Quebec ERs still overcrowded despite $100M
Patients being put on stretchers outside other wards of hospitals
Nearly five months after the Quebec government invested $100 million to ease emergency-room overcrowding across the province, ERs today are as crammed as ever — a situation that has infuriated Health Minister Gaétan Barrette, the Montreal Gazette has learned.
The minister summoned the executive directors of regional health authorities in early April to warn them to fix the problem, Barrette’s press attaché revealed on Friday.
“There are still congested emergency rooms even though we are not in the middle of the flu or gastro season,” Julie White said in an email in response to a query about new measures that some hospitals have been compelled to undertake to tackle the ER crisis.
White cited Barrette’s announcement on Dec. 7 that the government was spending $100 million to free up hospital beds so that ER patients could be admitted to them. Under the government plan, Quebec would create nearly 1,500 spaces in long-term care centres, which would then be able to absorb elderly patients from acute-care hospitals.
“The minister therefore reminded the institutions that it’s important that these investments be used in an appropriate manner that would result in a positive effect on the ERs,” White added.
“It is therefore normal that when we invest such significant sums, that we would monitor the results.”
And what are the results to date? On Monday, the occupancy rate of the ER at the Montreal General Hospital stood at 129 per cent. Of that number, 14 patients were being treated on stretchers in the hallways for the past 48 hours — with no privacy and at heightened risk of catching infections.
Ideally, the ER occupancy rate should be under 100 per cent so that patients don’t have to languish on stretchers in the hallways.
The situation was marginally better at the Glen site of the McGill University Health Centre, the so-called superhospital, where the ER’s full capacity was exceeded by 12 per cent. Elsewhere in Montreal, other hospitals reported ER overcrowding, including the Lakeshore General (with an occupancy rate of 187 per cent, by far, the highest in the city); Maisonneuve-Rosement at 128 per cent and the Jewish General at 125 per cent.
Last June, Quebec’s health commissioner concluded that wait times in the province’s ERs were the worst in Canada and among the longest in the western world. The waits were so long that one in 10 ER patients leaves in frustration without being seen by a doctor, commissioner Robert Salois observed.
In response to that report, Barrette kicked in the $100 million to free up hospital beds.
In December, the MUHC — which runs the Montreal General and the Glen site — revised its surge-capacity protocols for its ERs. Since then, it was forced to implement even more aggressive measures despite steep budget cuts imposed by Barrette over the objections of doctors, said Denyse Joseph, president of the 3,000-member Union of Nursing and Cardio-Respiratory Professionals at the MUHC.
“I was notified in mid-March 2017 that the MUHC was obliged by the minister of health to apply the overcapacity protocol,” Joseph said, explaining that once the protocol is activated, ER patients are transferred to other wards even if there are no beds available on other floors. That could mean that such patients would then have to wait on stretchers in the hallways of wards rather than outside the ER.
“Other health establishments in the province were, in fact, applying this protocol, but the MUHC was resisting to do so because of the risk for patients and staff,” Joseph explained.
“These patients are left in hallways of units, family rooms or could be doubled up in a private room. There is no emergency equipment in hallways and family rooms or in a private room that is (designed) for a single patient. The risk of transmission of infection increases drastically as well as the risk of falls.”
“And since there is no budget to increase the staffing,” Joseph added. “This means we have to take care of more patients. The (professional) licences of the nurses and nursing assistants are on the line.”
Vanessa Damha, a spokesperson for the MUHC, defended the new protocol on Monday.
“Should emergency patients require transfer to units ... under the over-capacity protocol, clinical spaces have been specifically chosen to ensure patient safety,” Damha said in a statement.
“The impact on the patient being moved to such a unit should always be weighed against the potential impact of a patient not able to access care due to a full ED (emergency department); i.e., the patient moved to the unit will free up resources in the ED for other patients. Over-capacity situations attempt to ensure all patients — the ones going to the units and the ones in the EDs — can access care when necessary with the resources at our disposal.”
Across the province, White noted that no new ER protocols have been in place since April 1.
Dr. Eddy Lang, a former emergency-room physician at the Jewish General who now heads four ERs in Calgary, said that Barrette’s infusion of $100 million was “doomed to fail” because it did not address the underlying systemic problems of Quebec’s health network.
Lang suggested that ERs alone shouldn’t be burdened with the ER crisis; hospital wards must get involved, too, as well as governmentrun nursing homes. Although Lang said he favours over-capacity protocols, they must be managed properly and well-funded.
“Emergency departments are the safety net for all medical, trauma and social emergencies,” Lang added. “We cannot also be the safety valve for a dysfunctional hospital system which allows itself to run upwards of 100-per-cent capacity.”