Emergency rooms in the greater Montreal area are still overflowing, despite the launch of a pediatric 811 line and the full deployment of first-line access counters (GAP), intended for patients without a family doctor. At Cité-de-la-Santé, in Laval, a GAP nurse tries to redirect patients with less serious problems as soon as they set foot in the hospital. Urgences-santé is also conducting a pilot project to avoid hospital transfers.
Traffic has exploded in the Cité-de-la-Santé since the wave of respiratory viruses. When passing the To have to, Tuesday morning, patients were installed in corridors, lying on stretchers isolated by a fabric screen. The occupancy rate was 153%. The emergency room was full.
A bad day, according to Sébastien Rocheleau, assistant director in the nursing care department, operation component. “In the past 24 hours, we’ve had 320 emergency room visits, which is huge,” he said. Our usual capacity is around 260 or 275.”
To reduce traffic, the CISSS de Laval has been assigning a GAP nurse to the Cité-de-la-Santé emergency room for three weeks. His mission ? Target non-urgent cases that can be redirected, assess them in an office without examining them and find them an appointment in a medical clinic or in another department.
“I try to take them as soon as they arrive, or almost, explains GAP nurse Mélanie Beetz, scrolling through the evaluation sheets of patients in the emergency room on her computer screen. Yesterday, I assessed 17, and 16 were redirected. »
Many patients are children suffering from a respiratory infection or an ear infection. Their parents, worried, come to the emergency room in desperation: they have been unable to obtain a consultation with their family doctor or their pediatrician or at a walk-in clinic.
“Many are not aware of the pediatric line [811] that has been put in place, indicates Mélanie Beetz, that The duty accompanied for a few hours on Tuesday morning. I raise awareness. »
Alexandra Desforges-Martel, she contacted the 811 pediatric line last Thursday, but could not get an appointment for her one-and-a-half-year-old boy, Daymien. She went to the emergency room on Tuesday morning. Her son hadn’t slept all night. She neither. “As soon as he’s in bed, he coughs a lot, a lot,” she explained to the nurse. He coughs until he wants to vomit. »
Mélanie Beetz had trouble understanding why 811 had not offered the toddler a medical consultation. She got him one the same day.
“For real, it’s a record! said Alexandra Desforges-Martel. I arrived at the ER at around 7:30 am. She left almost three hours later, an appointment in her pocket.
The few patients seen by Mélanie Beetz during our visit obtained a medical consultation on Tuesday afternoon.
Thanks to this new initiative, 33% of less urgent emergency cases were redirected to other services last week, says Sébastien Rocheleau. The ministerial target is 15%, he specifies. “We still want to increase this level to reduce the influx of people, and to be able to treat only people who need to come to the emergency room and not [ceux] who can see a family doctor, a first-line doctor,” he adds.
Other initiatives
Urgences-santé is also trying to unclog emergency rooms in its territory, namely Montreal and Laval. Since September, around 20 paramedics and six nurses have been taking part in a pilot project aimed at reducing the transfer of less urgent cases to hospitals.
When a “low priority” patient calls 911, a paramedic is dispatched solo to his bedside. Once there, he co-evaluates the patient’s condition with a nurse on the phone. “The objective of this co-evaluation is to see what would be the best service for this patient,” said Urgences-santé spokesperson Jean-Pierre Rouleau. Does he really need transport to an emergency room, or could he be referred to another service in the health network so that his needs can be met? »
The DD Eveline Gaillardetz, head of intensive care at home (SIAD) at CLSC Verdun, cites as an example the recent case of a 92-year-old patient, lucid and living alone, who contacted 911 because she had had a fever for four days. and did not feel well. A nurse from Urgences-santé referred her to her department, which took her in charge.
The DD Gaillardetz spoke with the patient on the phone and dispatched a nurse to her home that evening. “We did a blood test for him,” explains the family doctor, who also works in the emergency department of the Verdun hospital. She went the next day for an x-ray in a clinic. I spoke to him again 48 hours later. I couldn’t find any diagnosis other than influenza, and she got better. She saved herself long hours in an emergency waiting room.
The SIAD service is also trying to reduce the emergency room traffic at the Verdun hospital. For about three weeks, a nurse from the team has been rounding patients on a stretcher every morning, Monday to Friday. She determines who could return home with support from SIAD. “If we managed to get two or three patients out a week, it would be a huge success,” says Dr.D Eveline Gaillardetz. We must not forget that the elderly are sometimes hospitalized for two or three weeks. It is enormous. »