Montreal emergency rooms can’t keep up

A girl coughing up blood waited until early morning to see an emergency room physician. She arrived at the ER in the middle of the night recently. The hospital was backlogged, one doctor was working the midnight shift, and he was on a “code blue” resuscitating a dying patient. Everyone else waited and waited and waited.

Unfortunately, that’s become a common scenario, Montreal health officials say. So unless it’s a crisis, stay away from the emergency room.

The Montreal Health and Social Services Agency is reporting that its hospitals, on average, are coping with 144-per-cent capacity.

The worst ER situation registered Friday was at the Royal Victoria Hospital of the Mcgill University Health Centre with a 212-per-cent occupancy rate.

The department had 51 patients on stretchers occupying a space meant for 24 — and 18 of these patients had been waiting longer that 24 hours to be admitted to a ward bed.

According to the health agency, chronic overcrowding is afflicting nearly every adult hospital facility in the city.

The ER congestion is not a problem of overnight staffing, explained Dr. Bernard Mathieu, who heads the Quebec association of emergency physicians. Most emergency departments have one doctor at night and the busiest centres will have a second doctor on call, Mathieu said: “One doctor. This is the norm. Unless the ER is really busy.”

Patients cannot be cleared out of the emergency department in a timely manner, that’s the problem, he said. Emergency cases get treated first, so someone with a broken ankle who wasn’t seen for 12 hours won’t suddenly become a priority because it’s nighttime, Mathieu said.

“You come in at midnight, but I’m seeing patients that came in hours before,” said Mathieu, an ER physician at Maisonneuve-rosemont Hospital, which recorded a 131-per-cent capacity Friday with 71 patients on gurneys instead of the allotted 54. Of these, 47 patients had been waiting for a bed for one to two days.

“There’s a mismatch between services provided and the demand,” Mathieu said. “Sometimes the rooms used to see patients are blocked with patients on stretchers waiting for a room upstairs.”

There is no “standard” on how many doctors should work the graveyard shift — it’s up to each hospital to determine its staffing needs, Dr. Andrew Affleck, co-chair of public affairs of the Canadian Association of Emergency Physicians, told the

Montreal Gazette.

“The majority of hospitals will have an on-call system to deal with a surge in volume or acuity” in emergency, Affleck said. “You can’t just go by the number of stretchers.”

Overcrowding is a problem across Canada, and it’s particularly chronic in Montreal, he said.