Taking the pulse of 6 ERs before they lose overnight service: How busy were they?

Sussex Health Centre was the busiest last year of the sixNew Brunswick hospitals losing their overnight emergency room service,according to figures from the Department of Health.

It had 2,368 patients visit between midnight and 8 a.m. in 2018-19, an average of6.49 per night.

That's more than double the 903 overnight visitors at Sackville Memorial Hospital, the figures show.

Stella-Maris-de-Kent Hospital in Sainte-Anne-de-Kent dealt with the highest number of the most serious patients, with 950 assessed as being Level 1, 2 or 3, based on the Canadian Triage and Acuity Scale.

Level 1, or resuscitation,refers to conditions that are threats to life or limb, Level 2, or emergent, refers to conditions that are a potential threat to life, limb or function, and Level 3, orurgent, are serious conditions that require emergency intervention.

Those Level 1-3 patients represented more than 40 per cent ofStella-Maris-de-Kent's overnight caseload, andmore than four times the 222 seriouscases seen overnight in Sackville.

It looks like Plaster Rock-area residents will facethelongest tripto an emergency room with 24-hour service come March 11, when the six emergency roomsstop accepting patients after 10 p.m. and close at midnight to 8 a.m.

They would normally visittheGrand Falls General Hospital or the Hotel-Dieu of St. Josephin Perth-Andover, which are both about 38 kilometres away, or a 30-minutedrive, according to Google Maps.

But they willnow have to travel to either Edmundston Regional Hospital orUpper River Valley Hospital in Waterville, which are both about 98 kilometres away, or a 70-minute drive one-way.

The Progressive Conservative minority government announced the contentious health-care reforms on Tuesday, sparking angry protests, political divide and talk of an early provincial election.

In addition to the overnightER closures, patients in need of hospital care will notbe admitted to any of the six hospitals, which also include Enfant-Jsus Hospital in Caraquet. The acute-care beds will be converted to long-term chronic-care beds.

Horizon Health Network CEO Karen McGrath andVitalitHealth Network CEO GillesLanteignehave said the changes are needed because of staffing shortages, the aging population and increasing mental health needs.

They said each of the hospitals has seen an average of only five emergency room visits per night, most of themnot actual emergencies, and that 95per cent of patients will still be within 72 kilometresof a 24-hour emergency room.

Nearly 10,000 overnight patients

CBC News obtained the detailed Department of Health data.

The data shows the six ERs saw a combined total of 9,969 patientsbetween midnight and 8 a.m. in 2018-19.

Of those, more than a third, or 3,665, were considered the most serious types of cases.

It's unclear how many additional patients visited the ERs between 10 p.m. and midnight, the period during which they will now stop accepting patients in advance of the closures. The data is only divided into the periods of 8 a.m. to 4 p.m., 4 p.m. to midnight and midnight to 8 a.m.

The number of patients seen between 4 p.m. and midnight, however, ranged between9,954atStella-Maris-de-Kent and5,493atHotel-Dieu of St. Joseph.Stella-Marisalso saw the highest number of most serious cases during this eight-hour period, with 3,610 Level 1-3 patients, well above Enfant-Jsus Hospital, which ranked second with 2,575, and Sackville's lowest rank with 891.

The overnight totalfor all six ERs for 2019-20 was shaping up to be 10,272 if ithad stayed at the same pace as the first nine months, which saw 7,704 patients visit, 2,609 of themurgent or worse.

Although the Sussex Health Centre was the busiest of the six ERs in 2018-19, its total of 2,368 overnight visits was downfrom the previous year's2,475.

Its number of serious cases was up, however, at 803, compared with 746, for an average of 2.20 a night, the figures show.

The total overnight visits at three of the other hospitals, meanwhile, increased last year.

SackvilleMemorial Hospital saw90 more patientsfor a total of 903,Hotel-Dieu of St. Joseph was up 80 to 1,135, andL'Enfant-Jesus rose by 54 to 1,963.

Their per-night averages remained relatively low at 2.47, 3.11 and 5.38 respectively.

Urgent or higher cases represented0.61, 1 and 2.01 of those, according to the figures.

Maximum distance 114 km

Asked about the location of the five per cent ofpatients who will not bewithin 72 kilometres of a 24-hour hospital, spokesman Bruce Macfarlane said the calculation was made by measuring the driving distance between the centre of a community to the nearest hospital using Statistics Canada's census subdivision groups.

"There may be people living on the outskirts of a community who are slightly beyond the driving distance," he said.

"As such, the 5% that is beyond the 72km distance are not necessarily in a single community or area. It is distributed across the province in more isolated rural communities similar to other provinces and territories."

