Many residents of Fort Erie and Port Colborne have no alternative but to use their local hospital emergency department (ED) for primary or non-emergent care -- for example, for prescription refills or a doctor's note for work. There aren't enough family physicians or walk-in clinics or outpatient programs, so patients return to the ED time and time again.

Seriously ill emergency patients are transferred to the larger hospitals for the diagnostic, specialist and critical care they need. Often, patients go directly by ambulance from home or accident scene to a larger centre. In the case of a suspected stroke, ambulance paramedics rush patients to Greater Niagara General Site, where a specialty stroke team is on call.

From 10 p.m. to 8 a.m., our small EDs treat less than one patient per hour and the majority of these patients are less-urgent ones who could safely wait until morning. True emergency cases average less than one patient per night. Most often, these extremely ill patients are transferred to larger hospitals.

Despite this, we must fully staff our departments with doctors and nurses trained in emergency medicine. We know that continuing to staff smaller departments 24 hours a day will become more difficult due to our aging workforce and looming physician and nurse shortages.

To provide more appropriate care, we are proposing that the EDs at Douglas Memorial site and Port Colborne site transition to 14-hour prompt/urgent care centres open seven days a week.

These prompt/urgent care centres would treat over 95 per cent of the patients being seen in the EDs with physician coverage from 8 a.m. to 10 p.m. daily with on-site diagnostic, laboratory and pharmacy services available. (ed. note -- The NHS has stated prompt/urgent care will be a temporary measure ending by 2013)

For serious cases, Niagara Emergency Medical Services has an advanced-care paramedic on each ambulance, ensuring a high level of pre-hospital care en route to larger EDs with the back up of full diagnostic services, specialists and operating rooms. Having these EDs as the first destination for the sickest patients avoids delay in diagnosis and treatment.

Our vision seeks to establish comprehensive primary care centres in Fort Erie and Port Colborne sites, to offer new services for chronic illness by a team of physicians, nurse practitioners, social workers, community care access centre providers, physiotherapists.

The centres would serve the same number of the patients (over 95 per cent) who now currently use the emergency departments to be cared for chronic illness such as asthma, diabetes and hypertension.

We're recommending that outpatient clinics be part of this to provide ongoing care for our aging patients helping people stay healthier longer, enhancing their quality of life and reducing their need for hospitalization. All in all, there would be greater emphasis on preventive care and chronic disease management, helping people feel better and reducing the need for hospital admissions.

This is a snapshot of what the future could be. We know there needs to be much more discussion with health-care partners and the communities we serve.

We invite you to learn more about this vision, by going to www.niagarahealth.on.ca. We welcome the public's feedback on the vision for changes we've proposed.

Dr. William Shragge

Chief of Staff

Niagara Health System

Dr. John McAuley

Regional Chief

Department of Emergency Medicine