Five months after sounding the alarm, the Regroupement des chefs d’urgence du Québec does not mince its words in a missive to Minister Christian Dubé: the “breaking point” has been reached in Quebec’s emergency rooms and the management has not not acted to “distribute the pressure” in the network. At the Lakeshore General Hospital, the crisis is such that an external report obtained by The Press evokes “a real time bomb”.
Posted at 5:00 a.m.
“From the 1er June, we wrote to you to make management teams aware of the serious problems of overcrowding and shortage of resources experienced by emergency rooms in Quebec”, deplores the president of the Regroupement, the DD Marie-Maud Couture, in a second letter sent to the CEOs of the establishments and to the Minister of Health dated October 28.
In an interview, the DD Couture mentions having “a great collaboration” with the Ministry of Health. “We feel the openness and the desire for change. “But she regrets that” in some establishments, we feel that accountability is less felt “. This is particularly the case for certain regions “where emergencies are the most problematic”. “We have the impression that the emergency is not prioritized […]says the DD Sewing. We become the safety valve of the system. But we must be able to continue to treat the most vulnerable. »
The first missive from the Regroupement des chefs d’urgence du Québec, like the second that The Press was able to consult, contains a series of measures to unclog emergency rooms. Last Wednesday, after the resurgence of a wave of respiratory viruses, Minister Christian Dubé announced the creation of a “crisis unit” to identify rapid solutions.
Christian Dubé must make known in the coming days some of the measures adopted to reduce the pressure in the emergencies of Greater Montreal. The DD Couture, who is also head of the emergency medicine department of the CIUSSS de l’Estrie-CHUS, is not part of the “crisis unit” at this stage.
The composition of this group remains “evolving”, it was indicated to Mr. Dubé’s cabinet. Emergency physicians, doctors and nurses are part of it, as are Deputy Minister Dominique Savoie and the CEOs of the CISSSs and CIUSSSs.
On Wednesday, the members of the Association of Emergency Physicians of Quebec will meet in congress behind closed doors in Quebec. Several players in the emergency network, including the DD Couture, are expected there. Minister Christian Dubé will also deliver a speech.
Emergencies are now condemned to sacrifice their primary mission, which is to treat people whose clinical condition is unstable, even potentially fatal, in a timely manner.
The DD Marie-Maud Couture, in the missive dated October 28
Remember that the emergency rooms of the CHU Sainte-Justine are experiencing an unprecedented crisis, and that the Association of Emergency Medicine Specialists of Quebec has raised the red flag in recent weeks.
Lack of management support
According to the Regroupement, the “breaking point” has been reached in Quebec’s emergency rooms, although solutions and “concrete strategies” were presented to health establishments before the start of the summer. The summer season was particularly difficult in the network, with the seventh wave of the pandemic and the holiday period.
The “persistent and recurrent” closure of hospital beds is singled out as a problem that is causing a snowball effect.
The Regroupement is also concerned that “from now on”, it is the emergency managers who leave their posts “one after the other”. A “haemorrhage of expertise” which “is rooted in the lack of support offered to them, as well as the unspoken of an organizational culture that considers the use of emergency services as the common solution to problems of overflow and shortage of other services”, we write.
“Time bomb” at the Lakeshore
A sign that the emergency situation is tense, a report issued on October 11 on the emergency room of the Lakeshore General Hospital in Montreal speaks of a real “time bomb”. There, 27% of hours worked in the evening in 2021-2022 and 25% of hours worked at night during the same year were overtime. These rates are very high, because there is a shortage of 56 full-time equivalents in emergencies, or 52% of positions.
” It is enormous. This is a critical situation for a center of activity with high variability and unpredictability such as the emergency room,” writes nurse Marie Boucher, who submitted a mediation report for the CIUSSS de l’Ouest-de- the Island of Montreal and the local union of the FIQ.
Often a third of the staff in place is working overtime. It’s already been 8 hours of work in the body and another 8 hours remain to be done. Professionals are tired.
Excerpt from the report on the Lakeshore General Hospital
This cruel lack of staff adds to an increase in the number of customers. The number of “code 1s”, or the most seriously ill patients, “increased from 467 in 2019-2020 to 614 in 2021-2022, an increase of 31.5%”, is it written in the report. The emergency nurses questioned by Mme Boucher used the words “dangerous” and “scary” to refer to the situation.
The findings of M.me Boucher are unequivocal: “the management party must realize that an emergency plan must be put in place…in an emergency. In the current state of the workforce, it is a time bomb”.
President of the Union of Health Care Professionals of the West Island of Montreal, Johanne Riendeau mentions that the situation is difficult at the Lakeshore, but also at St. Mary’s Hospital. “This report makes recommendations that could be useful elsewhere. Because it’s bad elsewhere too. We hope that the crisis unit will be inspired by it, ”she said.
Spokesperson for the CIUSSS de l’Ouest-de-l’Île-de-Montréal, Hélène Bergeron-Gamache indicates that the conclusions of Ms.me Boucher are currently being analyzed and that an “action plan” is already underway. A joint committee is also responsible for finding solutions to the chronic overcrowding of emergency rooms.
Solutions from the Regroupement des chefs d’urgence du Québec
- Make the managers of other services accountable for unjustified refusals and unacceptable delays when requesting transfers of patients from the emergency room;
- Avoid emergency room closures to declutter a hospital;
- Avoid resorting to the closure of hospital beds and long-term beds to compensate for the lack of human resources;
- Provide 24/7 availability for directors to assist them in their roles with clinical teams;
- Sensitize the directors and managers of other services to the concrete issues of emergency department overcrowding, which must be considered unequivocally among the highest organizational priorities.