Three of the four phases of a plan to cut hospitalizations have already begun, and the Ministry of Health is preparing, if necessary, to review the “minimum quality” of care offered at the hospital to treat more patients. In addition, consideration is being given to appealing to families to help healthcare workers or expedite the return of patients home.
This is at least the essence of the hospitalization prioritization and management plan presented Tuesday by an ethics committee, called upon by the Ministry of Health and Social Services (MSSS) to propose scenarios that would prevent the health network is reaching a breaking point.
The fourth phase of this plan provides in particular for crossing a line never crossed — if the network were pushed to its limits — that of offering minimal care to a greater number of people, rather than offering care to fewer patients, at the risk of refusing those who need it the most. “There are risks that come with that, but it’s all the patients who would benefit from it,” said Dr.r Hoang Duong, member of this ethics committee, intensivist and president of the Association of specialists in internal medicine of Quebec. One thing is certain, this step has not yet been taken, insist the members of the committee, who have not set a specific “threshold” for the initiation of this extreme measure.
“We cannot say on what date or for how long” this phase, which is expected to last four to six weeks, would be initiated, said Marie-Ève Bouthillier, president of the COVID-19 Ethics Committee.
“Is this going to happen? I hope not,” she said.
The DD Lucie Poitras, Deputy Director General of the Department of Hospital Services of the MSSS, indicated that the Minister of Health, Christian Dubé, would choose the appropriate moment to initiate this phase, if necessary, and thus allow the health network to cross the spike in hospitalizations.
A plan in motion
Several measures planned for phases 1, 2 and 3 are already in place, but will have to move up a gear, insisted the Dr Duong. “We are reaching another level,” he added. It is not with a light heart that we do this. Decrease the intensity of care, […] we don’t learn [pas ça] in medical school. Before we get there, we can still relax the rules […] on the isolation of workers and facilitate the transfer of patients to other resources. The adherence of caregivers accustomed to “pandemic control” in hospitals, for an approach aimed at “harm reduction”, will be part of the challenges to be met, recognizes the committee.
The specter of having to move from “A+ care to B care for all” had been raised earlier in the day by Deputy Minister Lucie Opatrny, at a press briefing with the Minister of Health and the new national director of public health, the Dr Luc Boileau.
Prioritization teams, or swat teams “, will now judge the priority of all hospitalizations and all emergency admissions of all hospitals in Quebec according to clinical and ethical criteria, indicated the DD Lucie Poitras, in charge of implementing this action plan.
About 600 beds could be freed up by expediting COVID patients no longer requiring “acute care” — who occupy up to 13% of beds — and transferring them to other sites, she says. Especially in CHSLDs, seniors’ residences, or at home, with home care. “We are even going to ask families to speed up the return of the sick home,” she said.
Patients will be transferred from establishments as needed, or even from regions, in the event of an overflow. “We will do it, but first within the region,” said the DD Chests.
The measures also include a faster return of infected workers to the bedside, which would mean learning to “live with the virus”, and the end of strictly COVID zones in hospitals, says the DD Chests. She clarified that this would not go so far as to place vaccinated and unvaccinated, or COVID and non-COVID patients in the same room. Immunocompromised patients would be taken into account, and cancer sectors, placed in “cold zones”.
Concerns
Reactions to this plan were quick, both positive and negative. “If we go there, it’s because we have failed miserably,” laments the Dr André Veillette, a cancer researcher at the Montreal Clinical Research Institute, who fears that hospitals are no longer safe for cancer patients. “We need to minimize the risk of a worker giving them COVID. Why not wait a few weeks to reopen the schools, rather than come to that? »
The Federation of Medical Specialists of Quebec, consulted on this plan, is in favor of it to mitigate as much as possible the repercussions of the current load shedding on patients with other serious illnesses. The Coalition Priorité Cancer fears, however, that a prioritization plan will be detrimental to people with cancer, if it were to put the hope of survival in the balance in the provision of care. “It worries us. These patients are already afraid to go to the hospital, ”says its general manager, Eva Villalba, who expects excess mortality, like that observed during the first wave. In 2020, she says, about 4,400 cancer cases would have been underdiagnosed in Quebec due to load shedding.
The Dr Martin Champagne, president of the Association of Hematologists and Oncologists of Quebec, says he is concerned, since cancer patients in general are more at risk “of developing complications or dying from COVID-19” and that they are “less well protected than the population”, even if they receive a fourth dose of vaccine. “This plan includes […] risks. Does the overall benefit of being able to treat patients, of being able to give them access to care, outweigh these risks? »
The DD Marie-Pascale Pomey, from the School of Public Health at the University of Montreal, considers it unsustainable to maintain draconian measures to prevent COVID in hospitals. “We know that people are less sick with Omicron. We can protect immunocompromised people with home care,” she points out.
The Quebec Cancer Foundation also supports the government plan, despite the risks of increased circulation of the virus in hospitals. “We are much more worried about the status quo, says its general manager, Marco Decelles. It is necessary to stop that the ultimate solution is load shedding and that vulnerable populations are always those who are penalized. »
With Marie-Eve Cousineau