"Working in the emergency department is challenging, it’s exciting, it’s stressful – you’re constantly trying to make the most of limited resources."
If we’re lucky, most of us will only see the inside of the emergency department (ED) a few times in our lives – and hopefully for something relatively minor.
But there is a select group of people who are there almost every day: the highly trained health-care workers who have devoted their professional lives to ensuring that patients get the help they need. Whether they’re treating someone with a bad case of the flu, a child with a broken arm or a person having a heart attack, they are there day and night, ready to help.
Dr. Sam Campbell is one of those people.
After medical school in South Africa, he came to Canada, where he spent five years working as a family physician in northern British Columbia. He had long been interested in emergency medicine, so when the opportunity to move to Vancouver for a residency in emergency medicine presented itself, he took it.
After the residency, “my supervisor moved to Halifax and suggested I come out here for a summer locum position,” he says. “I’ve been here ever since.”
That was almost 20 years ago.
Now, in addition to practising as an emergency physician, Dr. Campbell is the site chief at the Charles V. Keating Emergency and Trauma Centre in Halifax, a researcher, and a professor at Dalhousie Medical School. His different roles mean that he is active in providing emergency medical care for patients, while also training medical students and residents, researching better ways to provide care, and making system changes to ensure that patients get the care they need, when they need it.
Every day is different, says Dr. Campbell.
“Because the emergency department is designed to stream different categories in the acuity and complexity of patients to different areas of the emergency department, three shifts in three days can be like working three different jobs,” he says. “During an eight-hour shift, I might care for just six to eight very complex patients in one zone, or I might see as many as 35 patients in another zone where the cases are less complex.”
“Early morning is the quietest, but patients really start arriving around 11 a.m., and that peaks at about 3 p.m. Patients start to back up then, and by 8 or 9 p.m., the waits are the longest. As the patient flow slows, the backlog starts to clear; at 4 or 5 a.m. we have the lowest number of patients arriving.”
The type and severity of ailments varies widely over the year, says Dr. Campbell.
“In the winter, patients are sicker and their cases are more complex. We see people with influenza and pneumonia, people requiring orthopaedic care because of slips and falls, and people who are dealing with depression and mental health issues, which is especially common around the holidays,” he says. “In the summer, we see more patients in general, but they are more likely to be seeking care for minor traumas and unexpected injuries.”
Nova Scotia’s aging population presents a particular challenge, says Dr. Campbell.
“As our population ages, we’re seeing more patients present with more complex problems, managing multiple chronic conditions, taking multiple medications – and their numbers are increasing steadily.”
For those patients, even the smallest change to their health – such as a different prescription, or a minor illness – can result in a major upset, resulting in a trip to the emergency room.
“Assessing and treating these patients is a lengthy process,” says Dr. Campbell. “It can take a long time to find them the appropriate follow-up care, too, and because of bed shortages we are sending patients home earlier than before, sicker than before, to be managed in the community.”
And if they must check into the hospital, things get even more complicated.
“Bed shortages elsewhere in the hospital can mean that patients may be left in the ED, sometimes on gurneys in the hallway, while they wait for a bed. No one wants that.”
The emergency department at the Keating Trauma Centre has 36 beds – which translates to a capacity of about 180 patients per day. But demand is often higher – especially in the winter months – and even one bed being occupied for longer than usual has an impact.
“The ED is a complex machine,” says Dr. Campbell. “Any kind of breakdown affects everything.”
As site chief, it falls to Dr. Campbell to help co-ordinate what’s happening in the emergency department – and a lot is happening.
“We do way more than just patch people up and send them on their way,” he says. “We provide pre-, post- and in-hospital care for patients. We arrange medical testing, and we provide advice to physicians in the community and paramedics in the field. We’re a training ground for medical students and residents. So we’re constantly co-ordinating all of these things, managing resources, allocating beds.”
“You want to provide the best care for your patient while also making sure that you’re not blocking resources for other patients,” says Dr. Campbell. “It’s a delicate balance.”
Working in the emergency department requires system awareness, flexibility and strong problem-solving skills, balancing care for one’s patients and for the system itself. Dr. Campbell and his colleagues put all that to work every day, as they strive tirelessly to provide their patients with the excellent care they deserve – today, and into the future.
“We’re providing better care this year than we were last year, and the year before. As a hospital, we’re serving the greater good, doing good for more people, and as a teaching centre, we’re ensuring the next generation of physicians are prepared to both deliver excellent care and make system changes.”