Emergency Departments

Annual Accountability Report on Emergency Departments Annual Accountability Report ON EMERGENCY DEPARTMENTS April 1, 2015 - March 31, 2016 April 1, 2015 - March 31, 2016

Table of Contents Accountability Statement 3 Map of Nova Scotia s Emergency Departments 4 Enhancing Emergency Care in Nova Scotia 4 Collaborative Emergency Centres 5 Hours of Operation and Scheduled Hours of Closure 5 Overview: Emergency Department Closures by Zone and Facility Type 7 Summary of Temporary Emergency Department Closure Hours and Public Consultations by Zone 8 Appendix A: Temporary Closures by Date and Hours Closed 16

Accountability Statement The Annual Accountability Report on Emergency Departments for the fiscal year ending March 31, 2016, is prepared pursuant to Section 6 of the Emergency Department Accountability Act. This Act requires that the District Health Authorities (now considered the NSHA) and the IWK Health Centre report on all emergency department closures, hold public consultations in communities that have experienced a pattern of ongoing closures, and report on the outcomes of those consultations directly to the Minister of Health and Wellness. Four hospitals in the province have established hours of operation that are different than 24/7. Hours that these facilities are not opened are considered scheduled hours of closure and were established after consultation with their communities. Emergency department closures that are unpredictable and unplanned are considered temporary closures. These were a result of emergency department staff (doctors, nurses, or paramedics) unavailability. Temporary closures present a challenge for both patients and the provincial emergency care system. In 2015/2016, sixteen hospitals experienced temporary closures. We acknowledge that this accountability report is the responsibility of the Department of Health and Wellness and is, to the greatest extent possible, a complete and accurate representation of emergency department closures reported by the District Health Authorities (now considered the NSHA) and IWK Health Centre in Nova Scotia between April 1, 2015 and March 31, 2016. Honourable Leo A. Glavine Minister of Health and Wellness Dr. Peter W. Vaughan Deputy Minister 3

rch 31, 2016 Nova Scotia s Emergency Departments Nova Scotia Health System Annual Accountability Report ON EMERGENCY DEPARTMENTS April 1, 2015 - March 31, 2016 Enhancing Emergency Care in Nova Scotia Emergency departments (EDs) in Nova Scotia are an integral part of the health care system, providing rapid assessment and management of patients with unknown or unexpected problems as well as those with deteriorating pre-existing illness or injury requiring emergency care. In recent years, enhancements in emergency care in the province have focused on improving access to quality patient care that best meets the need of local communities. This has been demonstrated through the implementation of Collaborative Emergency Centres (CECs) and through the establishment of regular hours of operation within some facilities. 4

Collaborative Emergency Centres Hours of Operation and Scheduled Hours of Closure CECs provide same day or next day access to primary health care (physicians and nurse practitioners) for extended hours. During night time hours, for most CECs, there is a collaborative care team available that consists of paramedics and/or Registered Nurses who are supported by an Emergency Health Services physician who provides oversight by being available by phone for consultation. In communities where the CEC model has been implemented, the frequency of these unscheduled, temporary, ED closures have been significantly reduced, providing area residents with reliable access to emergency care. As of March 31, 2016, there are eight facilities across the province that have implemented this model of care and planning continues for additional CECs to be established. Four EDs have established regular hours of operation that are less than 24/7 to provide consistent access to safe and quality care. Hours that these facilities are not opened are considered scheduled hours of closure. These facilities implemented these scheduled closures when faced with one or more of the following challenges in keeping their ED open: Core staffing A limited number of patients visiting the ED during overnight hours Inability to safely staff the ED at peak hours Instability in providing consistent ED access Meeting the needs of the local community in which the facility was located FACILITY South Cumberland Community Care Centre All Saints Springhill Hospital Lillian Fraser Memorial Hospital Annapolis Community Health Centre North Cumberland Memorial Hospital Twin Oaks Memorial Hospital Musquodoboit Valley Memorial Hospital New Waterford Consolidated Hospital COMMUNITY Parrsboro Springhill Tatamagouche Annapolis Royal Pugwash Musquodoboit Harbour Middle Musquodoboit New Waterford EMERGENCY HOURS OF SCHEDULED DEPARTMENT OPERATION HOURS OF CLOSURE Fishermen s Open daily from 3,294 Memorial 7:30 am to 10:30 pm Hospital Musquodoboit Open daily from 4,392 Valley Memorial 8:00 am to 8:00 pm Hospital New Waterford Open Tuesday to 3,644 Consolidated Saturday 7:00 am Hospital to 5:00 pm. The Mobile Care Team also operates Tuesday to Saturday 7:00 am to 5:00 pm Northside Beginning in 6,222 General December 2014, Hospital Open daily from 8:00am to 3:00 pm 5

