ER overcrowding: improvements, but nothing gained

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Bottleneck emergencies: improvements, but nothing is won

The Federation of General Practitioners of Quebec doubts that 50% of people who come to emergency can be redirected elsewhere in the health network to receive care.

A month after the Legault government presented three measures aimed at relieving hospitals, improvements are notable, but not enough to get hospitals out of the red zone.

Sunday, according to the government data, the occupancy rate in emergency rooms was considered very high in 12 of the 16 regions of Quebec. Radio-Canada has attempted to assess the results obtained so far by the three key measures announced in early November by the Minister of Health, Christian Dubé.

In order to free up 1,730 hospital beds currently occupied by elderly patients who no longer require hospital care, the Legault government had set itself the objective of finding places in CHSLDs, but also in clinics rehabilitation and intermediate residences for seniors.

At the last survey, 1,053 places are open, or 61% of the objective, indicates the Ministry of Health and Social Services (MSSS) by email. For the Montreal region, the number of NSA patients (that is to say who must be relocated to a place adapted to their care needs) has increased from 756 to 634, notes the ministry, which points out that it this is a decrease of 16% since September 1.

Historically, in Quebec, 8% of hospital beds are taken by these patients, then it rose to 13-14% this summer. So it really became a big problem, says Dr. Gilbert Boucher, president of the Association of Emergency Medicine Specialists of Quebec.

“Things are gradually improving, but it's going in the right direction. »

— Dr. Gilbert Boucher, President of ASMUQ

At the beginning of November, the Minister of Health Christian Dubé announced three measures aimed at unclogging emergency rooms in Quebec, under great pressure. A month later, there is improvement, but many challenges remain. Report by Marie Isabelle Rochon.

When the state of health of the patients allows it, the health authorities try to favor waiting at home rather than in the hospital for those waiting for a place in accommodation (CHSLD, residences for the elderly, etc. ) For Montreal, we are currently seeing a 30% decrease in the number of users waiting for accommodation from hospitals, from 212 users on September 1 to 148 users, says a spokesperson for the MSSS. This frees up beds for patients who really need them.

So that users can have access to an appointment with a doctor without going through hospital emergency rooms, the government is relying on the 811 telephone exchange, where an administrative agent directs the citizen to the health professional who will best respond to their needs. its need.

For the week ending November 12, 17,522 requests had been received and 93% of these requests were processed within 36 hours by the GAP ( First line access counter). But in Montreal, only 78% of applicants were able to get an appointment.

In the five regions of Greater Montreal with access to the GAP, the degree of satisfaction seems to vary if we rely on the testimonials collected by Radio-Canada. While some are happy to have obtained an appointment two hours after a call or the next day, others are more circumspect.

Unable to reach someone at 811, Karen Leon turned to Ste-Justine Hospital for her sick child.

I was unable to speak with a human being… I've been trying to communicate with someone for two days, says Karen Leon, whom she met at Ste-Justine Hospital because she couldn't get an appointment elsewhere for her child.

At this hospital, the ER occupancy rate was 150% on Sunday.

Others try to outsmart the system to get the precious sesame. The 811 in Montreal is much better than the 811 in Laval. I live in Laval and, sometimes, you have to lie and say that I live in Montreal, confides a father met at the same hospital.

A family physician in Montreal's east end, Dr. Pascale Breault says the patients she sees are generally satisfied with the new system. It is sure that there can be some bog down without the (telephone) lines, because we are in a period of increased demand.

But those with conditions that really need to be evaluated quickly are quickly transferred to appointments, she adds.

Dre Pascale Breault

Dr. Breault remains lucid, however. If it were simple, it would have been fixed a long time ago, she says.

However, every small measure can bring benefits and this one this, I think, is one that is important. Especially from the patient's point of view, because it simplifies their journey through the system, and therefore they have an alternative that is quite easy to find compared to the emergency.

The third key measure presented at the beginning of November by Minister Dubé concerns the opening of clinics managed by super nurses capable of providing certain medical care formerly reserved for doctors.

A first will open the December 1 at the CLSC Olivier Guimond, in the borough of Mercier-Hochelaga-Maisonneuve. The second will open in the Verdun CLSC by the end of December, while the opening of the third, at Notre-Dame Hospital, is scheduled for the end of January.

Notre-Dame Hospital is located on Sherbrooke Street East, in Montreal.

These new clinics will not be too much, because the current increase in flu cases among children announces a future wave among their parents around Christmas.

That's what scares us a little bit. We see it in the emergency room for 4 to 7 days, there is a lot more Influenza, according to Doctor Gilbert Boucher. We know, historically, 4-6 weeks after kids get it, it's the adults' turn to catch it. Then unfortunately, the next wave will probably be people more at risk.

A hypothetical unwelcome Christmas present, both for families and for the health system.

Based on information from Marie Isabelle Rochon

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