New project aims to find alternatives to ER visits

Emergency sign on the outside of a hospital. Wikipedia Commons

Researchers hope to alleviate suffering

While COVID-19 has raised a great deal of concern about the availability of medical care to people with chronic health conditions, Saskatchewan has faced a crisis of hospital capacity since even before the virus. Regina and Saskatoon reported such a crisis over a year ago, in February of 2020. Hospitals are often low on beds, and many emergency room visits are accounted for by patients who could be better served elsewhere. With the virus making available beds and equipment even more scarce – and even more crucial – putting intensive care units, which are dealing with the dual responsibility of caring for both COVID and non-COVID patients, under greater strain, has diverted people from the emergency room has become a critical point of focus.

The University of Saskatchewan College of Nursing in Saskatoon is currently working on two research projects that focus on reducing emergency room visits, specifically for people living with mental illness and addictions. These are two groups of emergency room patients, with great overlap between them, who are likely to be frequent visitors of the ER; that is, people who visit the ER at least four times a year. According to a study in the Canadian Journal of Addiction several years ago, those frequent visitors made up a full 25 per cent of all people who went to the ER, often because there’s simply nowhere else for them to go. Statistics from the Canadian Institute for Health Information reveal that within this group, 50 per cent visit the ER for both mental health problems and addiction. Fifty per cent are also people under 35, with young women and girls under 20 making up the majority at 63 per cent. It was also found that frequent ER visitors with mental illness and addictions are four times more likely to be low-income, and seven per cent are homeless. In an interview about the research projects, project head Dr. Hua Li said addressing this group’s needs would save the health system a great deal of money. 

But it isn’t only about savings and resources. Dr. Li also hopes that the projects can “save human suffering” by addressing the healthcare needs of these frequent visitors before they reach crisis. Mental health conditions, such as mood disorders, eating disorders, and schizophrenia, often lead to recurrent, acute symptoms that require emergency intervention (risk of suicide, psychosis, or an inability to care for the self, for example). However, these periods of crisis often come after periods of decline, where interventions and supports could prevent them from becoming worse. In the case of addictions, the issue is similar; support from the community when it comes to safely using and treating overdoses at centres like the new safe injection site in Saskatoon or Nēwo Yōtina in Regina would mean that the ER no longer has to be the first – and last – resort. 

As for the details of the Nursing College’s projects, the first is that Li’s team will survey frequent ER visitors by phone or Webex to gather more information about their needs. The interviews will be followed by focus groups with healthcare providers, as well as comparisons between frequent visitors and infrequent visitors in terms of their use of community resources. This is meant to address the fact that, as written on the U of S website, “what’s been missing from the conversation about how best to meet this patient group’s needs is the perspective of the frequent ER visitors themselves.” This is described as a three-year project, with the results of research expected to come out in the spring of 2023. 

The second project is the development of a smartphone app (a two-year endeavor), one that is meant to provide the caregivers of young people with mental health and addiction disorders support. Dr. Li said that these caregivers are likely to develop depression and anxiety symptoms of their own, and that young people are “significantly affected” by the health of their caregivers. With this in mind, addressing the needs of caregivers as well as those of frequent visitors may create a stronger foundation for community interventions.

These two Nursing College projects are made possible by grants, the first by a grant from the Saskatchewan Health Research Foundation (SHSF), and the second by the Jim Pattison Children’s Hospital Foundation. The grants total $225,000 ($120,000 for the research interviews, $105,000 for the app), a significant investment showing concern for the crises in Saskatchewan hospitals and vulnerable populations. The question remains whether this approach will be enough, or come soon enough, to make a real difference in the lives of frequent visitors. 

Dr. Li’s team will be collaborating on these projects with the Schizophrenia Society of Saskatchewan, as well as the Saskatchewan Health Authority’s services for mental health and addictions.

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