Nova Scotia’s ER death rate keeps increasing

More people are dying in Nova Scotia’s emergency rooms.

In the first nine months of 2023, 632 people died in the province’s ERs. That compares to 593 people who died in ERs in all of 2022.

The ER death figures were released by the Nova Scotia New Democratic Party (NDP) today. The NDP obtained them through a freedom of information request from Nova Scotia Health.

The data include monthly and quarterly death counts, as well as deaths as a percentage of people who entered ERs, from January 2017 to September 2023.

While the numbers and percentages vary throughout the period, there is a trend line showing an increase throughout the period. The increase is much larger than would be expected to be seen by population increases alone. And while there was a significant decrease in ER death in 2020, the first year of the COVID lockdowns, the number increased to record highs in 2022 and 2023.

By year, the annual ER death count is:

2017: 496
2018: 531
2019: 466
2020: 393
2021: 505
2022: 593
2023 (through September): 632

As well, the percentage of people who entered ERs and died has increased over the period, as follows, to a record high 0.15% in both December 2022 and September 2023.

See the data here.

At Question Period at the legislature today, NDP leader Claudia Chender had this exchange with Premier Tim Houston:

Chender: I want to ask the premier about the state of Nova Scotia emergency rooms. Freedom of Information data released to our caucus shows that there have been more deaths in emergency rooms in the last nine months than there were the entire previous year, or the five years before that. This government is failing to address a crisis in our emergency rooms, and it’s resulting in more deaths. As a Halifax Infirmary staff person said in the paper yesterday, “The crisis is constant.” What is the government doing to deal with the constant crisis in our emergency rooms? 

Houston: We all want the best possible outcomes for for Nova Scotians when they visit an emergency department. But the very nature of an emergency department means that the reality is that not everyone who goes to emergency room can be saved. That’s why there are emergency departments. So we will continue to work to support those working in health care. I know the minister was at the infirmary this morning; at that time, there was two people in the waiting room and zero offloads [from ambulances] waiting to happen. I know the team at the Infirmary has been innovative on the way that they’re coming up with suggestions on how to help support Nova Scotians that are arriving there. But we all want the best outcomes for Nova Scotians. And I would encourage the member opposite to share the full information, not just little snippets. 

Chender: Here’s some information that’s not an anecdotal story. On Monday of this week, the Halifax Infirmary score in the National Emergency Department Overcrowding scale was 354, which, according to a hospital staff member, is ‘disaster.’ It’s been in disaster mode for months. Rural ERs are closed. People don’t have a family doctor. And people are arriving at our ERs sicker and sicker. More deaths in the first nine months of this year than in the entire last year and the five before that. While the premier fails to make improvements in ER wait times, people are dying. When is this government going to do something for the people waiting and waiting in emergency rooms? 

Houston: We have, we have issues in health care, there’s no question. And our emergency departments often feel the brunt of that. There’s no question about that. And that is where people should go when they’re extremely sick. There are also other situations where maybe another course of access to care is more appropriate. That’s why we’ve opened up so many channels — the pharmacy clinics are getting national recognition. You might not hear it opposite, Madam Speaker, but nationally getting recognition. The mobile clinics, national recognition. Just yesterday, I’m so proud of the minister and the team, they launched an app. It was the fourth most downloaded app in the country, I believe. The purpose of the app is to get people to the appropriate care at the appropriate time. Appropriate care is often an emergency department, but not always.

Chender: The numbers don’t lie. Spin doesn’t work here. That app was pushed to every government phone in Nova Scotia. So let’s see who actually downloaded it and on whose phone it showed up on. Madam Speaker, the Freedom of Information data shows that it’s not just the number of people who are dying, it’s the proportion of people dying in emergency rooms that’s growing. As a hospital staff member said, people die in the ambulance hallway. On a monday at 4pm, there are nine in the ambulance hallway. The patient, who has waited the longest, has waited 113 hours and 39 minutes. And I’ll table that. How much longer will people have to wait before this government does something not about apps, not about pharmacy clinics, about the crisis in our emergency room?

Houston: Madam Speaker, all of these things are interrelated. There is no one single solution. That’s why they’re all important. And I will say I would just encourage the member to share the full, the full information, the proportion — obviously, our population is growing. Obviously, our population is aging. Of course, when you have more people, more aged, you have more visits. But when you look at the proportion, the proportions are steady. And of course the member is making comparisons over a period of time, which included COVID, where emergency departments were often closed. There was incredibly sharp decline during that period of time. So everything is relative, but the work that is being done by this government under that minister is leading the country in fixing health care. 

The new data reflect concerns raised in the aftermath of the death of Allison Holthoff, who died after waiting nearly seven hours to see a doctor in the emergency department of the Cumberland Regional Health Care Centre in Amherst.

There is a strong correlation between time waiting in emergency rooms and death rates in ERs. Additionally, however, a recent academic study led by Simon Jones, a researcher at NYU School of Medicine, found that the longer the wait at the ER (or ED, ’emergency department’ in Jones’ study), the higher the death rate over the next month:

Delays to hospital inpatient admission for patients in excess of 5 hours from time of arrival at the ED are associated with an increase in all-cause 30-day mortality. Between 5 and 12 hours, delays cause a predictable dose–response effect. For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death.

That study was specific to hospitals in England, and there has been no similar study of Nova Scotia hospitals.

Still, “I think we have demonstrated that the longer you wait in an emergency department is a bad thing,” Jones told HealthDay News.