Emergency physicians have been asking for it for a long time and they have been heard: hospital units and departments will welcome more patients to reduce the pressure on the emergency room. The office of Minister of Health Christian Dubé confirms that an “overcapacity protocol” will be implemented in hospitals, as recommended by the crisis unit set up by Quebec to find solutions to overflows in emergencies.
“Mr. Dubé met with members of the crisis unit [vendredi midi], says his press officer, Antoine de la Durantaye. It was agreed that the overcapacity plan is one of the measures that will be implemented in hospitals. »
The Dr Gilbert Boucher, president of the Association of specialists in emergency medicine, specifies that the crisis cell of which he is a member has been working for “several weeks” on an overcapacity protocol. “We hope it will be in place by the holidays because it will be a difficult time,” he said.
The Regroupement des chefs d’urgence du Québec is delighted that the overcapacity plan is the subject of a “ministerial directive”. “Never” had this measure been “imposed in establishments”, according to its president, the DD Marie Maud Couture. “We are happy especially for the patients, she underlines. It is a tool to protect access to the emergency room for the sickest patients. »
In a word addressed to its members on Friday, the president of the College of Physicians of Quebec – also a member of the crisis unit – pleads in favor of the temporary establishment of a hospital overcapacity protocol.
Patients stuck in the emergency room
The Dr Mauril Gaudreault underlines that “one of the nodes of the current crisis” is the fact that patients having to be hospitalized are stuck in the emergency room, for lack of places available on the floors. “The College is concerned about the repercussions of this situation on access to care, on the safety of patients and doctors, and on the protection of the public,” he wrote.
The President of the College invites its members to work together to improve the emergency situation. “If we want to support emergency care teams and ensure access to care for patients, EVERYTHING must [en majuscule dans le texte] the hospital shares the risk of ER admissions,” writes Dr.r Mauril Gaudreault.
“We must no longer dissociate the emergency from the hospital,” he continues. Everyone must lend a hand. It is a question of social responsibility. »
According to the Dr Gaudreault, this overcapacity plan has been implemented in “several provinces”. “Studies show that this protocol leads to an increase in the quality of care, a reduction in the length of hospital stay of 24 hours or more, a reduction of almost 50% in the number of admitted patients who stay in the emergency room and a decrease in the number of patients leaving the hospital before seeing an emergency doctor, he writes. There is no increase in readmissions after 72 hours. »
Range of measures to distribute the load
The duty was unable to obtain the overcapacity protocol proposed by the crisis unit. This plan could, however, provide for measures depending on the occupancy rate on stretchers, according to the DD Coulter. For example, extend the opening hours of the imaging department until 10 p.m. — so that patients receive a diagnosis more quickly — when the rate would fluctuate between 100% and 140%. Or accommodate more patients on floors above a certain threshold.
“We can imagine situations of patients in corridors of floors, in beds already closed or in less usual rooms”, she evokes.
The DD Couture points out that Quebec hospitals are already implementing an overcapacity protocol. But that’s not the case for everyone. “Contrary to the perception of the network, it is safer to place a patient admitted to a care unit, even if one unit is overflowing, than to keep him in an already very congested emergency room, she maintains. The patient has a better evolution of his disease just by being on a care unit. »
The president of the Regroupement des chefs d’urgence du Québec believes that the implementation of this protocol will encourage establishments to find various means to avoid finding themselves “overcapacity”.