Hospitals are overwhelmed with critically ill patients

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Of the 84 emergency rooms in the province, 57 are now in worse shape than they were five years ago, according to our rankings. The average length of stay in the emergency room, the number of hours a patient spends on a stretcher in the emergency room before being discharged, hospitalized or transferred, is higher than before the pandemic, but lower than in 2022-2023.

In the interview Pres, the Minister of Health, Christian Dubé, confirms that in terms of emergencies “not at the desired level”. He explains that he is in the process of making “fundamental changes” to the health network, the effects of which will be visible for years to come. Already, he sees a “positive trend” in emergency data. That's because “the profile of people coming to the emergency room has really evolved” in the past five years, he says. Patients are elderly and sick.

The Minister welcomes this progress and maintains the objective of achieving an average stay of 15 hours by 2025-2026.

President of the Association of Emergency Medicine Specialists of Quebec, Dr.^R Gilbert Boucher affirms that Quebec is slow to recover its efficiency before the pandemic, especially because hospitals are understaffed. “We've closed another 1,000 hospital beds because of that,” he said.

President of the Association of Emergency Physicians of Quebec, Dr.^D Above all, Judy Morris emphasizes that emergency rankings reflect the “overall performance of hospitals” and the health network. “Many efforts have been made to improve the situation in the last year. But there is no victory in the war,” she says.

In its 2019-2023 strategic plan, the government aims to reduce the average length of stretcher stay to 14 hours by 2023-2024 (in Canada the target is 8 hours). Minister Christian Dubé revised them last December, saying he wanted to set “more realistic” targets. The 14-hour target achieved in 2018-2019 has been postponed eight years later to 2026-2027.

Mr. Dubey says. “It's not true that we can aim for 12 hours,” he says.

Crowded beds on floors

As of April 12, 11.59% of hospital beds in the province are occupied by “Alternative Level Care” (ALC) patients. These individuals no longer require hospital care, but are awaiting a placement in CHSLD or home care, for example, to be discharged. The government has targeted 8% of NSA patients. The more crowded the beds are on the floors, the less emergency patients can be transferred there and the longer the wait in the emergency room. According to D^D Morris, the number of ALC patients “has been declining for months”.

Despite all that, the province's rate of emergency room stays on a stretcher of 48 hours or more reached 6.3% this year, up from 2.9% before the pandemic and 7.4% last year.

To get there, T^R Boucher specifically proposes further development of the home care offering.

Fewer ear infections, more seniors

After traffic slowed during the pandemic, Quebec emergencies are starting to receive more patients again.

But according to T, there are fewer cases of small cases^R Butcher.

D^R Boucher attributes this situation to better access to first line and the diversion of minor cases from emergencies to clinics.

Patients aged 75 years and older are in the emergency department. They represented 30.8% of all consultations in 2023-2024, compared to 28.1% five years ago. “The increase in older patients may seem small, but it requires many more resources in the emergency room,” Di notes^R Butcher.

Our team of journalists benefited from the expertise of Pierre Meslin, from the Data Science Department, to get the notes that appear in the rankings Pres, took into account various criteria, including the average length of stay on a stretcher in the emergency room, and weighted these results by certain factors, such as the number of hospitalizations and the proportion of people aged 75 and older. This method influences the results.

For example, Anna-Laberge Hospital has one of the longest average lengths of emergency department stay in the province (31 hours). But its clientele is much older (40.2% of patients are 75 and older) and much heavier (hospitalization rate of 36.5%), maintaining its performance this year.

In contrast, Montreal General Hospital has a shorter average length of stay (24.8 hours), but its clientele is much younger (20% of patients are 75 and older) and less burdened (hospitalization rate of 23.5%). The performance of the establishment ranks very poorly. Over the past two years, the rate of emergency department stays of 48 hours or longer has practically doubled at this institution compared to previous years.

According to MUHC spokeswoman Annie-Claire Fournier, many patients spend too long in the Montreal General Hospital's emergency room because they are “waiting to be admitted to the hospital for mental health issues.” On hospital floors, 30% of psychiatric beds are occupied by ALC patients.

The lack of beds on floors is evident throughout the MUHC and is explained by staff shortages, lack of beds in CHSLDs and rehabilitation in the community since the MUHC moved to the Glen site in 2015. , “Around a hundred beds have been removed from the MUHC admission, reducing our ability to accommodate more patients while the role of getting ambulances remains unchanged,” said M.^me Fournier.

The Laurentides, Montérégie and Outaouais regions provided the highest average accommodation this year. Sectors registering significant population growth, T indicates^R Butcher. A longtime model student in the rankings, Jewish General Hospital in Montreal has had a tough year. The number of visitors to this institution is growing strongly. “Even with the best system, if you double the demand, you won't succeed,” said D^R Butcher.

In collaboration with Thomas de Lorimier, Pres

Two Montreal University Hospitals, two facts

Aside from Montreal General Hospital, which had a tough year, the MUHC's Royal Victoria Hospital recorded the longest average length of stay in the province this year (31.67 hours). The specific situation of this university hospital was presented in 2022 Pres. Conversely, the University Hospital Center of Montreal (CHUM) is seeing its performance improve. “There's a lot of effort at CHUM to prevent patients from going through the emergency room,” Dee says.^R Butcher.

Read the report “MUHC Bursting at the Seams” published in 2022

Evacuate patients quickly

In 2023-2024, patients waited an average of 25 hours and 35 minutes in Quebec on stretchers in the emergency room awaiting admission to hospital. For non-hospitalized patients, the length of stay was 11 hours 09 minutes. D^D Morris. According to her, “we don't need to keep more patients in hospitals”. He cites the example of patients awaiting surgery who can go back to sleep at home, but are kept in the hospital so they can act quickly. Some patients are admitted to the hospital to have tests done quickly, such as magnetic resonance examinations. “We have to find a way to not keep these patients,” he said.

Those who don't

Psychiatric, pediatric and specialty hospitals such as the Montreal Heart Institute are not on the list PresBecause their specific mission makes it difficult to compare with general hospitals.