The Minister of Health and Social Services, Christian Dubé, wants to set up teams to improve “fluidity” in hospitals. We know that patients stay in hospital because they are waiting for accommodation. But others have to stay in hospital an extra night for a simple blood test or check-up. What should be done to unblock beds and unclog emergency rooms? The duty interviewed four experts.
A night in the hospital for a blood test. Patients occupying beds for an extra night because they need a blood test or a diagnostic check-up the next day, a service they cannot obtain within 24 to 48 hours if they have their discharge from the hospital, indicates the president of the Association of specialists in internal medicine of Quebec, the Dr Hoang Duong.
In the hospital center where he practices (Pierre-Le Gardeur in Terrebonne), the day medicine unit is reserved for patients with “certain very specific diseases”, explains the Dr Duong. Patients who do not suffer from these health problems do not have access to a blood test once they have been discharged from the hospital.
The Dr Duong cites the case of an 82-year-old as an example. “We ask him to book his appointment online with Clic Santé,” he explains. She’s 82, she doesn’t have the Internet, and even if she had access to it, it often takes two weeks or more to take a blood test. The attending physician then preferred to keep her in the hospital to ensure that she would have her sample taken.
“Making a patient sleep in the hospital for a blood test the next day is expensive, judges the Dr Duong. It’s not very efficient. »
According to him, many patients could “leave a day or two earlier [de l’hôpital], provided they can be seen again within the next 24 to 48 hours”. Day medicine units – open from morning to evening, 7 days a week – must however be set up to accommodate them. “ The majority of hospitals have a day medicine unit, but very few offer services there 7 days a week. »he said.
At Charles-Le Moyne Hospital, located in Greenfield Park, the day medicine unit is open from 7 a.m. to 11 p.m., every day of the week, according to the DD Chantal Vallée, internist and head of the specialized medicine department. “It allows patients, even if they are at home, to have access to a nurse for extended hours,” she says. It helps to unclog [les urgences]. »
Overflows in the emergency room, but not on the floors. When the emergency room is overflowing, patients are placed in corridors. Why not do the same on the different floors? Emergency physicians believe that hospitalization units should practice “overcapacity”, as is already the case in emergencies. “This measure could quickly help us”, thinks the DD Véronique Gauthier, co-head of the emergency department at Saint-Jérôme hospital.
Patients don’t walk enough. After two days on a stretcher in the emergency room and three in a bed upstairs, seniors are deconditioning, says Dr.r Duong. Impossible to return them immediately to their homes. These patients need to see a physiotherapist or occupational therapist to regain their mobility. “What we could do is have walk attendants,” he said. No need for a university degree. Just with that, one would prevent deconditioning. This would free up beds more quickly and allow patients stuck in the emergency room to go upstairs.
No place in rehabilitation. According to the DD Chantal Vallée, the lack of rehabilitation places is a problem As of November 11, 18% of patients no longer requiring short-term care but remaining hospitalized were due to an insufficient number of rehabilitation places, according to the ministry of Health and Social Services.
“What we have worked to put in place for day medicine, we are seeing if we cannot do the same for home rehabilitation, says the DD Valley. This requires personnel: physiotherapists, occupational therapists at home or through the CLSC, who are able to see patients quickly, to conduct rehabilitation sessions remotely. It’s not easy to set up. We are working on that. The CIUSSS du Centre-Ouest-de-l’Île-de-Montréal already offers virtual rehabilitation sessions to patients located in Montreal, Lanaudière or Outaouais.
Waiting to obtain a place in a CHSLD. As of November 11, 12.82% of hospitalized patients in Quebec no longer required hospital care, indicates the Ministry of Health and Social Services in its dashboard. Of these, 37% were waiting for a place in a CHSLD, an intermediate resource or a family-type resource.
According to Minister Dubé, the situation is improving in this regard. The percentage of hospitalized users no longer requiring short-term care was 13.73% on 18 September.
“There are big, big gains to be made on this side, thinks the Dr François Marquis, head of intensive care and internist at Maisonneuve-Rosemont Hospital in Montreal. When I do internal medicine, there are always three or four patients waiting to be placed in a centre. »
To free up beds in hospitals, the Quebec government announced in early November that it would create 1,700 places in CHSLDs or intermediate resources. It also relies on an approach adopted by the CISSS de Lanaudière. In this region, patients who need to be admitted to residential accommodation wait for their place at home, not in hospital. A team of managers is responsible for determining the resources they need. Caregivers are involved.