The 28 hospitals whose emergency departments are the least efficient in Quebec have their work cut out to achieve the targets set by the Ministry of Health and Social Services (MSSS). The team of experts charged by Quebec to follow them closely raises a series of problems in its recent summary report, obtained from the MSSS.
The University of Montreal Hospital Center (CHUM) has been the subject of three visits by the STAT team (support, transformation, access, field) since 2021. The experts’ observation is relentless: “priority recommendations issued by the STAT team not enforced due to low management buy-in,” the report read.
The STAT team notably recommended that the CHUM “develop a decluttering plan” for the emergency room and “modify [sa] culture of hospital-centred care”, following his first visit. “Little improvement” having been observed, she reiterated her recommendations after her second round. At the end of the third, she asked the CHUM to “continue” the implementation of the proposed solutions.
The STAT team believes that the CHUM must “review [ses] organizational priorities so as to include decluttering the emergency room, maximize the quality and safety of care for users in the emergency room and optimize hospital fluidity. The establishment’s culture must also be “adapted” in order to “include all clienteles”.
According to the report, patients who come to the CHUM emergency department wait a long time in the waiting room before seeing a doctor: on average 310 minutes (about five hours) in the spring of 2022. However, the target for Quebec is 90 minutes.
The “not in my backyard” and “it’s not my fault” attitude is no longer acceptable
Since 2019, the average interval between the request for admission of patients and their departure from the emergency room (to a care unit, another establishment or their home) has also increased, according to the STAT team. It was 20.9 hours in April and May 2022, well above the departmental target of 2 hours.
Questioned on this subject, the CHUM said to share “totally the objective of the STAT team” to improve hospital fluidity. He ensures that “all the multidisciplinary teams are mobilized in this direction”. “All patients are important,” we write in an email. On the other hand, given its mission in specialized and superspecialized care, the CHUM must always maintain its capacity to receive patients who require the expertise and technical platforms of the CHUM who are referred by the network or who are directly assessed at the CHUM. »
Culture change needed
Set up by the MSSS in 2021, the STAT team’s mission is to diagnose fluidity problems in targeted hospitals, propose solutions and offer support during their implementation. The committee of experts is made up of physicians (internist, emergency physician and psychiatrist), nurse managers from the MSSS and an occupational therapist, notably specializing in home care. A patient partner was previously one of them.
In its summary report, the STAT team reviews the 28 hospitals visited and reports its observations and recommendations. According to experts, the “decluttering” of the emergency room must be “prioritized” at the Royal Victoria Hospital, of the McGill University Health Center (MUHC), at the Pierre-Boucher Hospital, located in Longueuil, and at the Granby Hospital.
For other hospitals, such as Honoré-Mercier (Saint-Hyacinthe) and Pierre-Le Gardeur (Terrebonne), the STAT team advocates a change in “the culture of hospital-centered medical care – everything must be done when the patient is hospitalized, and not in an outpatient setting, for example. She notes a lack of options other than hospitalization and a “human resources issue” in various establishments, including the Saint-Jérôme hospital.
The president of the Quebec Association of Emergency Physicians, Dr.D Judy Morris is not surprised by these findings. However, she finds it “a bit distressing that the committee has to repeat [aux établissements] that the decluttering of the emergency is to be prioritized”. “In the media, sometimes we blame the ministry, we say “he could have done something”. But at some point, the responsibility and the accountability, they rest with the managers and the workers, the different groups that practice in the establishments. The “not in my backyard” and “it’s not my fault” attitude is no longer acceptable. »
In its report, the STAT team recommends that the Hôtel-Dieu de Lévis “target the bottlenecks” and “determine the responsibility and accountability of each of the players concerned”. It underlines in particular the “absence of rules prohibiting the observations [de patients] in the emergency room, requested by medical specialists”.
good shots
The DD Marie-Maud Couture, president of the Regroupement des chefs d’urgence du Québec, said she was “satisfied” with the report. “The beauty of the STAT team is that they have a global vision of the province,” she thinks. Experts know the “success stories” of hospitals and can share them.
The report cites the successes of each hospital centre. At Notre-Dame Hospital in Montreal, a specialized educator is present in the evening in the emergency waiting room. Charles-Le Moyne Hospital in Greenfield Park has set up a day medicine service open from 7 a.m. to 11 p.m., seven days a week.
Other initiatives have been implemented in the wake of the creation, last fall, of the emergency crisis unit. It now remains to measure their impact on the ground. According to the MSSS, the STAT team will visit 19 facilities by next September.