Semi-urgent cases leave the emergency room without being seen, after long hours of waiting

The influenza season has not started, but emergencies are already overflowing in Quebec. Doctors report that more and more patients, whose problems are semi-urgent, are leaving the hospital without having been seen by a doctor. These patients — judged to be “priority 3” on a scale of 1 to 5 — suffer, for example, from acute abdominal pain or intermittent chest pain, but have normal vital signs during triage.

“This is a new phenomenon and it worries us,” says the D^D Marie-Maud Couture, president of the Regroupement des chefs d’urgence du Québec. In the past, only patients with non-urgent problems (priority 4 or 5) gave up after long hours of waiting. “P3s are patients who need to see a doctor and might need to be put on a stretcher,” she explains.

The president of the Association of Emergency Medicine Specialists of Quebec, Dr.^r Gilbert Boucher says he is concerned about this trend. He said patients with chest pain that “comes and goes,” who sometimes have shortness of breath and who have normal vital signs at triage, should be seen by a doctor.

“It’s chest pain, so there are potentially dangerous and life-threatening illnesses,” he said. On the other hand, it could be a much more benign problem, like anxiety, reflux, or muscle pain. But these patients are not supposed to wait three or four hours in a waiting room. »

Over the past ten days, the situation has gotten worse in Quebec emergencies. The stretcher occupancy rate was on average 131% Friday afternoon in Montreal, 155% in Montérégie, 160% in the Laurentians and 158% in Lanaudière, according to the Index Santé site. It was around 180% in Pierre-Boucher, in Longueuil, at the Hôtel-Dieu in Sorel and at Anna-Laberge, in Châteauguay. It exceeded 200% at the Royal Victoria and at the Jewish General Hospital in Montreal.

“We must recognize that there is a crisis in emergencies in Canada, and particularly in Quebec,” says the D^D Judy Morris, president of the Association of Emergency Physicians of Quebec.

The D^D Morris sits on the board of directors of the Canadian Association of Emergency Physicians (CAEP), which released a report on Tuesday on the state of emergencies in the country. The ACMU is sounding the alarm: hospital congestion and emergency department closures pose “significant risks” to patient care and safety.

The group calls on the federal and provincial governments to recognize the current “crisis”. CAEP met this week in Toronto with provincial and territorial deputy ministers of health — including Daniel Paré and Daniel Desharnais, from the Quebec Ministry of Health and Social Services — to raise awareness of the issue and make recommendations to them. According to the Association, health ministers must in particular “make the establishments in the network responsible” and demand that hospital emergencies reach stretcher occupancy rates of 85% on average.

Measures not applied

In Quebec, the emergency crisis continues despite the establishment last fall of a group of experts responsible for finding solutions to the problem, doctors report. “We know that the ministry is in action and that the minister regularly monitors the state of the situation in emergencies and the network,” said the D^D Sewing. But the problem of hospital congestion has never been greater than now, despite all the steps that have been taken. There is a certain inertia in the progress of [la question de] hospital fluidity. »

According to the D^D Morris, not all hospitals have implemented overcapacity protocols, as recommended by the crisis unit formed by the government. When the emergency department is overflowing, patients should be transferred to hospitalization units on the upper floors in order to “distribute the pressure,” she recalls.

However, the shortage of personnel does not facilitate the implementation of these initiatives, recognizes the D^D Morris. Staff shortages are rife everywhere, both in emergency rooms and in hospitalization units, CHSLDs and rehabilitation centers. “It sure hurts,” she said.

In recent weeks, Quebec has recorded a high rate of users remaining hospitalized, but no longer requiring hospital care: 14% (the government target is 8%). These people — often seniors — are waiting for a place in a CHSLD or rehabilitation center, among others. Result: patients remain stuck in the emergency room, due to a lack of beds available on the upper floors. Added to this problem is an increase in emergency room traffic and an increase in the number of patients with COVID-19, observe the doctors consulted.

Despite everything, hospital fluidity has improved in emergencies in the last year, according to the D^r Gilbert Boucher, who is part of the crisis unit formed by the government. “There are still problems,” he admits. But, compared to a year ago, there are many more hospital fluidity teams in establishments: medical coordinators in hospitalization, medical coordinators in emergency, people who monitor statistics [de performance]. »

According to the D^r Boucher, the number of patients on stretchers for 24 or 48 hours has also decreased compared to last year. But in the field, caregivers always have the impression of walking on a wire, he notes. “Most emergencies start with a shortage of nurses on each shift,” he explains. Not many people start with 100% staff. »

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