Fishermen s Memorial Hospital (Lunenburg) Fishermen s Memorial Hospital s ED began overnight closures, (10:30 pm to 7:30 am daily) in July 1, 2008, after experiencing frequent closures due to staffing issues and a low number of patient visits between midnight and 7:00 am (average of 1 to 2 visits per night). Establishing hours of operation has helped ensure that the ED is safely staffed during its busiest times and has provided a more reliable, consistent level of service to the community. Musquodoboit Valley Memorial Hospital (Middle Musquodoboit) Due to lack of physician resources, Musquodoboit Valley Memorial Hospital (MVMH) has operated under a new model of care since July 2009. This model included an ED that operated from 8:00 am to 5:00 pm Monday to Friday in conjunction with a collaborative care clinic, which provided sameday appointments with family physicians and improved access to primary care. There was 24-hour access to the ED on Saturdays and Sundays. This model of care helped with the retention of family doctors and provided stable regular ED hours for community residents. MVMH converted to a CEC model in March 2013 and regular hours of operation were modified and are now 8:00 am to 8:00 pm, 7 days per week. New Waterford Consolidated Hospital (New Waterford) New Waterford officially transitioned to a CEC on September 30, 2013. However, this model of care was phased in beginning in June 2013. The New Waterford CEC model provides enhanced access to primary care (physicians and nurse practitioners) from 7:00 am to 5:00 pm Tuesday to Saturday. Additionally, this model provides care for people with non-urgent health needs in their own home through a Mobile Care Team which includes a Registered Nurse and an Advanced Care Paramedic from 7:00 pm to 7:00 am Monday to Thursday. To accommodate reduced physician availability, in the summer of 2014 New Waterford modified the hours of operation to Monday to Friday 7:00 am to 5:00 pm. In December 2014, the hours of operation were modified to the current model of Tuesday to Saturday 7:00 am to 5:00 pm. Northside General Hospital (North Sydney) To accommodate ongoing staffing challenges at Northside, scheduled closures were implemented in June 2014. At that time, regular ED hours of operation were 8:00 am to 10:00 pm. In December 2014, hours of operation were modified to 8:00 am to 3:00 pm. This was to ensure safe staffing and consistent access to emergency care for residents in and around North Sydney. 6

Overview: Emergency Department Closures by Zone and Facility Type Zone Facility Type Facility Name Hours of Closure (2015/16) Temporary Scheduled Total 1 Regional South Shore Regional Hospital 0 0 5,107 Regional Yarmouth Regional Hospital 0 0 Regional Valley Regional Hospital 0 0 Community Digby General Hospital 194 0 Community Fishermen s Memorial Hospital 187 3,294 Community Roseway Hospital* 1,331 0 Community Soldiers Memorial Hospital 60 0 Community Queens General Hospital 0 0 CEC Annapolis Community Health Centre* 41 0 2 Regional Colchester East Hants Health Centre 0 0 1,321 Regional Cumberland Regional Health Care Centre 0 0 Regional Aberdeen Hospital 0 0 CEC All Saints Springhill Hospital 300 0 CEC North Cumberland Memorial Hospital 160 0 CEC South Cumberland Community Care Centre 762 0 CEC Lillian Fraser Memorial Hospital 99 0 3 Regional Cape Breton Regional Hospital 0 0 11,620 Regional St. Martha s Regional Hospital 0 0 Community Eastern Memorial Hospital 0 0 Community Guysborough Memorial Hospital 0 0 Community St. Anne Community & Nursing Care Centre 114 0 Community St. Mary s Memorial Hospital 0 0 Community Strait Richmond Hospital 36 0 Community Buchanan Memorial Health Centre 0 0 Community Glace Bay Health Care Facility 1,066 0 Community Inverness Consolidated Memorial Hospital 0 0 Community Victoria County Memorial Hospital 20 0 Community Northside General Hospital 154 6,222 Community Sacred Heart Community Health Centre 0 0 CEC New Waterford Consolidated Hospital 364 3,644 4 Tertiary QEII Health Sciences Centre 0 0 4,457 Regional Dartmouth General Hospital 0 0 Community Cobequid Community Health Centre 0 0 Community Eastern Shore Memorial Hospital 0 0 Community Hants Community Hospital 0 0 CEC Musquodoboit Valley Memorial Hospital 0 4,392 CEC Twin Oaks Memorial Hospital* 65 0 IWK Tertiary IWK Health Centre 0 0 0 TOTAL 4,953 17,552 22,505 * Zone totals may be off by a maximum of 1 hour due to rounding of individual values for display 7

