Patients are staying longer and longer on stretchers in emergency rooms in Quebec. The average length of stay on a stretcher reached 16 hours and 45 minutes last year, or 51 minutes more than the previous year, according to data obtained from the Ministry of Health and Social Services (MSSS). The Legault government thus misses its 2021-2022 target, set at 12.5 hours in the MSSS’s 2019-2025 Strategic Plan.
This ministerial objective appears out of reach for many hospitals. In 23 hospitals, the average length of stay on stretcher was more than 20 hours in 2021-2022. At the Suroît hospital, located in Salaberry-de-Valleyfield, in Montérégie, it was 32 hours and 36 minutes.
“It’s a sign that things are not going in the right direction,” said the Dr Gilbert Boucher, President of the Association of Emergency Medicine Specialists of Quebec. We need better management and better hospital flow. »
The stretcher waiting time has been climbing year after year for the past five years, data from the MSSS show. The number of patients on stretchers for 48 hours or more more than doubled, from 29,806 in 2017-2018 to 64,494 in 2021-2022.
“It’s huge, says the DD Judy Morris, president of the Quebec Association of Emergency Physicians. This is the signal that there are no beds in the hospitals for [les patients sur civière]. They hang around the emergency room longer than we would like. It shows that the rubber band is stretched to the maximum in a large part of the network. »
According to the Dr Boucher, a 48-hour stay in the emergency room is not necessary. “It’s associated with an increase in mortality,” he says. Patients also recover more slowly. “If you need seven days in the hospital for pneumonia and you spend two days in the emergency room, your day 1 starts when you get to the floor,” he says. It really is a waste of time. »
“Structural issues”
In the office of Minister Christian Dubé, it is argued that the situation in emergencies depends on “Structural issues” present “For decades” and exacerbated by the pandemic.
“Far too many patients are waiting for a place either in a CHSLD or in another place of accommodation,” explains the Minister’s press secretary, Marjaurie Côté-Boileau. Although we have increased the number of beds available in CHSLDs for these people by 2,500, the lack of staff and the aging of the population are increasing the pressure on emergency rooms. »
The firm recalls that Christian Dubé’s plan aims to direct the patient “to the right place, at the right time”. “At the same time, we have already taken action to monitor the management indicators for the 25 emergency rooms in poorer condition in Quebec, in addition to working in collaboration with paramedics so that 60,000 transports to emergency rooms are redirected to other resources starting this year”, adds Mr.me Cote-Boileau.
The Dr Boucher believes that it is high time for Quebec hospitals to equip themselves with an emergency medical coordinator and a command center in order to improve hospital fluidity. “It will take someone, in the hospitals, who will coordinate the care, because just on a day-to-day basis, leaving the emergency department alone does not work,” he believes.
The Jewish General Hospital in Montreal has implemented such initiatives. His average length of stay on stretcher was 12 hours and 46 minutes in 2021-2022, compared to 11 hours and 58 minutes in 2020-2021, and 11 hours and 44 minutes in 2017-2018.
The director of hospital activities at the Hôpital du Suroît, Dominique Pilon, has visited the Jewish General Hospital twice since last fall. His hospital center had to suspend its outpatient servicesres for 4 p.m. in mid-September. Since then, management has set up a “fluidity team”; it is also working on the development of a command centre.
“Since January, the number of stretcher users has decreased by 25%,” says Dominique Pilon. It went from 58 to 42 when taking a “picture” of the situation at 10 a.m. The hospital specifies that patients on stretchers do not end up in corridors, but in rooms. The emergency overflow unit is located in new facilities that are still unoccupied.
The CIUSSS du Centre-Sud-de-l’Île-de-Montréal, for its part, claims to have set up a “major mobilization project” to improve “hospital fluidity” at Notre-Dame Hospital. The hospital center recorded an average stretcher stay of 27 hours and 34 minutes in 2021-2022. The CIUSSS explains this long waiting time by clients struggling with “complex situations” (homelessness, drug addiction, prostitution, low-income population, high number of elderly people) and requiring “the involvement of several services”.
Bed accessibility is a problem, adds the CIUSSS. “Since the beginning of the pandemic, there are more or less 72 short-term beds closed and the postponement of the opening of a 32-bed unit,” one wrote in an email.
The CIUSSS du Nord-de-l’Île-de-Montréal, for its part, points out that we cannot compare the emergency department of the Albert-Prévost mental health hospital — which obtains the worst score in Quebec — with that other hospital centers whose vocation is very different. However, the CIUSSS indicates that the hospital has seen a 10% increase in admissions since last year. “When our units are full, we have to keep patients longer in the emergency room until a bed becomes available upstairs,” it says. Many patients also have to be kept in the emergency room for lack of a place to sleep.
With Sandrine Vieira