One of the most pressing health system issues facing this week is the many patients who no longer need acute care but are still in hospital due to delays in their transfer.
There is plenty to do with it, as soon as the crisis is over, a fascinating case study for anyone interested in the complexity of the decision-making process in the healthcare setting during a pandemic.
It is also a striking example of the difficulties our decision-makers face in finding solutions.
Journalists Ariane Lacoursière and Léa Carrier recently painted an illuminating portrait of the problem, its sources and the dilemmas it poses.
“The trauma of the first wave of COVID-19, where sometimes infected seniors were sent to living environments for seniors, resulting in outbreaks, is still alive,” they reported.
And that’s a big part of why more than 600 patients are now occupying beds they no longer need.
Under the circumstances, keeping these patients awaiting transfer in hospital no longer appears to be a viable solution.
“There is no zero risk solution. If we weren’t so busy, we would keep these patients in the hospital. But we got to [envisager d’annuler des opérations] of cancers… ”, explained the president of the Association of specialists in emergency medicine of Quebec (ASMUQ), Gilbert Boucher, to our journalists.
In other words, zero risk, in this specific case, puts the entire network at risk. And this approach penalizes patients who themselves need care.
The best thus becomes the enemy of the good.
Hospitalizations have climbed worryingly (we are at 2554 linked to the disease) and, according to Quebec, there will soon be a shortage of some 1,000 beds to cope with the influx of new patients.
This is not to mention that the load shedding, necessarily, is increasing. With all the problems that this poses for a large number of patients who would need to be operated.
Many physicians therefore believe that Quebec should very quickly advocate more flexibility for the transfer of patients to CHSLDs and retirement homes.
Note that some of the patients who no longer require care may still have symptoms of COVID-19. Many in the network therefore do not want these patients to change environment, among other things to find themselves in a CHSLD or a retirement home.
But even the potential transfer of these patients can no longer be dismissed out of hand today. We have to think about it seriously.
All of this can, yes, seem counterintuitive based on the conclusions drawn from the first wave.
However, if the situation is not rosy in the CHSLDs, where outbreaks are more and more numerous, the fire is squarely caught in the hospitals.
This is possibly, under the circumstances, the least bad of all the options.
A bit like when Quebec decided to resort to healthcare workers suffering from COVID-19, but asymptomatic, in order to avoid further load shedding.
The various living environments for seniors are now able to manage patients with COVID-19 much better than in 2020.
Also, the vaccination of almost all residents and employees is a game-changer. However, of course, it would be necessary to provide them with a sufficient number of tests and to ensure that they have sufficient staff to provide the care and services required.
At the same time, we are told of certain measures which previously seemed prudent, but which now seem excessive because the hospitals are in critical condition.
For example: impose a negative test on an elder before he can return to his living environment, even if he has only spent a few hours in the emergency room of a hospital. As access to testing is difficult and the shortage of healthcare workers is hitting hospitals hard.
That said, it is not only retirement homes and CHSLDs that can be used (since this is not ideal).
It is also possible to transfer more patients to non-traditional sites, such as hotels.
Excellent idea, which we advocate more and more … but where to find the necessary staff when there is a shortage of employees in hospitals?
This is another case where an extra dose of creativity will be essential.
Do you remember that image according to which, in the first wave, we had to build a plane in mid-flight?
Here we realize that some of the parts used must be replaced urgently by others, completely different, without the plane even having permission to land to be repaired.