Summary of Temporary ED Closure Hours and Public Consultations by Zone Health human resources continue to be a challenge throughout the province. In 2015/16, temporary ED closures were the result of nursing, physician and paramedic unavailability. For specific dates of closure see Appendix A. In accordance with the EMERGENCY DEPARTMENT ACCOUNTABILITY ACT, the District Health Authorities (now considered the NSHA) with an ongoing pattern of emergency department (ED) closures are expected to hold two public consultations throughout the fiscal year with the community served by the ED. The consultation must include consideration for proposed community solutions to mitigate further ED closures. Western Zone FACILITY Digby General Hospital Fishermen s Memorial Hospital Roseway Hospital Soldiers Memorial Hospital Annapolis Community Health Centre TOTAL HOURS OF TEMPORARY ED CLOSURES 194 hours 187 hours 1,331 hours 60 hours 41 hours 1,813 HOURS PUBLIC CONSULTATION #1 Date/Time Community Chair/Speakers Attendance (approx.) Various Annapolis Dan Marsh (Site Manager, Committee members of local Annapolis Community stakeholder groups) stakeholder groups Health Center) Summary of Discussion: Regular meetings with foundations, auxiliaries, and municipal leaders occur. All topics including sustainability of the Collaborative Emergency Centres (CEC) were discussed. Closures have been minimal in 2015-2016. Zone ACTION (specific to Emergency Departments): Active recruitment of nursing staff. Consider staffing model in CEC. Commit to continued communication with the community. 8

PUBLIC CONSULTATION #2 Date/Time Community Chair/Speakers Attendance (approx.) Ongoing Lunenburg Wanda Matthews 2-30 people depending on (Executive Directive Operations, event Western Zone, NSHA) Theresa Hawkesworth (Communications and Public Relations & Community Engagement, NSHA) Lynn Farrell (Director of Emergency, Western Zone, NSHA) Summary of Discussion: Representatives of Nova Scotia Health Authority (NSHA) participated in a meeting called to discuss the future of South Shore area hospitals. ED closures and future roles of Fisherman s Memorial Hospital and the South Shore Regional Hospital (SSRH) were included in the discussions. ED staffing availability has impacted our ability to remain open for scheduled hours; however, past work with the community set expectations that closures would be accepted with access to SSRH ED close by. Local MLAs, municipal leaders, foundations and auxiliaries were engaged in discussion on several occasions (e.g. Auxiliary AGM, MLA & Foundation joint meeting, MLA individual meetings) Zone ACTION (specific to Emergency Departments): Work to address the staffing challenges in the South Shore area a priority for the NSHA. Commit to continued communication with the community. PUBLIC CONSULTATION #3 Date/Time Community Chair/Speakers Attendance (approx.) Various Digby Hubert d Entremont, 2-15 members (at a time) from Site Manager (NSHA Digby local stakeholder groups General Hospital) Summary of Discussion: Regular meetings with foundations, auxiliaries, and municipal leaders occurred. All topics including sustainability of the ED were discussed. Closures have increased in 2015-2016 due to loss of family practice physicians. Discussion also included the impact of closures on rural areas (e.g. ambulance fees to nearest open ED, loss of physicians) Work is underway to recruit ED/Primary Care physicians to the area as well as locums to augment the team. Zone ACTION (specific to Emergency Departments): Build recruitment strategies for physicians within the NSHA aligned with local opportunities. Commitment to improved communication with the community. 9

PUBLIC CONSULTATION #4 Date/Time Community Chair/Speakers Attendance (approx.) Various Shelburne Jodi Ybarra (Site Manager, 2-10 committee members NSHA Roseway Hospital) (at a time) of local stakeholder groups Wanda Matthews (Executive Directive Operations, NSHA Western Zone) Alenia Kysela (Medical Lead, NSHA Western Zone) Summary of Discussion: Representatives from the NSHA, the Department of Health and Wellness (DHW), Minister of Health and Wellness, and the Department of Transportation and Infrastructure Renewal (TIR) have participated in various public meetings that were called to discuss Roseway Hospital ED closures as well as primary care physician recruitment challenges. Presentations included emergency room data (visits, triage codes) and NSHA s vision for community based primary health care. Recruitment challenges and opportunities for stakeholders to support initiatives were discussed. The discussion included: - ED staffing complement (e.g. number of registered nurses (RN), licensed practical nurses (LPN)). - Scope of practice for RNs and how the scope of RNs, paramedics and other health professionals can be examined to allow a different mix of health professionals to provide ED care. - Impact of closures on rural areas (e.g. ambulance fees to nearest open ED). - Including more local family physicians in ED coverage. - Status of Shelburne health centre renovations. - Status of provincial physician recruitment strategies and resource planning. Zone ACTION (specific to Emergency Departments): Work to address the challenges in Shelburne a priority for the NSHA. The commitment of NSHA is to significantly reduce closures and work toward sustainable access to emergency services in Shelburne County. Some actions taken as a result of the community consultation in 2014-2015 include: - Hiring additional registered nurses to allow flexibility in staff scheduling. Nurses are cross trained in medicine and ED. - Taking advantage of provincial, NSHA, approach to service planning and delivery to find options for sharing nurses from other hospitals. - Recruitment of paramedics to augment team and reduce nursing related closures. - Build recruitment strategies for physicians within the NSHA and ensure aligned with local opportunities. - Improved timeliness of physician schedule generation and sharing. - Improved connection with Roseway and other facilities/physician groups who have provided aid and reduced closures. - Commitment to improved communication with the community (e.g. meetings with community group Save Our Services addressing questions and concerns as they arise). - Zonal medical and administrative leadership meet every two months with Town and Municipal councils. - Jodi Ybarra site manager and other program leads attend, upon request, council meetings to respond to Q&A and present on topics of interest. - Newsletters are shared with the community on a periodic basis to share successes including those impacting emergency. 10