He did say the maximum a patient will have to travel at night is 116 kilometres. The average is 26 kilometres.

Dr. Alan Drummond, a rural physician in Perth, Ont., who works in the ER and is co-chair of public affairs for the CanadianAssociation of Emergency Physicians, said small community hospitals are "the quintessential health-care safety net for rural Canadians who don't want to be forced to travel an extra hour on wintry, windy roads in the middle of the night with a sick child or a sick loved one."

If patients have to drive more than 30 minutes to reach an emergency room, said Drummond,advanced life-support equipment and paramedics need to be on board ambulances.

"You need to make sure that you have a robust and responsive helicopter ambulance service because sometimes roads are impassable, and I think you need to have avery good communications strategy to facilitate communicationbetween the transporting and receiving hospitals," he said.

Meeting to discuss ambulance volumes

Lanteigne, of Vitalit, said Ambulance New Brunswick is currently meeting its targetsand has made great strides with better-trained paramedics, more technology on the ambulances and improved communication with emergency rooms.

But members ofthe two regional health authorities andgovernment officials will meet with Ambulance New Brunswick in the coming days to consider the additional volume of patients the cutbacks will bring.

In addition, "we have to make sure that the transfer corridors are well established with the regional hospitals;that they have capacity to be able to receive these patients," Lanteigne said.

"So there are a number of really minute details here that we need to make sure because what we're aiming here is to have certain services that are going to be safe and of quality and that are sustainable."

Chris Hood, executive director of the Paramedics Association of New Brunswick, said of the 1,100 paramedics in the province, 70 have advanced care training. Theycouldputthat training to better use to help more patients, especially now because there will be "sicker patients who will be travelling longer distances," he said.

Lanteigne said he is confident the government will "make adjustments,if required."

Not 'putting lives at risk'

Some people have accused the government and the regional health authorities of putting lives at riskwith the reforms.

"Any changes are very disrupting," Lanteignesaid in response. But after studying the data, he rejects the notion they are putting anyone in danger.

"In fact, we're improving the system because we're maintaining these emergency room services seven days a week, 16 hours, which is considerable access because that's when there are more people that are utilizing these services," he said.

"And in addition, we're putting more resources in the community."

Another 336 doctor hours

For example, the physicians who were working in the ERs overnight will now be freed up to work during the busier daytime hours either in anER, a family practice, a clinic or other medical service, said Lanteigne.

He could not estimate how many more patients the physiciansmight see because it will be up to themif they want to work andhow much. Some are so-called locums from out of province who temporarily fill in during absences or illnesses.

But it's the equivalent of336 hours a week, he said.

"We know it's not going to be 336 hours, but it's not going to be zero either. So it's going to be somewhere in there."

A nurse practitioner will also be hired in each of the six communities, said Lanteigne. Each nurse practitioner will see about 20 to 25 patients a day, he said.

In addition, nurse practitioner clinics will open in Saint John, Fredericton and Moncton with six nurses each, which is expected to reduce the number of people waiting for family doctors by 18,000 or 54 per cent. Some nurse practitioners will also be added to the ERs in those three cities to see less urgent (Level 4)and non-urgent (Level 5) patients.

"It's not like we're moving from a perfect functioning system right now," said Lanteigne. "Everybody agrees that the health system is in crisis and that we need to make changes.

"We think it's the best solution for what's happening now and at the end, we'll be able to sustain the service, we'll be able to have quality and [safe]services."

Do I think that consultation was warranted in this case? No,I don't, because it is only us as leaders [who] know the full picture of what we're facing.- Karen McGrath, Horizon Health Network CEO

There will be atransition period once the changes take effect March 11 to ensure people get accustomed and everything goes smoothly, Lanteigne stressed. He did not say how long the transition period would last.

The changes take effect just one day after the legislature is scheduled to resume sitting. But Department of Health officials and thehealth authorities'CEOs will appear before the public accounts committee nextweek.

MLAs and other critics of the changes have complained the government didn't consult the six communities but instead surprised them with the planned cuts to ER hours.

But McGrath, of Horizon, said her job was to come up with a plan for sustaining the network's health-care service.

"Do I think that consultation was warranted in this case?" she asked. "No,I don't, because it is only us as leaders [who] know the full picture of what we're facing.

"So people in Sussex know the situation in Sussex. They do not know the situation in Saint John or in Minto or anywhere else. So what I am looking at is sustainability of the system."

The following data is from the Department of Health's Management Information System. The data is subject to a quality assurance process and used nationally and internationally for analysis and comparison, said Vitalit spokesperson Thomas Lizotte.

Horizon's 3 affected hospitals:

Vitalit's 3 affected hospitals:

Travel distances: