Boost ER resources, doctor pleads

With COVID here and flu season coming, overcrowding is a major concern

In late June, as hospital emergency rooms across Quebec began to overflow again with NONCOVID-19 patients, a physician in the Laurentians took to Twitter to plead with the provincial government to boost resources to ERS.

The major problem, Dr. Simon-pierre Landry lamented, is that ERS have become much less efficient as a result of the pandemic because medical staff must don and doff personal protective equipment between patients and spend extra time disinfecting examination rooms.

Yet Landry’s ER at Hôpital Laurentien in Ste-agathe-des-monts was again treating the same number of patients as before the public health crisis. And with the fall season approaching, Landry expressed concern about a potential second wave in the pandemic, exacerbated by the seasonal flu, with patients flooding into ERS.

More than a month later, Health Minister Christian Dubé unveiled a nine-point plan Tuesday to respond to a second COVID-19 wave. The minister announced $106 million in emergency funding to hire 1,000 public-health workers.

He spoke at length about the province’s network of long-term care centres, but not a word about Quebec’s beleaguered ERS.

Landry checked Dubé’s plan to see if he missed some possible references to ERS. He didn’t.

“Emergency departments are usually not the priority of the decision-makers, even if they talk a lot about them,” Landry told the Montreal Gazette.

For more than two decades, Quebec’s overcrowded ERS have been the canary in the mine shaft of the province’s health-care network. Every incoming health minister has pledged to solve the crisis in ERS, but the doctors and nurses who work in them say little has changed.

On Thursday afternoon, Montreal’s ERS were filled to 106 per cent of their capacity.

The Douglas Mental Health University Institute was the hardest hit, with an occupancy rate of 183 per cent, followed by Verdun Hospital at 162 per cent.

At Maisonneuve-rosemont Hospital, 26 patients were being treated on stretchers in the ER’S corridors for at least 24 hours, and six for more than two days. Such numbers were never medically acceptable, but such overcrowding is now occurring in a pandemic.

A veteran Montreal ER nurse denounced what he suggested was Dubé’s tunnel vision.

“He is completely neglecting the one area in the health-care system that has been crippled by COVID-19: Quebec’s emergency rooms,” said the West Island nurse, who agreed to comment on condition of anonymity for fear of professional reprisals.

“Unlike when the shutdown was in place and ERS were operating at approximately 60-per-cent capacity, we are now routinely operating at well over 100 per cent, as the public seems to no longer be afraid of contracting COVID -19 in the waiting room or in the ER itself.

“Due to COVID, most clinics across Quebec are no longer accepting walk-in patients and I can no longer refer patients with relatively minor problems, such as ear infections, for appointments to super clinics,” the nurse added.

“The result is a jammed triage with (relatively) well patients who should be in clinics, waiting hours to be seen by doctors who should be seeing sicker patients. If this dysfunctional process continues and there is a second wave, I can’t see how we are going to cope.”

It’s not just a question of jammed triages. In late May, some Montreal hospitals were grappling with outbreaks in ERS as they started to become congested, since it was harder for staff to separate COVID-19 patients from NONCOVID -19 ones.

Quebec hasn’t totally abandoned hospitals. It did spend $12 million building a prefabricated wing of 24 beds at the Lakeshore General Hospital. Dubé himself toured the facilities.

A similar structure was erected outside St. Mary’s Hospital in Côte-des-neiges. The government hopes to build as many as 20 such units to treat an overflow of patients in the event of a second wave.

In theory, these units should free up hospital beds for ER patients, easing overcrowding. In reality, many hospitals have more than enough physical beds. What they lack are the full-time nurses to provide care to patients in those beds.

Both Landry and the ER nurse recommended that rather than build more prefab units, Quebec should sign agreements with clinics to redirect patients to them during a second wave.