Frequently Asked Questions - Emergency Department Consolidation

Anyone requiring immediate medical attention should call 911 to be taken to the nearest Emergency Department. 

Minden and the surrounding communities will be able to access emergency care at the Haliburton Emergency Department, located at 7199 Gelert Road in Haliburton, Ontario. 

For non-urgent health care needs, Health Connect Ontario is available 24/7 for non-emergency health-related questions by calling 811.

The decision to consolidate emergency services in Haliburton was not made based on patient volumes. Rather, the only in-patient (acute care) beds in Haliburton County are currently located at the Haliburton site, and HHHS cannot separate the Emergency Department from those beds. The Minden site is not suitable for permanent in-patient beds. It would require over a million dollars in renovation costs, and likely more, as well as a multi-year approval and renovation process to try to create an in-patient space in Minden, and even then, there would be fewer beds (6 – 10 beds) than what is currently available at the Haliburton site (15 beds).

The beds that were installed at the Minden site during the early days of the COVID-19 pandemic were a crisis measure, meant to ensure there could be separation of patients with the virus from those who did not have it. The space does not meet current requirements for permanent in-patient beds.

Other factors that led to the decision to consolidate emergency services at the Haliburton site include:

• Feedback received from local paramedic services, who highlighted that the Haliburton site is more centralized in the County for patient transfers.
• The close proximity of the Haliburton site to the Haliburton Family Medical Centre, which helps to facilitate easy access for primary care physicians to see patients in the Emergency Department and in-patient unit when needed.

It should be noted that both HHHS Emergency Departments are having physician and nursing staffing challenges. While the physician gap in the past has been at the Haliburton site, the Minden site is now also participating in the HealthForceOntario Emergency Department Locum Program to fill physician staffing vacancies. The ability to recruit physicians from other hospitals to fill shifts at the Minden Emergency Department has become more limited as those hospitals are also experiencing shortages.

It should also be noted that the decision to consolidate emergency services at the Haliburton site has nothing to do with the exemplary care provided by the staff and physicians who work primarily at the Minden Emergency Department site. HHHS has heard many powerful stories from community members about the high-quality patient care they received at the Minden site and the positive impact staff have made. The organization is grateful to all of the staff and physicians who have worked at the Minden Emergency Department, and to everyone who worked so hard to keep both Emergency Departments over during the past few years.
 

Both the Haliburton and Minden ED sites have been experiencing severe and persistent nursing staff shortages over the past 18 months, in addition to physician staffing shortages primarily at the Haliburton site.

Our nurses work across both sites, so an overall shortage affects both the Haliburton and Minden EDs. Without adequate nursing coverage, the EDs cannot stay open.  It is these nursing staff shortages that have created the greatest risk for unpredictable, short-notice closures, which would have had a serious impact on our ability to provide safe, quality, reliable emergency care for the whole community.

The Minden site also began to experience physician shortages in April 2023, and had to turn to the HealthForceOntario Emergency Department Locum Program for coverage. The ability to recruit physicians from other hospitals to fill shifts at the Minden ED (which has been the staffing model) has become more limited as those hospitals are also experiencing shortages.

Physician coverage at both the Haliburton and Minden ED sites has been one physician, at each site, per shift. The Minden Physician Group works in 24-hour shifts, and as a result, they indicated to HHHS that if the Haliburton ED were to close as a result of a physician staff coverage, it would not be safe for that one Minden ED physician to provide coverage for the entire County - which meant that the Minden ED would also have to close, leaving Haliburton County with no local services.    

It has taken extraordinary measures over the past 18 months to keep both of HHHS’ Emergency Departments open, including many personal and professional sacrifices by our staff.

HHHS has spoken publicly in the past about the fact that there were more than 20 official ‘close calls’ in 2022, which would have required short-notice temporary closures, but there were also many more unofficial close calls involving nursing staff shortages at both sites. Sometimes these close calls were happening on a weekly basis, and would have required the closure of both Emergency Departments at the same time. Both physicians and nurses are required to keep an emergency department open, and the nursing staff shortage is the primary driver for this change. 

The organization fought as hard and as long as it could to keep the both Emergency Departments open, but with no long-term solutions in sight, it couldn’t go on any longer.

A temporary closure would not address the broader staffing crisis HHHS is experiencing, and it would not give staff or the community the certainty they need when it comes to delivering and receiving emergency care.

HHHS considered every option to ensure it could continue delivering emergency services in Haliburton County. This included consideration of continuing to keep both Emergency Departments open, consolidating in Minden, and consolidating in Haliburton.

The review process included:

• Consideration of patient volumes, including the feasibility of maintaining the same volumes at one consolidated site,
• Different levels of resources required for each option, including financial, staffing, and equipment requirements,
• Alignment with HHHS’ strategic priorities, values, and mission,
• The healthcare needs of all of Haliburton County and how best to ensure HHHS can sustain its operations in the long-term to address those needs,
• HHHS’ obligations under our Hospital Service Accountability Agreements with the government,
• Information received through numerous discussions about potential temporary ED service reductions at one or both sites with medical leadership, nurses, managers, and the Executive Leadership team, and,
• The results of numerous discussions with Ontario Health East and the Ministry of Health, as well as our MPP and local elected officials about staffing and other pressures in general.