PUBLIC CONSULTATION #5 Date/Time Community Chair/Speakers Attendance (approx.) Various Middleton Jeanne Saulnier Committee members of local (Site Manager, NSHA Soldiers stakeholder groups Memorial Hospital) (attendance varies) Donna Arsenault (Site Manager, NSHA Soldiers Memorial Hospital) Summary of Discussion: Regular monthly meetings with foundations and auxiliaries and attendance at municipal council occur. Topics of discussion always include sustainability of ED closures. ED closures have increased in 2015-2016 due to nursing shortages. Discussion included the impact of closures on rural areas (e.g. ambulance fees to nearest open ED, recruitment challenges for health care team members). Work is underway to sustain nursing and physician complement. Zone ACTION (specific to Emergency Departments): Build recruitment strategies for physicians within the NSHA and ensure they are aligned with local opportunities. Increase access to collaborative teams in the Middleton community cluster. Work to address the staffing challenges in Middleton/Annapolis Valley area a priority. Above core staff hired to mitigate gaps in the overtime of FTEs. Commit to continued communication with the community Northern Zone FACILITY All Saints Springhill Hospital Lillian Fraser Memorial Hospital North Cumberland Memorial Hospital South Cumberland Community Care Centre TOTAL HOURS OF TEMPORARY ED CLOSURES 300 hours 99 hours 160 hours 762 hours 1,321 HOURS PUBLIC CONSULTATION #1 Date/Time Community Chair/Speakers Attendance (approx.) Nov. 16, 2015 Parrsboro, River Hebert Cheryl Northcott (Executive Annual General Meeting Director Operations, NSHA Northern Zone) Ann Keddy (Director of Public Relations, NSHA) 11

Summary of Discussion: Emergency services within South Cumberland facility were discussed as part of the AGM agenda. Zone ACTION (specific to Emergency Departments): Data on the utilization of South Cumberland CEC/ED was shared and reviewed South Cumberland CEC/ED was referenced in the Provincial Review CECs Community representatives advised PUBLIC CONSULTATION #2 Date/Time Community Chair/Speakers Attendance (approx.) March 1, 2016 Pugwash Janet Knox (CEO, NSHA) Redevelopment Committee Lindsay Peach (VP, NSHA Northern Zone) Cheryl Northcott (Executive Director Operations, NSHA Northern Zone) Ann Keddy (Director of Public Relations, NSHA) Summary of Discussion: Redevelopment plan for North Cumberland facility discussed regarding continued operations of services, including emergency services to meet the needs of the community. Eastern Zone FACILITY Glace Bay Health Care Facility Northside General Hospital St. Anne Centre Strait Richmond Hospital Victoria County Memorial New Waterford Consolidated Hospital HOURS OF TEMPORARY ED CLOSURES 1,066 hours 154 hours 114 hours 36 hours 20 hours 364 hours TOTAL 1,754 hours 12

