CAEP Media Logs

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News

Healthcare continues to be a top of mind issue for Canadians as reflected by the media in a multitude of news programs, daily print articles and web stories. Your association plays an active public affairs role with the media, offering them expert accounts and insight from physicians who have first hand experience and understand where emergency medicine factors into the larger system.

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Letters

Globe and Mail

May 25, 2010

We agree entirely with Dr. Howard Ovens that there is a cure to the problem of crowded emergency departments.

Timely access to emergency care is a basic human right and Ontario is to be commended for being the first and thus far,the only province to acknowledge its shortcomings in this regard, the threat that this poses to its citizens and addressing the problem in a well-thought out systematic manner.

They have set and monitored wait time targets, targetted deficient hospitals for improved system design, impressed upon hospital administrations the need for improved patient flow and appropriate bed management practices and called for greater direct acccountability.

The only thing lacking is improved hospital bed availability to meet the needs of an aging population.  It is felt that crowding does not occur when hospital bed occupancy is at 85%, occurs regularly when hospitals are at 90% occupancy and is a given when hospitals function at 100% bed occupancy, as they often do in urban Ontario hospitals.

This is the missing piece of the diagnostic puzzle but with Dr. Oven's leadership, and the demonstrated commitment of the Ontario government, we feel confident that Ontario will continue to lead the way to solving ED crowding on a national basis.

Alan Drummond, MD

Chair, Public Affairs, Canadian Association of Emergency Physicians

Ottawa

In Search of the RX for ER

The Globe And Mail

Tue May 25 2010

Page: A17 Section: Comment Column Byline: Margaret Wente

Dr. Howard Ovens walks so briskly that it's hard to keep up with him. He's an emergency-department doctor, and speed matters.

But if you're waiting in ER, speed doesn't seem to matter. When I took my mom to the hospital a couple of weeks ago, she waited 10 hours to see a doctor. After 17 hours, the doctor decided to admit her. In all, it took more than a day to get her from her bed to a hospital bed. She wasn't in any danger. But it's hard, and her experience is far from uncommon.

Dr. Ovens is passionately determined to change that. He's head of emergency at Toronto's Mount Sinai Hospital, and he's also one leader of an ambitious three-year project that's tackling ER gridlock across Ontario. The stakes are high. "If people think the emergency problem is unsolvable, then they won't touch it for years to come."

The primary problem in ER is not that too many people are showing up with the sniffles. The problem is that truly sick people wait too long to see a doctor and get a hospital bed. That leads to overcrowding, back-ups and sometimes tragedies, to say nothing of headlines that are highly embarrassing to politicians. Politicians are extremely eager to fix ER wait times.

So what's the key to busting up the ER gridlock? Think like people who work in manufacturing. Measure everything. Gather data. Set standardized performance targets. Align people and systems with incentives. Analyze the data. Make the data public so that every hospital can see how it's doing compared to others. "People and systems respond rationally to incentives," says Dr. Ovens.

At the heart of Mount Sinai's emergency department is a big electronic display board that registers the status of each patient and the time remaining to meet the wait-time target. For example, the standardized target for treating simple cases (a broken arm, an earache) is four hours from the time the patient arrives until the time she goes home. For complex cases, it's eight hours. The staff can look at the digital board and see at a glance that in order to meet the target, they have 57 minutes left to finish treating Ms. X. All the performance stats are constantly updated and available by computer. This year, every hospital in Ontario is expected to discharge 80 per cent of the complex cases it sees in emergency within eight hours. Mount Sinai is currently achieving 85 per cent. The hardest nut to crack is wait times for people like my mom, who need a hospital bed. But beds are hard to find, so big urban hospitals are way behind on that one.

Last year Mount Sinai got an $800,000 incentive bonus from the government for improving its emergency department performance. The money went for extra staff and beds. There are intangible rewards as well - such as improved staff morale and fewer surly patients. "The greatest reward for staff is a better professional working environment," Dr. Ovens says.

The notorious problem with ambulance offloading has been fixed, too. Paramedics used to hang around for hours (frequently on overtime) waiting to turn their human cargo over to the hospitals. Hospitals were punished for success, because the faster they treated ambulance cases, the more ambulances would pour in. Now there's a dedicated nurse assigned to ambulance cases, who can take them over right away. All hospitals are obliged to share the ambulance load. At Mount Sinai, the turnaround time for ambulances is down to 18 minutes.

Then there's the dog that didn't bark. Last fall, emergency departments across the province were hit with record volumes during the H1N1 epidemic. They handled it. No bad-news headlines. Proof, says Dr. Ovens, that the system is markedly improving. The biggest enemy of progress is fatalism, he argues. "If we're fatalistic, we let the system off the hook." Then he says goodbye and strides away, fast. _________________________________________________________________

National:

CTV April 29, 2010

Doctors say scrapping long-gun registry a health risk

OTTAWA — A group of emergency doctors, nurses and suicide prevention workers asked members of Parliament to vote against a federal bill that seeks to quash the long-gun registry.

