After a record-breaking number of patients visited the IWK Health Centre’s emergency department on Sunday, a pediatric emergency physician said she’s concerned about what could happen if things don’t slow down.
“I am afraid of it getting worse. I’m afraid (with) these high volumes that it’s difficult for us to manage, I am worried about patients waiting longer or potentially getting worse and them not being seen in a timely manner,” Dr. Kirstin Weerdenburg said in an interview Monday.
“I’m worried about people not coming to the emergency department when they really need to because they’re too worried about waiting.”
This comes after the emergency department at the children’s hospital hit its highest-ever recorded number of visits in a single day on Sunday at 200 patients. This was after the hospital’s emergency department saw 165 patients on Saturday and 140 on Friday.
“It is unheard of. We’ve never seen that many, and usually our viral season starts out West and then moves towards the East Coast. But we’re seeing it earlier than usual,” Weerdenburg said.
“We’re averaging about 150 patients a day and we wouldn’t see this many patients at this time of year.”
‘Lots of factors leading to this’
The IWK Health Centre isn’t alone. Pediatric emergency departments in other parts of the country have been swamped by children presenting earlier than usual with respiratory syncytial virus (RSV).
Weerdenburg said at the IWK, 25% are testing positive for RSV. Influenza A has already started circulating in the community along with COVID-19 and other overlapping viral illnesses that she believes are also contributing to the current situation.
This is further complicated by a shortage of children’s Tylenol and Advil typically used to help manage fevers and pain, and an increasing lack of primary care providers in the province.
“There are lots of factors that are leading to this,” she said.
Pre-pandemic, Weerdenburg said they’d start seeing patients with RSV and influenza around this time of year but it would typically peak after the holiday season.
“We are all speculating that many of these children in the age group that are most affected by RSV are those that really haven’t developed that natural immunity to these viruses yet because they didn’t really see them for a couple years because of the pandemic,” Weerdenburg said.
‘Bracing for the worst’
The fact they’re breaking records this early in the season is a concern. Weerdenburg said during the colder winter months there tends to be a lot more viral illness. She can’t imagine more than what she’s seeing now.
“With kids not developing that natural immunity, their symptoms are worse and more prolonged and it’s just going to keep on going up and up,” she said.
“It literally is like you’re bracing for the worst. That’s what you feel like.”
One factor making it challenging to see patients in a timely manner is that many of those showing up at the IWK’s emergency department are also quite ill.
“About a third of those patients are what we consider, based on a triage system, as the higher acuity patients who need more emergent urgent care,” Weerdenburg said.
But that doesn’t mean those who are left waiting for many hours don’t require emergency care. It just means that compared to others who show up, their issues aren’t as urgent.
“It’s those patients that come in with a laceration. Well, there really isn’t anywhere else you can go to get a laceration repaired other than the emergency department…but their acuity isn’t as high, so they end up waiting longer,” Weerdenburg explained.
“Fractures, broken bones. There really isn’t anywhere else you can go but the emergency department. But if you don’t have severe symptoms, then you’re stuck waiting.”
‘Stretched pretty thin’
On Monday morning, Twitter user Amy Spurway tweeted that a friend’s child had waited 10 hours at the IWK’s emergency department on Sunday for necessary care.
She described the department as “packed with screaming, puking, coughing kids” and added that “it’s only a matter of time before something horrifying happens under these circumstances.”
Weerdenburg said while patients coming in may not be triaged as high acuity upon arrival, they can certainly get worse while waiting for prolonged periods of time in the emergency department.
“You’re in the right place, but I completely agree. It’s hard when you have so many patients in the waiting room…When they’re triaging, there’s multiple patients in line for triage, and it’s taking a couple of hours just to do triage,” she said.
“How do you manage all the patients in the waiting room as well and check on them to make sure they’re OK? It’s really hard to do that, right? There’s only a couple of them to do it, and we’re also short-staffed too.”
Being short-staffed complicates an already difficult situation. Weerdenburg said they’re “stretched pretty thin,” adding that she and her colleagues are also upset about wait times because they want to be able to help patients much more quickly.
‘Never seen it like this before’
Weerdenburg said it’s disheartening when patient volumes are higher than they’ve ever been, many patients are more ill on arrival, and some people are so angry about wait times that they take it out on health care workers.
“I have never seen it like this before and it’s been hard. It’s really hard to go to work and feel like you’re doing a good thing for people when you know that everybody is upset and you’re just trying to do your best,” Weerdenburg said.
“I know that they know that, too, but sometimes their frustration gets out in the wrong places and they put blame where they don’t need to put blame and it ends up going on us.”
While there’s a simple pre-triage assessment that takes place when a patient arrives at the emergency department, Weerdenburg said some patients are now waiting several hours for the more comprehensive triage assessment.
“That’s when things can get missed. You do a simple pre-triage (assessment) where you want to make sure, is a patient well looking or not, it’s a very simple assessment,” she said.
“But then you don’t get to do that comprehensive assessment for a while and what if something happens in that time while you’re waiting in line?”
Don’t stay away if your child needs care
Weerdenburg said while it’s critical that children go to the emergency department when guardians suspect they need emergency care, families should also know what options are available and explore other avenues if and when possible.
This includes contacting their primary care provider first and/or calling 811.
Depending on a child’s age (and the availability of the medication), it also includes giving Advil or Tylenol to help manage things like fevers that can make children look and feel miserable.
“Obviously with the more severe symptoms, come to the emergency department immediately for those, but it depends on lots of different things, including age,” she said.
Supports that Weerdenburg would like to see to help address the current situation include access to care in the community and appropriate staffing in the hospital’s emergency department. She said they’re often short-staffed, especially when it comes to nursing support.
She also urges families to practice infectious control measures by keeping children at home when they’re unwell and engaging in good hand hygiene.
“Probably my biggest concern is that parents have a child that’s sick and their child needs to be in the emergency department and they’re avoiding it because of the wait times,” she said.
“And then also that children are waiting too long and something happens because they’ve been waiting. Those are probably what I worry about most.”
In mid-June, the IWK’s emergency department chief Dr, Katrina Hurley told the Halifax Examiner that on the busiest day in the department’s history they’d seen 180 patients.
At that time, she said the volume of visits was skyrocketing (it hit a high of 178) and expressed concern at the time that things were heading into “unknown territory.”
“I’m not sure what our theoretical capacity is because we are often able to surge with those volumes, but I’m quite confident that 178 is beyond what we are capable of doing, even on our very best day,” Hurley said.