PUBLIC CONSULTATION #1 Date/Time Community Chair/Speakers Attendance (approx.) June 29, 2015 Baddeck/Victoria County Mary Lou O Neill (Executive Municipal Warden and October 2015 Director Operations, NSHA councillor representatives in Eastern Zone) attendance Dr Jeremy Hillyard (Medical Executive Director, NSHA Eastern Zone) Eileen Woodford (Director, Rural Health) Summary of Discussion: The meeting focused on the recruitment of registered nurses and primary health care physicians and the impact on the health care of residents if this was not already addressed. It was noted that the Victoria County Memorial Hospital (VCMH) is a blended model where inpatient care and ED staffing are integrated. The 24/7 ED is also staffed by primary health care physicians. Victoria County council offered to partner with Nova Scotia Health Authority (NSHA) to support recruitment and infrastructure initiatives. Eastern Zone ACTION (specific to Emergency Departments): The municipal council passed a motion to support primary health care physician recruitment and infrastructure improvement/ renovation to appeal to potential recruits. A Victoria County contribution funding contribution will support the project 100%. Eastern Zone leadership requested approval/support from NSHA Executive Leadership Team. An MOU between NSHA and Victoria County was signed in October 2015 PUBLIC CONSULTATION #2 Date/Time Community Chair/Speakers Attendance (approx.) Sept. 15, 2015 Eastern Zone Council of CHB Chairs Meeting was held in Baddeck. Attending were: Antigonish Town and County CHB Central Cape Breton County CHB Central Inverness CHB East Cape Breton County CHB Guysborough County CHB North Inverness CHB Northside the Lakes CHB Strait Richmond CHB Victoria County CHB Mary Lou O Neill (Executive Director Operations, NSHA Eastern Zone) Tricia Cochrane (Vice President Integrated Health, NSHA) Geoff Wilson (Director of Public Engagement & Community Health Board Support, NSHA) Melissa Lee Ross (Manager, Primary Health Care, NSHA) Sarah MacDonald (Communications and Public Relations & Community Engagement, NSHA) CHB Chairs from across the Eastern Zone were represented 13

Summary of Discussion: While the initial focus of the meeting was new legislation for Community Health Boards (CHB) as well as NSHA s vision, access to Emergency Care/Departments was also discussed. Emergency care discussion focused on the population health needs in communities where there are people with particular chronic health needs. A feedback/question and answer session was also held that covered multiple topics. Eastern Zone ACTION (specific to Emergency Departments): Information was shared about current ED physician and nursing shortages as well as ongoing efforts to recruit and retain physicians and staff. PUBLIC CONSULTATION #3 Date/Time Community Chair/Speakers Attendance (approx.) Sept. 18, 2015 East Cape Breton County CHB Mary Lou O Neill (Executive 10 CHB members Director Operations, NSHA Eastern Zone) Summary of Discussion: The primary focus was renal care in Glace Bay. Discussion also moved to people living with chronic and co-morbid health conditions a (renal disease/ heart disease). Concerns were also raised about the ongoing demand on ED because of chronic disease. A feedback/question and answer session was held that covered multiple topics. Eastern Zone ACTION (specific to Emergency Departments): Ongoing tracking of the impact of chronic illness on patient flow including ED visits/admissions. This includes daily Patient Flow rounds. Because people may have a family physician (or Most Responsible Physician) outside of their home community, data shows that this can impact patient flow in hospital and ED. A provincial committee is meeting on remuneration and funded positions for hospitalists. Hospitalists may help with patient flow throughout hospital, which could positively impact patient flow through EDs. PUBLIC CONSULTATION #4 Date/Time Community Chair/Speakers Attendance (approx.) Jan. 28, 2016 New Waterford Martha Cooper (Director of CEC team includes EHS/ DHW/ Cardiac/Critical Care & Zone reps/ Community reps Emergency Department/CEC) Summary of Discussion: In New Waterford, the CEC/ED and primary health care are linked. Discussion at this meeting included CEC/ED progress and utilization. A feedback/question and answer session was also held. Eastern Zone ACTION (specific to Emergency Departments): Data on the utilization of New Waterford CEC/ED was shared and reviewed. NW CEC/ED was referenced in the Provincial Review CECs. 14

PUBLIC CONSULTATION #5 Date/Time Community Chair/Speakers Attendance (approx.) June 17, 2015 Eskasoni First Nation Mary Lou O Neill (Executive Representation from all five Director Operations, NSHA First Nations Communities Eastern Zone) in Eastern Zone Tim Guest (Vice President Integrated Health, NSHA) Tricia Cochrane (Vice President Integrated Health, NSHA) Sarah MacDonald (Communications and Public Relations & Community Engagement, NSHA) Nov. 24, 2015 Potlotek First Nation Mary Lou O Neill (Executive Representation from all five Director Operations, NSHA Director Operations, NSHA Eastern Zone) First Nations Communities in Eastern Zone Sarah MacDonald (Communications and Public Relations & Community Engagement, NSHA) Dr. Linda Courey (Senior Director, Mental Health and Addictions, NSHA) Summary of Discussion: Zone First Nations meeting started in spring 2015, and were scheduled throughout the year. While these meetings covered a variety of topics (i.e. mental health, cultural sensitivity etc.), EDs were implicated in some conversations. Feedback/question and answer sessions were also held that covered multiple topics. In November 2015, improving the discharge process, including from EDs, was tabled as an issue. Eastern Zone ACTION (specific to Emergency Departments): Discharge improvements communication occurred in November 2015. - First Nations were given Patient Flow leads at both ends of Eastern Zone so issues can be identified and follow-up done. - First Nations were told about the role of the Patient Representative in the eastern part of the zone and how it works. - After meeting with First Nations, Executive Director of Operations spoke with lead management for Patient Flow (discharge) to make them aware of discharge concerns. Central Zone Isolated closures in Twin Oaks and Musquodoboit Valley no public consultations occurred though in all areas public concerns related to emergency access could be raised and addressed through annual general meetings and as needed throughout the year. 15

