A report by the auditor general indicates the government has no strategy to address excessive wait times in New Brunswick emergency rooms.
“Emergency room wait times consistently exceeded established targets and there is a lack of monitoring by the department to analyze gaps and risk areas,” said Auditor General Paul Martin.
He told the Standing Committee on Public Accounts this week that the contributing factors included insufficient treatment spaces and a budget that he said “wasn’t aligned with the current service delivery needs.”
The audit examined the period between April 1, 2020 and Dec. 31, 2024. It received 1.7 million complete reports from the health authorities.
“We analyzed data related to over 1.4 million emergency department visits during our audit period and found that 66 per cent of those visits did not meet the established targets for the time between triage and physician assessment,” he said. “Furthermore, 44 per cent of visits categorized as level one, with a described acuity level of resuscitation, did not meet the established timeline to be seen by a physician immediately.”
He said 75 per cent of those described at level two – emergent – also did not meet the targets. A similar trend was observed in the different levels of acuity all the way to five.
Martin said 77 patients who were triaged at the most serious level had waited more than two hours; meanwhile, 11 patients waited more than 24 hours.
“This is the information the government has at its disposal upon which to make decisions,” he said. “We noted the department is not effectively using data to analyze high-risk areas in provision of emergency services.”
Martin told the committee roughly 249,000 patients had left New Brunswick emergency departments without being seen. He said not analyzing the data is a missed opportunity for the department because it would assist them in creating risk mitigation strategies.
He said base budgets for emergency services in fiscal years 2021 to 2024 have been “consistently overspent.” Martin’s report indicated the Holt government intends to review the budgets for the regional health authorities (RHAs).
The audit found the department does not publicly report on timely access to emergency care services. He also said the department is not monitoring key performance indicators (KPIs) related to urgent priority addiction and mental health services.
Ian Lee, the Progressive Conservative MLA from Fundy-The Isles-Saint John-Lorneville, asked whether there was any data monitoring to ensure the RHAs were meeting the national benchmark for wait times.
Martin said the audit was only about the department and said additional information may be available. He was presenting what is available from the Department of Health (DOH).
“We were informed by the department that they receive reports on indicators such as volume of emergency department visits per CTAS level, however, these reports do not include achievement of wait time KPIs,” the report said. “The RHAs analyze and monitor wait time data against KPIs, but this information is not obtained by the department.”
Health Minister Dr. John Dornan said he was not surprised by the auditor general’s report.
“I could say I’m disappointed. I wish we had no significant wait times, but it’s why we are in government to tackle those wait times to get more appropriate in-time care where people need it,” he said, speaking to The Courier.
He challenged the report’s assertion that some CTAS level one patients are waiting hours to be seen.
“It’s 100 per cent not accurate,” he said. “If you wait two hours when your heart has stopped. It’s nonsensical. If you’ve been in a motor vehicle accident where there’s significant injury, trauma, middle of a stroke, head injury, and you wait two hours, it’s nonsensical.
“My major concern is the other parts that say patients are waiting too long before they get the care they need, and that’s our challenge.”
He said the government and the department of health are taking the Auditor General’s report seriously.
“This report was dealt with up until the end of 2024 and since then, we have put orders to our RHAs, to monitor, to report back, to be held accountable for those things that the auditor general recommended,” he said.
He said the government is undertaking a base budget review to determine whether the resources applied to emergency care are appropriate.
“I would say we’re acting on all of those Auditor General recommendations,” Dornan said.
The New Brunswick Medical Society said the province’s emergency departments remain consistently overcrowded, with “unacceptably long wait times.”
“We appreciate the Auditor General’s recent report and the light it shines on certain issues within our emergency care framework, especially recommendations that a dedicated strategy be developed in response to their actual needs, and that a review of the base budgets assigned to this essential service be conducted to ensure they are appropriately funded,” the statement went on to say.
Babin said there are several factors contributing to this issue, but the biggest is the “unacceptable” level of acute level care patients—those waiting for a nurse home placement—staying in the hospital.
“Our emergency rooms cannot function properly without solving this patient flow issue, regardless of how many resources we provide to them, or how many systems are created to track their performance,” she said.
She said she appreciates the efforts undertaken by the new Liberal government, including its signing a new Physicians’ Service Agreement.
“Shortfalls in emergency department staffing and resources is the last pillar in the equation,” she said. “As part of the new Physician Services Agreement with the government, we were pleased to be able to include several enhancements for emergency department physicians and emergency room resourcing. Solutions are available, and with better funding and support now in place, we are hopeful that we will see improvements in the coming months.”
