Emergencies under pressure: the Ministry of Health explains

Overflows in emergencies. Saturation of clinics and superclinics. Once again this winter, the health network is struggling to meet demand. Le Soleil met Thursday with the National Director of Emergencies, Dr. Élyse Berger-Pelletier, in order to better understand the situation and learn about the solutions from the Ministry of Health to reduce the pressure on institutions. Report.
C is known, too many patients present in emergency rooms as their medical condition did not require. Several months ago, the Ministry of Health instructed hospitals to adopt a protocol for redirecting minor cases to clinics or superclinics. This directive was “reinforced” before the winter season, specifies Dr. Élyse Berger-Pelletier.

“We have reorientation champions. I am thinking in particular of the Cité-de-la-santé Hospital [in Laval] or the Maisonneuve-Rosemont Hospital, which redirects more than 30 patients a day on average. But there are other establishments that are more difficult to structure at present, ”she explains.

These establishments can in particular face geographic challenges, says the doctor. “A patient who presents to an emergency x may not be interested in going to the nearest clinic if that clinic is 15 kilometers away. There is a stake of refusal on the part of the patients, therefore, but there is also the stake of certain clinics which do not necessarily see the added value of having redirected clientele ”, explains Dr. Berger-Pelletier .

While almost all of the superclinics adhere to reorientation measures for ambulatory emergency patients, the same does not apply to traditional family medicine groups (GMF) (which do not have a network or superclinical mission). “You should know that GMF and GMF-R have no obligation to take patients redirected from the emergency room, but they have every interest in doing so, especially if the patient who presents to the emergency department has a family doctor in a GMF, ”said the emergency physician.

Could the ministry force clinics and superclinics to take emergency referrals? “I think family doctors and patients would have a vested interest in this happening.” We’re watching this. It’s been on the drawing board for a few months already. But there are certain issues. You would be surprised at the number of patients who come to the emergency room who have no idea who their family doctor is and where he works, ”illustrates the emergency physician.

If work remains to be done with the population and clinics, more and more emergency ambulatory patients are being redirected, notes Dr. Berger-Pelletier. “We are currently at 8% of the ambulatory emergency patients who are redirected. Our target is 10%, ”she says.

Saturated clinics

Asked about the numerous testimonies, especially on social networks, of patients who say they tried in vain to consult in a clinic or in a superclinic before falling back on the emergency, Dr. Berger-Pelletier was good at made this issue.

“We are not deaf or blind, we hear and see the same comments as you. I did six shifts in the emergency room during New Year’s Day, and I was hit hard by this increased traffic and by the presence of patients who told us that they had tried to consult in but which unfortunately had not been successful. ”

Before Christmas, most winter clinics – there are nearly sixty in Quebec, the list is on the site of the Minister of Health – had available consultation periods, observes Dr. Berger-Pelletier.

“But there was a perfect storm. Around December 26, there was an increase in influenza A and B at the same time. […] Then there was gastro, which is particularly intense this year. I have also seen more cases of gastroenteritis than cases of influenza. With that, there was ice [and falls], so that demand increased by about 300% in 48 hours. It is certain that with a network that is already at full capacity, we did not manage to respond to this request in 48 hours, ”says the emergency physician.

Nevertheless, the 20,000 hours of additional winter clinics offered this year “probably do not meet 100% of the demand,” agrees Dr. Berger-Pelletier.

“Probably next winter, we will be even better on other initiatives, other ways of working to improve the service offer. We have agreements with family doctors that are renegotiated year after year. The objective is to meet the needs of the population. If the winter clinic hours were not enough this year, there will be more next year, ”says the doctor.

For now, she adds, “we’re asking all of our family doctors, GMFs and GMF-Rs if they can offer more hours.”

A population to educate

On the other hand, notes Dr. Berger-Pelletier, we find in clinics, superclinics and emergencies a “high clientele” who does not need to see a doctor. According to her, about 40% of patients who consult do not need it.

“There are really many, many patients to whom I replied [to the emergency room during the holidays]: listen, this is a virus, unfortunately, modern medicine can not do much for you, it you have to wait for it to pass. So there is population education to do too, “believes Dr. Berger-Pelletier, recalling that the Ministry of Health promotes decision-making tools, especially on social networks and on its website. .

You can also consult the pharmacist or call 811 to find out how to rehydrate during a gastro, for example, she adds. “I saw a lot of destitute parents during the holiday season, and I didn’t install a lot of solutions. In most cases, it was not severe dehydration, ”said the emergency physician.

“We, what we fear as a clinician, is that in a crowded waiting room hides a seriously ill patient who will wait unnecessarily for a long time,” explains Dr. Berger-Pelletier, who recalls that the Canadian scale of triage is “not perfect” and that a patient rated P4, for example, may ultimately need to be seen quickly.

Occupancy rate of stretchers

Regarding the occupancy rates of stretchers, considered “very high” again on Thursday in 11 regions of Quebec, Dr. Élyse Berger-Pelletier underlines that the Minister of Health, Danielle McCann, announced in November the funding of 800 additional places hosting. She recalls that several beds in hospitals are occupied by patients who are unable to return to their living environment after an episode of care and who are waiting for a place in a CHSLD.

“These 800 places are not all open [just under half are]. We follow up with the establishments, which are trying to open them as quickly as possible. All of this will help free the beds, ”says Dr. Berger-Pelletier.

Funding was also provided to several hospitals this fall to open beds in overflow units, said the national emergency director. “There have been things done. We understand that it does not meet 100% of the needs, but when we compare to last year or two years ago, there has been a lot of progress, ”she says.

Longer term solutions

According to Dr. Élyse Berger-Pelletier, another part of the solution is found in the longer term in the projects of new hospitals, particularly in Vaudreuil-Soulanges. “There is also the Pierre-Boucher Hospital [in Longueuil], where we will increase the number of hospital beds. These are regions that are very critical right now. ”

The Ministry of Health also says to turn to “alternative” methods. “Rather than the elderly who live in private residences coming to the hospital, why wouldn’t it be the hospital that would go into the private residence to put on fluids when there is an explosion of gastro, for example?” We have a lot of projects like that to prevent people from going to the emergency room, ”says Dr. Berger-Pelletier.

Yes, the ministry still has homework to reduce the pressure on emergencies, but it’s not just his job to do, believes the emergency physician. The population too must do its bit by finding out before consulting, she insists.

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