Appendix A Temporary ED Closures by Date and Hours Closed (Reporting Period: April 1, 2015 March 31, 2016) ZONE 1 Digby General Hospital JULY 7/1/2015 7.0 7/10/2015 12.0 7/15/2015 7.0 7/29/2015 7.0 AUGUST 8/5/2015 12.0 SEPTEMBER 9/17/2015 12.0 9/23/2015 4.0 9/25/2015 12.0 DECEMBER 12/17/2015 12.0 12/21/2015 12.0 12/22/2015 24.0 JANUARY 1/20/2016 25.0 1/27/2016 24.0 FEBRUARY 2/3/2016 12.0 MARCH 3/4/2016 12.0 TOTAL 194.0 ZONE 1 Fishermen s Memorial Hospital APRIL 4/11/2015 4.5 MAY 5/28/2015 7.5 JUNE 6/26/2015 8.5 6/27/2015 5.5 JULY 7/4/2015 5.5 7/5/2015 5.5 7/22/2015 5.5 7/25/2015 8.5 7/27/2015 5.5 7/28/2015 5.5 7/29/2015 5.5 7/30/2015 5.5 7/31/2015 5.5 AUGUST 8/1/2015 5.5 8/2/2015 5.5 8/15/2015 5.5 8/16/2015 5.5 8/22/2015 11.0 SEPTEMBER 9/17/2015 5.5 9/18/2015 5.5 OCTOBER 10/14/2015 9.0 10/16/2015 5.5 10/17/2015 5.5 NOVEMBER 11/7/2015 15.5 11/15/2015 8.5 11/17/2015 5.5 FEBRUARY 2/16/2016 3.5 2/27/2016 3.5 MARCH 3/16/2016 8.0 TOTAL 187.0 ZONE 1 Roseway Hospital APRIL 4/5/2015 12.0 4/10/2015 12.0 4/27/2015 13.0 MAY 5/3/2015 11.0 5/9/2015 2.0 5/11/2015 11.0 5/15/2015 12.0 5/19/2015 13.0 5/22/2015 8.0 5/30/2015 19.0 JUNE 6/5/2015 13.0 6/6/2015 13.0 6/8/2015 13.0 6/11/2015 10.0 6/19/2015 13.0 JULY 7/4/2015 13.0 7/5/2015 13.0 7/9/2015 11.0 7/10/2015 13.0 7/13/2015 12.0 7/18/2015 25.0 7/20/2015 24.0 7/21/2015 12.0 16

AUGUST 8/1/2015 24.0 8/6/2015 14.0 8/13/2015 13.0 8/16/2015 25.0 8/19/2015 13.0 8/25/2015 10.5 8/26/2015 12.0 8/27/2015 13.0 SEPTEMBER 9/3/2015 13.0 9/4/2015 13.0 9/8/2015 13.0 9/11/2015 13.0 9/25/2015 24.0 9/27/2015 24.0 9/30/2015 13.0 OCTOBER 10/2/2015 24.0 10/3/2015 37.0 10/7/2015 12.0 10/9/2015 14.0 10/11/2015 24.0 10/20/2015 14.0 10/28/2015 13.0 10/30/2015 11.0 NOVEMBER 11/2/2015 24.0 11/9/2015 11.0 11/18/2015 17.0 11/27/2015 14.0 11/28/2015 14.0 DECEMBER 12/21/2015 24.0 12/24/2015 38.0 12/28/2015 24.0 12/31/2015 24.0 JANUARY 1/1/2016 14.0 1/2/2016 14.0 1/3/2016 13.0 1/11/2016 24.0 1/18/2016 24.0 1/23/2016 26.0 1/25/2016 26.0 1/27/2016 26.0 1/31/2016 26.0 FEBRUARY 2/7/2016 26.0 2/8/2016 15.0 2/12/2016 15.0 2/15/2016 15.0 2/20/2016 26.0 2/22/2016 16.0 2/25/2016 38.0 2/27/2016 14.0 MARCH 3/11/2016 26.0 3/14/2016 14.0 3/15/2016 15.0 3/17/2016 14.0 3/18/2016 14.0 3/28/2016 15.0 TOTAL 1330.5 ZONE 1 Soldiers Memorial Hospital SEPTEMBER 9/1/2015 24.0 NOVEMBER 11/12/2015 12.0 11/13/2015 12.0 DECEMBER 12/20/2015 12.0 TOTAL 60.0 ZONE 1 Annapolis Community Health Centre OCTOBER 23/10/2015 13.5 24/10/2015 12.0 FEBRUARY 18/02/2016 15.0 TOTAL 40.5 ZONE 2 All Saints Springhill Hospital APRIL 4/1/2015 12.0 4/9/2015 12.0 4/14/2015 12.0 4/15/2015 12.0 4/17/2015 12.0 4/21/2015 12.0 4/22/2015 12.0 4/23/2015 12.0 4/27/2015 12.0 4/28/2015 12.0 MAY 5/1/2015 12.0 17

