appointment in the next day or so. Generally, most doctors and nurse practitioners try to leave some space for this each day, but people don’t always think to check.

Other helpful phone numbers

  • Dial 211 to find the right community and social services.
  • Dial 1-800-225-7225 to obtain information regarding continuing care.
  • Dial 1-888-429-8167 when in mental health crisis (available for children, youth and adults).
  • Dial 1-877-488-7338 to access free services and programs at Caregivers Nova Scotia, a non-profit organization created specifically to help unpaid caregivers.

 

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Raissa Tetanish
Raissa Tetanish is the editor of the Tatamagouche Light. She has more than 12 years experience as a reporter, with a background in both photography and photojournalism. She can be reached at 902-305-6177, or raissatetanish@tatamagouchelight.com.