The group says a significant drop in gun-related suicide since 1995 is evidence the registry works and scrapping it would set them back years in suicide prevention.

"Suicide, contrary to public opinion, is often an impulsive gesture," Dr. Alan Drummond of the Canadian Association for Emergency Physicians said Wednesday.

"Keeping guns away from depressed people is essential."

Drummond has never seen a handgun injury in his 27 years as an emergency physician in rural Ontario, but he's seen more than a few injuries and deaths inflicted by rifles and shot guns -- most of them suicides.

"As a coroner I go to lots of gun-related suicides. I'm telling you it's difficult, it's gut-wrenching."

The majority of firearm deaths in Canada are suicides and the guns most often used are rifles and shotguns, the group wrote in an open letter to MPs Wednesday.

That's why the 61 organizations and medical professionals who signed the letter see gun registration as a public health issue rather than a crime control issue.

A private members bill introduced by Manitoba Conservative MP Candice Hoeppner seeks to scrap the long-gun registry. The bill has already passed two readings in the House of Commons with support from eight Liberal MPs and a third of the NDP caucus. A third passage will send it to the Senate where a Conservative plurality makes its adoption much more likely.

The long-gun registry has been highly divisive since its inception. A Canadian Press/Harris Decima poll released in November found 46 per cent of Canadians believe abolishing the long gun registry is a good idea, while 41 per cent think it's a bad idea.

The registry has been criticized for being inefficient, ineffective in reducing crime and massively overrun in cost.

Liberal leader Michael Ignatieff, who supports a reduction or elimination in penalties for long-gun owners but wants to keep the registry, has said he will force his MPs to vote against the bill when it comes up for its third and final reading.

"The Liberal leader is not fooling anyone with his proposals for unconstitutional amendments to Bill C-391," Minister of Public Safety Vic Toews said in the House of Commons Wednesday. "It is time to end the criminalization of our hunters and outdoor enthusiasts once and for all."

There may be more guns and stronger opposition to the registry in rural areas. But health experts point out that there are also higher rates of gun deaths in rural communities and western provinces.

"Firearm related injury is not an urban crime problem in downtown Toronto. These things happen in idyllic little communities like Perth," said Drummond, who is a physician at the Perth and Smiths Falls District Hospital.

Since the gun registry was implemented there has been a 23 per reduction in gun-related suicide and a 36 per cent reduction in the use of firearms in intimate partner violence, Drummond said.

He said people who are suicidal are often brought to the hospital by police who can alert doctors if the person has a gun in his or her home.

"Knowing that a patient owns a gun is extremely important and valuable information for us as we determine the future risk of suicide."

"We commonly ask the police to remove guns from the home of those identified at risk."

Gun-related suicide attempts are far more lethal than other methods. Gun users stand a 96 per cent chance of dying, while the lethality rate of drug overdose is six per cent.

Drummond said he is a gun owner himself and is not against gun ownership but he is an advocate for responsible use.

"Suicide usually affects young people with big lives ahead of them," he said. "And we know that with effective treatment for depression and mental illness that they can go on to lead productive lives."

"Every potential suicide victim counts."

Toronto Sun   APRIL 28, 2010

Doctors: Gun registry helps prevent suicide

By CHRISTINA SPENCER, Parliamentary Bureau

Last Updated: April 28, 2010 6:59pm

OTTAWA — Scrapping Canada’s long-gun registry would undermine significant gains in suicide prevention since the registry was put in place, emergency doctors and public health organizations say.

In an open letter to MPs Wednesday, 28 medical and health organizations said most firearms deaths in Canada are suicides, and the guns most frequently used are rifles and shotguns. They argued gun-related deaths and suicides in particular have diminished since the gun-registry law was passed in 1995.

“As a coroner, I go to lots of gun-related suicides,” said Dr. Alan Drummond of the Canadian Association of Emergency Physicians. “I’m telling you it’s difficult, it’s gut-wrenching.”

A private member’s bill to scrap the registry, put forward by Tory Candice Hoeppner, is before the House of Commons.

The health groups said most firearms deaths “occur when an ordinary citizen becomes suicidal or violent,” perhaps as a result of alcohol or drugs, or because of a personal crisis such as job loss.

Drummond said, “Suicide is not a premeditated act usually; it’s usually impulsive, somebody feels overwhelmed, the gun is available, they pull the trigger.”

He said the registry is particularly helpful when police or a family member bring someone who is depressed or suicidal to an emergency department. If there is a gun in the home, physicians can recommend police remove it.

But Gary Mauser, professor emeritus of political science and criminology at Simon Fraser University, said the long-gun registry has had no real impact on suicide rates.

“The gun registry only keeps track of guns; it does nothing to screen individuals,” he said.

National ED News Series

Emergency Room Overcrowding

Ending Canada's Emergency Room Waiting Game

Worry in the Waiting Room - Health Care Reform