We don't feel the water that would put out the fire.
But here I am, I've got my hands on the action plan to solve the problem once and for all, drawn up by the clinical organization expert group tasked with finding solutions. He was successful. “The report proposes priority actions and a strategic plan aimed at ensuring smooth operations during emergencies. The aim is a gradual disappearance of emergency overflows and an operation that ensures the quality of emergency services. Eleven priority actions are proposed to achieve these objectives.”
The problem?
This report was commissioned by Pauline Marois in 1999 when she was health minister, when she was in the spotlight because emergency departments were more crowded than ever before, with patients piling up on stretchers in the corridors. The situation didn't improve the following winter, so she had to rush back from her vacation in the south.
“Pauline on the beach,” headlined the newspapers as Quebecers waited hours to see a doctor.
But the worst thing is that we could change the date on the report presentation page and not see anything. Almost a quarter century later, the results are similar and overlapping. We put our finger on the aging population, the increase in stretchers on stretchers aged 65 and older accounted for 80% of the total increase since 1994.
We talked about pressure, winter and respiratory diseases.
We pointed to the mergers that led to the withdrawal of around a hundred stretchers, but also the closure of 6,000 short-term beds, “which reduces the admission capacity in the emergency rooms of hospital centers.” In 1998 and 1999, the average wait time for a stretcher in Montreal-Centre was 15.4 hours.
On Thursday it passed 9 p.m.
Doctors and nursing staff were consulted and found “that the clientele has increased and that diagnostic and treatment procedures have become more complex over the years”. We are already finding that “customers are more informed about their condition and need better explanations.”
We complained about “the lack of staff” and also that “a large part of the clientele present in emergencies comes there because they do not have access to services elsewhere”. While nursing staff are currently in negotiations, 25 years ago they complained about the lack of “salary recognition”.
I'm telling you, it's copy and paste. The emergency doctor Alain Vadeboncœur was also a member of the expert group; He, too, had been given the task of presenting the reality of emergencies in more detail and proposing solutions. The title of the discussion document – 117 pages long – speaks for itself: “Emergency Project 2000: From Lightning Rod to Turntable”.
We're still on the lightning rod.
The Urgence 2000 project proposed 74 solutions, the expert group 11. We are talking about better emergency organization, better continuity of care, exactly the same solutions that the current unit is trying to implement. We are talking about an expansion of home care, more effective communication between different stakeholders, but above all, better access to the front line.
We keep coming back to it.
To remedy this, the CLSCs were created, but they gradually became distracted from their purpose and never really delivered good results. This time, Minister Dubé is betting everything on GAP 2.0, the front-line access window that, he promises, will finally put an end to the overflows.
He is betting that his future mammoth health authority will achieve this goal.
As in 1999, too many patients come to the emergency room because they have no option to seek treatment elsewhere, either because they don't have a family doctor or because they can't get an appointment. SHE. Even walk-ins require an appointment, which shows that front-row access is a fiasco.
According to the Régie de l'assurance-santé du Québec, often more than half of the people waiting in the emergency room should not be there, but the famous “P4” and “P5” should not be there. You have nothing to do there. Between October 2021 and September 2022, they were around 60% in hospitals in Quebec and up to 78% in the Hôtel-Dieu in Lévis.
The record 89% belongs to Pontiac Hospital.
Of course, as doctors reminded us this week, there are many people who fear a serious health problem and feel the need to go to the emergency room. But there are many who choose emergency care out of default and defiance and resign themselves to spending hours there to see a doctor.
Send those patients somewhere else, and by a simple rule of three, emergency rooms are no longer overcrowded, not even at capacity. While you're at it, find a place to transfer patients who are hospitalized and shouldn't be hospitalized, and you'll no longer have 940 people waiting on a stretcher for 24+ hours .
Minister Dubé is working on this, just as his predecessors tried to do.
Will this time be the right one?
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