For months (nay, years), we have been told that the emergency room is full and that people should see a doctor in a clinic or call 811 before going to the emergency room. Instead of asking people, why not impose it? We have all the organizational and technological elements to try to reduce this traffic.
Posted at 12:00 p.m.
Currently, there are two main ways to be admitted to the emergency room: either by ambulance or directly by going to the scene. Those who arrive by ambulance are in principle assessed by first responders. For others, their condition is prioritized by nurses before they are admitted.
Thereafter, the patient can wait hours before seeing a doctor. The lack of triage personnel is, in my opinion, one of the causes of congestion in emergency rooms.
Now imagine a system where access to the emergency room would only be possible if the patient was referred or assessed by a health professional before arriving at the emergency room. This assessment could be done either by nurses from the 811 service, or by a nurse in a pharmacy, RPA or CLSC. People arriving by ambulance would still be admitted, of course.
Once the person has been assessed, the nurses could thus determine whether they should go to the emergency room or make an appointment at a clinic. If her case requires her to go to the emergency room, she would receive an access code allowing her to reserve her place online at the emergency room.
This type of decentralized sorting is used, among other places, in security checkpoints at large airports. In order to avoid creating congestion during the inspection of hand luggage, the X-ray images of the luggage are transmitted to a central located outside the inspection area where dozens of operators try to detect threats in the luggage. If necessary, an alert is transmitted to the security officers in order to intercept the owner of the baggage. This type of “decentralized sorting” has made it possible to significantly reduce queues at airports.
In addition to this principle of decentralized sorting, the concept of making appointments in advance could reduce waiting times in emergencies. With an application similar to the one used in walk-in clinics or the one used to make an appointment for the vaccine during the pandemic, the person would be able to know what time to go to the emergency room and would thus avoid clogging up the emergency room for nothing.
I find the “with appointment” walk-in clinic approach great. By calling the day before, one may be able to get a time when one should come to the clinic. This saves us from waiting long hours in the room, not knowing when we will see a doctor.
Just before our appointment, we receive a notification reminding us to show up within the next hour. If there is the possibility of coming by earlier, we would receive a text message telling us to introduce ourselves. In principle, this type of management is already implemented and has been used successfully during the pandemic. Personally, I have rarely waited more than an hour indoors with this system.
Most health workers tell us that the solution to emergency room congestion requires better organization. However, there are solutions such as decentralized sorting or even making emergency appointments. Why is no one addressing this issue?