Hospitals overloaded with more complex patients

Despite the decrease in COVID-19 cases and the establishment of a crisis unit, the province’s emergency rooms were very busy in 2023-2024. The average length of stay was 17:26 for all hospitals in the province, which received a grade of C+ in our ranking.

The latest ranking of emergencies The Press was published in 2018-2019, a year before COVID-19. The exercise was subsequently put on hold, with the pandemic situation changing the situation. We are resuming its publication this year. The observation: if the performance of emergencies has improved in 2023-2024 compared to the previous year, it is in regression compared to the pre-pandemic era.

Consult our list of emergencies

Of the 84 emergency rooms in the province, 57 are currently in a worse situation than five years ago, according to our rankings. The average length of stay in the emergency room, i.e. the number of hours the patient spends on a stretcher in the emergency room before being discharged, hospitalized or referred elsewhere, is higher than before the pandemic, but down compared to 2022-2023.

In interview with The Press (next screen), the Minister of Health, Christian Dubé, claims “not to be at the desired level” in terms of emergencies. He explains that he is in the process of making “fundamental changes” in the health network, the effects of which will be visible in the coming years. Already, he sees a “positive trend” in emergency data. Because “the portrait of people who come to the emergency room has really evolved” over the past five years, he says. Patients are older and sicker.

The minister welcomes this improvement and maintains the objective of achieving an average length of stay of 15 hours in 2025-2026.

President of the Association of Emergency Medicine Specialists of Quebec, Dr.^r Gilbert Boucher affirms that Quebec is slow to regain its performance before the pandemic, in particular because it lacks staff in hospitals. “We still have 1,000 hospital beds closed because of that,” he said.

President of the Association of Emergency Physicians of Quebec, Dr.^D Judy Morris emphasizes that the emergency rankings above all reflect “the overall performance of hospitals” and the health network. “Many initiatives have been taken in the last year to improve the situation. But the battle is not won,” she says.

In its 2019-2023 strategic plan, the government aimed to reduce the average length of stay on a stretcher in its emergency departments to 14 hours by 2023-2024 (this target is 8 hours in Canada). Saying he wanted to set “more realistic” objectives, Minister Christian Dubé revised them last December to aim for an average length of stay of 17 hours for 2023-2024. The objective of 14 hours, which was almost achieved in 2018-2019, is postponed to 2026-2027, eight years later.

Mr. Dubé says he adjusted the targets to “take reality into account”. “It’s not true that we can aim for 12 hours,” he says.

Congested beds on the floors

As of April 12, 11.59% of hospital beds in the province were occupied by “alternative level of care” (ALC) patients. These people no longer need hospital care, but are waiting for a place in a CHSLD or home care, for example, to be discharged. The government is targeting a rate of 8% of NSA patients. The more the beds are congested on the floors, the less it is possible to transfer emergency patients there and the more the waiting in the emergency room increases. According to the D^D Morris, the number of ALC patients “has been decreasing for several months”.

Despite everything, the proportion of stays of 48 hours or more on a stretcher in the emergency room in the province reached 6.3% this year compared to 2.9% before the pandemic and 7.4% last year.

To get there, the D^r Boucher notably proposes to further improve the home care offer.

Fewer ear infections, more seniors

After a drop in traffic during the pandemic, Quebec emergencies are starting to receive many patients again.

But minor cases are less present, according to the D^r Butcher.

The D^r Boucher attributes this situation to better access to the first line and the redirection of minor cases from emergencies to clinics.

There are more and more patients aged 75 and over who are presenting to the emergency room. They represented 30.8% of all consultations in 2023-2024 compared to 28.1% five years ago. “The increase in elderly patients may seem small, but it requires many more resources in the emergency room,” notes the D^r Butcher.

To obtain the notes appearing in the rankings, our team of journalists, who benefited from the expertise of Pierre Meslin, from the data sciences department of The Press, took into account different criteria, including the average length of stay on a stretcher in the emergency room, and weighted these results according to certain factors, such as the number of hospitalizations and the proportion of people aged 75 and over. This methodology has an impact on the results.

For example, the Anna-Laberge hospital has one of the longest average lengths of stay in the emergency department in the province (31 hours). But because its clientele is very elderly (40.2% patients aged 75 and over) and very heavy (hospitalization rate of 36.5%), the establishment has still managed to maintain its performance this year. .

On the contrary, the Montreal General Hospital has a slightly shorter average length of stay (24.8 hours), but its clientele is much younger (20% of patients aged 75 and over) and less burdensome (rate of hospitalization of 23.5%). So much so that the establishment’s performance is the worst in the ranking. Over the past two years, the rate of stays of 48 hours or more in the emergency room has practically doubled compared to previous years in this establishment.

According to MUHC spokesperson Annie-Claire Fournier, many patients stay for a very long time in the emergency room of the Montreal General Hospital because they are “waiting for hospitalization for mental health problems.” On the hospital floors, 30% of mental health beds are occupied by ALC patients.

The lack of beds on floors is evident throughout the MUHC and is explained by the shortage of staff, by the lack of beds in CHSLDs and in rehabilitation in the community and by the fact that since the move of the MUHC to the Glen site in 2015, “Around a hundred beds were removed from the MUHC permit, thus reducing our capacity to accommodate more patients while the share for receiving ambulances has not changed,” notes M^me Fournier.

The Laurentides, Montérégie and Outaouais regions are those which presented the highest average length of stay this year. Sectors which are recording significant population growth, notes the D^r Butcher. Long a model student in the rankings, the Jewish General Hospital in Montreal has had a more difficult year. The number of visits is growing strongly in this establishment. “Even with the best system, if you double the demand, you won’t succeed,” says the D^r Butcher.

With the collaboration of Thomas de Lorimier, The Press

Two Montreal university hospitals, two realities

In addition to the Montreal General Hospital, which had a tough year, the Royal Victoria Hospital of the MUHC recorded the longest average length of stay in the province this year (31.67 hours). The particular situation of this university hospital was presented in 2022 by The Press. On the contrary, the University of Montreal Hospital Center (CHUM) is seeing its performance improve. “There are a lot of efforts at the CHUM to prevent patients from going through the emergency room,” says the D^r Butcher.

Read “The MUHC is bursting at the seams”, report published in 2022

Discharge patients more quickly

In 2023-2024, patients on stretchers in the emergency room waiting to be hospitalized waited an average of 25 hours 35 minutes in Quebec. For patients not requiring hospitalization, the stay was 11 hours 09 minutes. “It’s not necessarily the emergency departments that are not performing well, but the entire establishment,” says the D^D Morris. For her, “we still keep too many patients in hospitals who do not need to be there”. She cites the example of patients awaiting surgery who could go back to sleep at home, but who are kept hospitalized so that they can operate more quickly. Some patients are also kept in the hospital to undergo tests, such as magnetic resonance exams, more quickly. “We have to find a way not to keep these patients,” she said.

The absents

Psychiatric, pediatric and specialized hospitals, such as the Montreal Heart Institute, do not appear on the list of The Pressbecause their particular mission makes any comparison with general hospitals difficult.