TORONTO – Canadians may be going through a bout of Stanley Cup fever, but it’s unlikely many of them have sought care at hospital emergency departments during the key games.
At least that was the case during the men’s gold-medal hockey game during last year’s Olympics, when the number of patients seeking urgent treatment at Ontario hospitals plummeted dramatically while Canada battled the U.S. for the glittering prize.
During the broadcast of that iconic event—which drew 16.6 million viewers, the largest TV audience for a single event in Canadian history—there was a 15 to 20 per cent drop in patient visits to Ontario ERs, researchers say.
A study of all 170 emergency departments in the province found that on average, there were 136 fewer patients per hour seeking medical attention during airing of the do-or-die match-up at the Vancouver Games.
“It’s about 3,000 kilometres away from the venue, so it’s not a reflection of a disruption in local services, nor is it just some fluke at one or two hospitals … (it was) every single emergency department in Ontario,” said principal investigator Dr. Donald Redelmeier, an internal medicine specialist working the ER at Sunnybrook Health Sciences Centre that day.
“I was actually working in the hospital on Sunday, Feb. 28, 2010,” Redelmeier said in an interview. “And I really noticed at the time that there were just fewer patients around. It didn’t empty out. There was just a marginal reduction in patients at Sunnybrook that led to a substantial improvement in patient flow.”
Research by Redelmeier and a colleague, published Monday in the online journal Open Medicine, discovered that the Toronto hospital was not an anomaly.
The study shows that while the greatest declines were among middle-class, middle-aged men, there were noticeable drops in the typical numbers of teenagers, young adults and older people, women as well as men, from all socioeconomic levels, and at small community hospitals and large university-affiliated urban institutions.
While the percentage of people looking for help with gastrointestinal disorders, joint pain or traumatic injuries was reduced, the number of patients with heart attacks and other heart-related emergencies was higher than usual, Redelmeier said.
“That’s the one exception we found,” he said. “They went up and there could be a couple of explanations. First is just the raw excitement of the game being too much and precipitating a heart attack or that people get sloppy about their medications—they’re so wrapped up in the game that they forget to take their afternoon dose—or there’s so much alcohol and other lifestyle indiscretions, so that that tips them over.”
Redelmeier said the study is not so much about what happens during a single event like the Olympics or a Stanley Cup playoff game, but what occurs on the other 364 days of the year.
Often emergency department overcrowding and excessive hospital expenditures are blamed on physicians, administrators or antiquated computer systems, he said. “Our study suggests instead that one other large contributor can be patient preferences.
“When there is a major broadcast on television, some patients have an increased reluctance to seek care,” he said, adding that someone engaged in watching a critical game may be distracted from arthritis pain or willing to ride out abdominal upsets that otherwise might have sent them seeking attention at the ER.
“There is the other option, though, of a decreased need to seek care, specifically if you’re sitting on a couch watching television. It means you’re not outside playing football and breaking your arm or spraining your ankle.”
What was most surprising, Redelmeier said of the study findings, was that no upsurge in typical patient numbers occurred in the hours before or after the gold-medal game broadcast, nor in the days following.
“So for all practical purposes, these emergencies disappeared.”
Dr. Eric Grafstein, head of emergency medicine at St. Paul’s Hospital in Vancouver, said the patient fall-off effect during big events is widely recognized by doctors, nurses and others working in emergency departments.
“I think that it was slightly quieter during the games in the department and that things picked up afterwards,” Grafstein said, referring to the Vancouver Canucks’ playoff match-ups. “I know it’s been busier after some of the key games, especially the key games on the weekend and the games where there was a victory.”
Post-game ER visits were likely related to injuries or illness among local fans taking part in alcohol-fuelled celebrations in the streets.
Redelmeier stressed that people who need urgent care should not hesitate to go to their hospital emergency departments.
But he said the size of the drop in patient numbers seen in the study suggests that an estimated one in six ER visits are actually a product of patient choice.
“I think our results would extend to any broadcast where there is a large television viewing audience, such as the Olympics, such as the NBA basketball, such as potentially the World Cup of soccer, because patient preferences are a universal feature.”