Jennifer Geens
Northern News Services

Yellowknife (Oct 07/05) - It's getting on towards midnight in Stanton hospital's emergency department. In the waiting room, a girl's head droops and she sways towards her mother's shoulder, falling asleep.

Luckily, she's not waiting for care; she's waiting for doctors to finish treating her brother. In all, the family will spend a little over two hours in the emergency department and, according to a new report, that's the norm in Canada.

Findings of the Canadian Institute for Health information report Understanding Emergency Department Wait Times: Infants and elders visit emergency departments most often In 2003-2004, 48 per cent of Ontario infants visited an emergency department. Most emergency department visits happen between the hours of 8 a.m. and 8 p.m. - peak arrival time is in the morning, with a second peak at pediatric hospitals between 7 and 10 p.m. More than half (57 per cent) of emergency department visits in 2003-2004 were for less urgent or non-urgent ailments. Most patients' emergency department visits lasted about two hours. More than 80 per cent of patients were

The Canadian Institute for Health Information's report "Understanding Emergency Department Wait Times" used data from hospitals in Ontario, Nova Scotia, British Columbia and Prince Edward Island.

The study found that the average Canadian emergency department is busiest between 8 a.m. and 8 p.m.

Alex Hoechsmann, the head of the emergency department at Stanton, said their busy period runs from 9 a.m. to 11 p.m., with a smaller spike when the bars close. The busiest time is probably Monday morning.

On weekends, holidays, and after hours, Stanton's emergency room is the only medical service in town. On this night, the waiting room empties of patients just after 11 p.m., right on schedule. The team is awaiting a medevac from Kugaaruk, but the weather in the Kitikmeot is delaying take-off. Though the lull is a good opportunity to catch up on paperwork, Hoechsmann says "anything can happen."

Each new arrival stands in the middle of a busy hallway to explain their health problem to the triage nurse, within earshot of the waiting area. Whoever designed it "didn't have high volume in mind," said Hoechsmann.

The department has 10 beds in eight examination rooms, but as the city grows, things are getting a little cramped.

20,000 patients pass through Stanton's emergency room every year, and the department's doctors field an additional 2,000 to 3,000 telephone consults from health centres in the communities. On average, the emergency teams treat 40 to 60 people a day.

The triage nurse uses the Canadian Triage and Acuity Scale to rank the patients' ailments by urgency.

Heather Leslie, Stanton's manager of ambulatory services, said the tool ranks patients on a scale from one to five, from most to least urgent.

Category 4 and 5 patients are classified as less urgent and non-urgent. They are the patients with problems that could have been handled by their family doctors. They make up 57 per cent of the average Canadian emergency department's patient load.

Hoechsmann estimated somewhere between 40 and 60 per cent of the patients he sees in the emergency department fall into Categories 4 and 5.

Patients with less urgent ailments wait the longest, as urgent cases get treated first.

Noticing that wait times grew into the afternoon, Hoechsmann proposed overlapping the physicians' shifts by an hour.

During that hour, the doctor going off shift deals with the less urgent patients, while the doctor whose shift has just started handles the urgent cases.

Hoechsmann can call up bar graphs on his computer, showing how the arrangement helped reduce average wait times from 101 minutes in 2004 to 88 minutes in 2005.

Stanton plans to add a full-time nurse practitioner to its emergency department staff next April, which will also help reduce wait times, said Hoechsmann.

But people with less urgent problems will still have to wait, and Stanton never turns anyone away.

"There will always be people who choose to get their primary care in the emergency department," said Leslie.