montreal's er crisis is being made worse by new policy, doctor says
it's intended to lessen pressure on ers, but may be having the opposite effect in some cases, prolonging the stay of elderly patients in hospital wards.
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most quebecers are painfully aware that a perfect storm of dire conditions is pushing the province’s already beleaguered emergency rooms to the breaking point.
a dearth of family doctors, a shortage of medical staff in hospitals, too few beds, an aging population with increasingly complex problems, a resurgence in contagious viruses besides covid-19, and pent-up need from patients who were unable or unwilling to seek care for minor ailments due to the risks of the pandemic are all taking a serious toll on the fragile health-care system.
and a recent policy change implemented by the health ministry intended to relieve some of the pressure on montreal-area ers may be having the opposite effect, according to one front-line practitioner.
when dr. steven grover arrived for his most recent block of shifts treating patients admitted to the wards of the montreal general hospital, which is part of the mcgill university health centre, he soon realized something was different from his previous tour of duty just a few weeks earlier.
previously, when it came time to release the many elderly patients who experience life-altering events like falls and are unable to return home, the clinical team would forward their evaluations to the various clscs for followup. doctors, nurses, social workers, physiotherapists and occupational therapists conduct rounds five days a week, meeting as a group to discuss the status of each individual in their care.
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but since september, grover said, someone also has to come from the patients’ local clscs, which are also short-staffed, to do their own assessments — prolonging hospital stays at a time when beds are desperately needed and ers are overwhelmed.
“the idea was the clsc would be more actively involved in determining what the patient’s care needs were, and that has resulted in huge delays. it can take two weeks before the clsc shows up with somebody to do an evaluation — even longer in some cases,” said grover. “it’s completely unnecessary, because after weeks of having them on the hospital ward and caring for them 24 hours a day, not to mention having these multidisciplinary rounds five days a week, we know what that patient needs.”
the delays in discharging people on the wards is having a ripple effect on clogged ers, he said.
“instead of patients waiting in the emergency room for a day or two to be admitted, we have patients who come up from the emergency room and they’ve been down there five days,” said grover, who is also a professor of medicine at mcgill and director of the comprehensive health improvement program at the muhc research centre.
“emergency rooms are jammed up because they can’t send patients upstairs, and they can’t send patients upstairs because the patients upstairs aren’t leaving the hospital. there’s no question this new policy is playing a major role in this.”
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indeed, the er occupancy rate was 165 per cent at the montreal general and 218 per cent at the royal victoria hospital on tuesday. there were 13 patients at the general and 19 at the royal vic who had been waiting on stretchers for more than 48 hours, according to daily statistics published by the quebec government. similarly, in the east end, santa cabrini hospital had 10 patients waiting over 48 hours for a bed, while pavillon maisonneuve had 13.
these waits are inhumane for patients — and the workload is inhumane for medical professionals. no hospital has been spared what the president of the collège des médecins du québec, dr. mauril gaudreault, recently called “an emergency in the emergency rooms,” in which department chiefs “fear for the security of patients as much as their own.”
la presse wrote about the er at the centre hospitalier universitaire ste-justine scrambling to find space to treat a never-ending stream of seriously ill children a week ago. the lakeshore general in the west island and hôpital du suroît in salaberry-de-valleyfield have been struggling with staffing shortages. over the weekend, nurses at suroît doing their third, fourth and fifth obligatory overtime shifts in a week wore hospital bracelets in protest and posted a picture of their wrists online.
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six ers in quebec had to close down overnight for periods this summer because there weren’t enough staff on duty.
wait times have become frustratingly long everywhere — and perhaps even dangerous. cbc reported a patient left one er after 16 hours without being seen by a doctor, only to show up at another hospital where he died a short while later of cardiac problems.
noémie vanheuverzwijn, a spokesperson for the health ministry, confirmed a new protocol was put in place last month aimed at freeing up hospital beds and helping clear emergency rooms, where patients line the corridors waiting to be admitted.
“considering the progression of short-term bed occupancy by a clientele requiring an alternative level of care in the montreal region, a specific accompaniment by a ministerial team has been in place since september to co-ordinate all the best practices required on the island of montreal,” she said.
the change is part of a greater push to send patients home with support while they await openings in long-term care facilities or other transitional care.
“the involvement of the pivotal actors from the first day of hospitalization permits an acceleration of the return home or move to a temporary establishment,” vanheuverzwijn added. “while this requires a certain reorganization of work, the teams are presently in an adaptation period. for the ciussss, it’s even an opportunity to reach a clientele that wasn’t known to their services.”
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annie-claire fournier, a spokesperson for the muhc, said the institution is “supportive of all initiatives that can improve bed management in our hospitals as well as reduce emergency room traffic often caused by reduced bed capacity on floors.”
but grover said hospitals have been “blindsided” by a change that is so far proving counterproductive.
“there was no warning, there was no input — it just suddenly was a new policy, and it’s not clear to me who’s watching the situation to determine whether or not it’s working,” he said. “i know they’ve set some very aggressive milestones, targets they would like to hit, in terms of improving things. but i can’t see that things are improving — i can only see in the limited time i was there for two weeks that things have deteriorated markedly.”
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