HHHS has been prepared for a temporary closure of one or both Emergency Departments for many months, and has run through various scenarios with its staff teams in terms of how emergency services would operate with only one ED.

HHHS is working with its staff teams, as well as Ontario Health East and the Ministry of Health, to ensure we have sufficient staff and physician coverage, as well as equipment and physical space needed to address the expected increased volumes in the Haliburton ED. Staff were asked for their input on different options in terms of patient flow and how best to address increased volumes, including reconfigurations of space at the Haliburton site to allow for additional waiting room space and parking.

Patient spaces in the Haliburton ED will increase from 9 to 14/15, with 1 new trauma bed (currently there are 2), 1 new procedure/treatment room, 1 new fast-track/rapid assessment room. Current care spaces that will be maintained include 1 isolation space, 3 stretchers, and 3 exam rooms. 

Waiting room spaces will increase from 14 to 27. Laboratory space is being expanded as well. 

An extra physician shift is being added during the busiest time of the day (9 AM - 9 PM), so that there will be 2 physicians available during this time. 

Extra nursing coverage will see an additional Registered Nurse added (24 hours a day, 7 days a week), access to an additional Registered Practical Nurse from 11 PM to 7 AM (shared with the acute care unit), an additional summer Registered Nurse shift, and a charge nurse during the day for the initial transition period. 

Diagnostic imaging will see coverage at the Haliburton site remain status quo, with staffing to maintain bone densitometry and outpatient x-ray services at the Minden site (by appointment). There will be increased hours at the Haliburton site for patient registration, lab services, and security services. 

Staffing will be assessed regularly and adjusted as needed.

HHHS will continue to work closely with Ontario Health East, the Ministry of Health, and HealthForceOntario to ensure we have the physician and staffing coverage that is needed, and these organizations are well aware of our coverage needs. 

Please see the graphic below, which is current as of May 18, 2023. 

There are now 26 patient parking spaces at the Haliburton, which is an increase of 15 spots, and signage has been installed to designate these spaces for patients. 

The expanded parking was achieved by adding new spaces on HHHS grounds for staff parking, and shifting other staff parking to the medical centre parking lot (thanks to approval from the Municipality of Dysart et al to use a portion of the far side of the lot for this purpose).

HHHS would not have made it through this summer without multiple, unpredictable, short-notice, temporary closures of one, or more likely, both Emergency Departments at the same time. In some cases, the notice could be less than two hours, which would make it nearly impossible to properly notify the entire community, including visitors and tourists, of the closures. This would create significant confusion and make it unsafe for the community as a whole. The short notice would also make it difficult for EMS to add more ambulance support, which would be needed in order to transport all patients out of the County if both Emergency Departments were to close.

HHHS is using the time between the announcement of the consolidation and June 1^st to share the news broadly with the community and surrounding communities.

HHHS fought as long and as hard as it could to keep both Emergency Departments open. The organization had to act when it did to ensure that it could continue to provide emergency services to all of Haliburton County.

No. Consolidation of emergency services at the Haliburton site is being done to address persistent staffing shortages. This decision will enable HHHS to continue to provide high-quality, more sustainable emergency services for the whole community. If the application for the CT scanner is approved, it will help to enhance the services HHHS can provide to the community, as well as assist in its recruitment efforts, particularly for physicians - but it is not the reason for the consolidation.

HHHS does expect that wait times may increase during certain times, especially for non-emergency issues.

If there was a surge in patient admissions, HHHS would rely on our regional management system to support the transfer of patients to other regional hospitals. HHHS would do the same for the other hospitals in our region, as our partners support each other in managing surge situations. 

In the case of an emergency, residents and visitors to Haliburton County should call 911.

We know that many residents do not have a family doctor and cannot access primary care, so they turn to the Emergency Department for their non-emergency health needs. This is something HHHS is taking into consideration as we plan for the future use of the Minden Emergency Department space.

Other services will continue at the Minden site, including Hyland Crest Long-Term Care, ambulatory clinics (physiotherapy, Bone Densitometry, and outpatient X-rays by appointment), and Community Programs that use space at the Minden site, like the Adult Day Program and Diabetes Education Program.

HHHS is exploring all options for the Minden Emergency Department space that would serve the healthcare needs of the community.

Signage will be posted at the entrance to the Minden site as well as at the different entrance doors to the site (including the ED doors, physician clinic doors, and Hyland Crest Long-Term Care) to alert anyone who may arrive at the site. 

A phone will be made available outside the entrance to the ED space, which will be able to dial 911, and signage beside the phone will include directions to the Haliburton site. 

The Minden ED will stop registering new patients as of 12:01 AM on June 1, 2023. 

Any remaining patients in the Minden ED will be seen by the physician and a treatment plan determined. Any remaining patients requiring care after 4 AM will be transported to the Haliburton ED via paramedics. 

Remember - if you are in need of serious medical attention, always call 911. Paramedics will determine the closest open emergency department to transport you to, as required.