Reduction of surgical activities | The duty

The sixth wave is slowing the catch-up in surgeries. And according to Lucie Opatrny, assistant deputy minister at the Ministry of Health and Social Services, surgical activities will continue to decrease in several regions this week, due to the “metarous increase” in the number of caregivers isolated or infected with COVID- 19. Some 11,300 health workers are absent from the network.

“It’s really an extremely important issue,” said Dr.^D Opatrny during an interview with The duty late Friday afternoon. Hospital capacity is directly linked to the number of health professionals present at work. »

Pressure is mounting in hospitals outside of Greater Montreal and around Quebec City. The North Shore, Abitibi-Témiscamingue and Bas-Saint-Laurent are currently at load shedding level 3, according to the Ministry of Health and Social Services (MSSS). Gaspésie and Saguenay–Lac-Saint-Jean have reached level 2. According to the assistant deputy minister, some regions among those will go to levels “3 and 4” this week. Quebec hospitals are ready to receive, if necessary, patients from the north and east of the province requiring urgent surgical procedures.

The D^D Opatrny hopes caregivers can return to work quickly. “There are a lot of people who are on infection leave, but not necessarily so sick, she observes. So, we will have to see how to really use the rules that have been updated [la semaine passée] by Public Health for a return as quickly as possible in a safe environment. »

The National Institute of Excellence in Health and Social Services predicts about 200 new hospitalizations per day within two weeks. Some 1,350 patients with COVID-19 were hospitalized on Sunday – including 72 in intensive care.

The threshold of 800 hospitalizations, once considered critical according to Quebec, has been crossed since December 28. Shouldn’t we be worried about that?

The situation has changed, answers the D^D Opatrny. “The majority” of hospitalized patients with COVID-19 are now in hospital “with COVID and not for COVID”. “Almost 60% of all COVID admissions are not even for respiratory symptoms [liés à] COVID, she says. These are people who would have had care anyway. »

The D^D Opatrny adds that patients hospitalized “for COVID-19” are “much less sick” thanks to vaccination. “There are less than 10% who go to intensive care,” she said. It is a reassuring aspect. The cases of COVID-19 remain heavier, however, she nuances, because of the protection and infection control measures they require.

Catch-up

Some 160,500 Quebecers are waiting for surgery, and the list continues to grow, with operating theaters unable to operate at maximum capacity. According to the D^D Opatrny, the rate of surgical activities amounted to 85% last week, taking into account the contribution of specialized medical centers (CMS), private clinics that perform day surgery on behalf of the public network. .

“Of course, we would have hoped for several months of peace and not a sixth wave,” admits the assistant deputy minister. However, she assures us that the government is maintaining its objective of reducing the number of people waiting for surgery to reach, in March 2023, 115,000 people, i.e. the pre-pandemic level. ” That [la sixième vague] does not change our point of arrival too much if we are still able, in the coming months, to return to a rate of 100%, as we had planned, ”she believes.

In his plan to reform the health network, Minister Christian Dubé is counting in particular on an “increased contribution” from the CMS to carry out catch-up surgery. “Year in, year out, apart from the pandemic”, private clinics carry out “14 or 15%” of surgical activities in the province, he explained at a press conference on Tuesday.

“We are aiming [avec le plan] about 15% or 20%, no more,” says Dr.^D Opatrny during his interview with The duty. She explains that the capacity of the CMS is limited. Private clinics do not have intensive care, unlike hospitals. They cannot deal with the most complicated cases. “Even for cataract surgery, you often have to call 40 patients to find 10 suitable for CMS,” she argues.

According to the D^D Opatrny, private clinics could nevertheless accommodate patients with more complex conditions, such as sleep apnea or a high body mass index. The Association of Anesthesiologists of Quebec is also working on the development of a guide indicating, “condition by condition”, the “safe and acceptable” interventions to be carried out in CMS, she points out. “Right now, you see CMSs where anesthesiologists are very comfortable seeing a patient who would be turned away by an anesthesiologist from another CMS,” she says. However, there is no question of allowing CMS to perform surgical procedures requiring hospitalization for 24 or 48 hours, according to the D^D Opatrny. She fears that this will lead to an exodus of staff from the public to the private sector. “As soon as we do a brief hospitalization, where do they [CMS] going to pick up the nurses for the evening and night shifts? It may come from the network, ”she judges.

The D^D Opatrny points out that hospitals are also questioning their “practices” to be more efficient and catch up on surgical activities.

They are based on the principles of Enhanced Recovery After Surgery programs. “Often, it reduces complications, says the D^D Opatrny. But it also reduces, for certain diagnoses, the length of hospital stay. Freeing up beds makes it possible to accommodate new patients.

To see in video