JUNE 6/24/2015 12.0 6/26/2015 12.0 AUGUST 8/20/2015 12.0 SEPTEMBER 9/8/2015 12.0 9/29/2015 12.0 OCTOBER 10/1/2015 12.0 10/2/2015 12.0 10/9/2015 12.0 10/10/2015 12.0 10/11/2015 12.0 10/16/2015 12.0 10/19/2015 12.0 10/20/2015 12.0 10/23/2015 12.0 TOTAL 300.0 ZONE 2 Lillian Fraser Memorial Hospital APRIL 4/10/2015 4.0 MAY 5/29/2015 6.0 AUGUST 8/5/2015 4.0 SEPTEMBER 9/18/2015 3.0 OCTOBER 10/2/2015 6.0 10/16/2015 8.0 NOVEMBER 11/20/2015 4.0 11/25/2015 4.0 DECEMBER 12/20/2015 12.0 12/25/2015 12.0 12/26/2015 4.0 12/27/2015 12.0 12/29/2015 4.0 JANUARY 1/1/2016 12.0 FEBRUARY 2/26/2016 4.0 TOTAL 99.0 ZONE 2 North Cumberland Memorial Hospital APRIL 4/17/2015 12.0 4/18/2015 12.0 4/19/2015 12.0 4/21/2015 12.0 MAY 5/26/2015 4.0 JULY 7/6/2015 12.0 7/17/2015 12.0 AUGUST 8/4/2015 12.0 8/13/2015 12.0 SEPTEMBER 9/7/2015 12.0 9/15/2015 12.0 OCTOBER 10/9/2015 12.0 JANUARY 1/18/2016 12.0 MARCH 3/24/2016 12.0 TOTAL 160.0 ZONE 2 South Cumberland Community Care Centre APRIL 4/1/2015 12.0 4/10/2015 12.0 4/13/2015 12.0 4/14/2015 12.0 4/15/2015 12.0 4/17/2015 12.0 4/21/2015 12.0 4/23/2015 12.0 MAY 5/1/2015 12.0 5/11/2015 12.0 5/15/2015 12.0 5/26/2015 12.0 JUNE 6/15/2015 12.0 6/24/2015 12.0 6/26/2015 12.0 6/29/2015 12.0 18

JULY 7/3/2015 24.0 7/6/2015 24.0 7/8/2015 12.0 7/10/2015 24.0 7/11/2015 12.0 7/14/2015 12.0 7/15/2015 12.0 7/17/2015 12.0 7/21/2015 12.0 7/22/2015 12.0 7/23/2015 12.0 7/25/2015 12.0 7/27/2015 12.0 7/28/2015 12.0 AUGUST 8/4/2015 12.0 8/5/2015 12.0 8/6/2015 12.0 8/7/2015 12.0 8/11/2015 12.0 8/12/2015 12.0 8/13/2015 12.0 8/14/2015 12.0 8/17/2015 12.0 8/18/2015 12.0 8/19/2015 12.0 8/21/2015 12.0 SEPTEMBER 9/11/2015 2.5 NOVEMBER 11/25/2015 12.0 11/27/2015 12.0 DECEMBER 12/4/2015 24.0 12/23/2015 12.0 12/29/2015 12.0 12/30/2015 12.0 JANUARY 1/29/2016 12.0 MARCH 3/1/2016 12.0 3/2/2016 12.0 3/3/2016 12.0 3/15/2016 12.0 3/16/2016 12.0 3/17/2016 12.0 3/18/2016 3.5 3/26/2016 12.0 3/27/2016 12.0 3/29/2016 12.0 3/30/2016 12.0 TOTAL 762.0 ZONE 3 Glace Bay Health Care Facility APRIL 4/1/2015 16.0 4/4/2015 16.0 4/6/2015 25.0 4/7/2015 16.0 4/10/2015 16.0 4/13/2015 16.0 4/14/2015 16.0 4/17/2015 16.0 4/19/2015 16.0 4/26/2015 16.0 4/30/2015 16.0 MAY 5/1/2015 64.0 5/4/2015 16.0 5/10/2015 16.0 5/17/2015 16.0 5/21/2015 16.0 5/29/2015 16.0 JUNE 6/2/2015 16.0 6/3/2015 16.0 6/4/2015 16.0 6/5/2015 16.0 6/14/2015 16.0 6/21/2015 13.0 6/23/2015 16.0 6/24/2015 16.0 6/25/2015 16.0 6/28/2015 16.0 JULY 7/2/2015 16.0 7/3/2015 16.0 7/5/2015 16.0 7/6/2015 16.0 7/17/2015 16.0 7/18/2015 16.0 7/20/2015 16.0 7/24/2015 16.0 7/25/2015 16.0 7/27/2015 16.0 7/28/2015 16.0 AUGUST 8/1/2015 13.0 8/2/2015 16.0 8/3/2015 16.0 8/5/2015 16.0 8/7/2015 16.0 8/8/2015 16.0 8/19/2015 16.0 8/22/2015 16.0 8/23/2015 7.0 19

NOVEMBER 11/28/2015 16.0 DECEMBER 12/23/2015 16.0 12/24/2015 16.0 12/25/2015 16.0 JANUARY 1/24/2016 16.0 FEBRUARY 2/3/2016 16.0 2/14/2016 16.0 MARCH 3/6/2016 16.0 3/10/2016 16.0 3/12/2016 16.0 3/13/2016 16.0 3/16/2016 16.0 3/18/2016 16.0 3/20/2016 16.0 3/21/2016 16.0 3/26/2016 16.0 3/27/2016 16.0 TOTAL 1066.0 ZONE 3 Northside General Hospital APRIL 4/7/2015 7.0 MAY 5/22/2015 7.0 5/23/2015 7.0 5/24/2015 7.0 5/31/2015 7.0 JUNE 6/5/2015 7.0 6/7/2015 7.0 6/19/2015 7.0 6/20/2015 7.0 6/21/2015 7.0 JULY 7/4/2015 7.0 7/5/2015 7.0 AUGUST 8/18/2015 7.0 8/23/2015 7.0 JANUARY 1/10/2016 7.0 1/17/2016 7.0 FEBRUARY 2/13/2016 7.0 2/19/2016 7.0 2/21/2016 7.0 2/28/2016 7.0 MARCH 3/13/2016 7.0 3/15/2016 7.0 TOTAL 154.0 ZONE 3 New Waterford Consolidated Hospital APRIL 4/3/2015 10.0 4/30/2015 10.0 MAY 5/8/2015 10.0 5/16/2015 10.0 5/22/2015 10.0 JUNE 6/5/2015 10.0 6/20/2015 10.0 6/24/2015 10.0 JULY 7/2/2015 10.0 7/4/2015 10.0 7/9/2015 10.0 7/21/2015 10.0 7/24/2015 10.0 7/25/2015 10.0 7/31/2015 10.0 AUGUST 8/5/2015 10.0 8/13/2015 10.0 8/25/2015 10.0 8/29/2015 10.0 SEPTEMBER 9/3/2015 10.0 9/25/2015 10.0 OCTOBER 10/1/2015 10.0 10/31/2015 10.0 DECEMBER 12/12/2015 10.0 12/24/2015 32.0 12/26/2015 10.0 12/31/2015 32.0 JANUARY 1/2/2016 10.0 MARCH 3/5/2016 10.0 3/10/2016 10.0 3/15/2016 10.0 3/31/2016 10.0 TOTAL 364.0 20

ZONE 3 Strait Richmond Hospital MAY 5/16/2015 24.0 AUGUST 8/16/2015 12.0 TOTAL 36.0 ZONE 3 Victoria County Memorial Hospital SEPTEMBER 9/14/2015 7.0 OCTOBER 10/15/2015 13.0 TOTAL 20.0 ZONE 3 St Anne Centre JULY 7/9/2015 12.0 SEPTEMBER 9/5/2015 10.0 OCTOBER 10/8/2015 12.0 NOVEMBER 11/16/2015 12.0 11/17/2015 12.0 11/18/2015 12.0 11/19/2015 12.0 11/20/2015 8.0 DECEMBER 12/25/2015 24.0 TOTAL 114.0 ZONE 4 Twin Oaks Memorial Hospital APRIL 4/15/2015 1.5 4/22/2015 12.0 MAY 5/2/2015 12.0 JUNE 6/5/2015 12.0 JULY 7/6/2015 12.0 AUGUST 8/27/2015 2.5 SEPTEMBER 9/14/2015 1.5 FEBRUARY 2/21/2016 11.0 TOTAL 64.5 21

Annual Accountability Report ON EMERGENCY DEPARTMENTS April 1, 2015 - March 31, 2016