Canadians deserve the very best in emergency care . Let's work to restore their confidence in the emergency health care system.

ER crowding in Quebec

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The Quebec Health Minister recently announced a funding increase of $100 million dollars to address hospital bed capacity issues in the provinces hospitals.  This was reported in the Montreal Gazette.

The Gazette has an annoying practice of not publishing letters to the editor on-line so unless one is a Montrealer on the island, one never knows if their letters were published.

Over the last few weeks, I have written a number of letters to the Gazette and I have no idea if they were ever published.

This is to-day’s missive:

The Canadian Association of Emergency Physicians would like to congratulate Quebec Health Minister Barrette on his very welcome announcement of increased funding for hospitals aimed at reducing congestion in the province’s emergency departments. 

To understand the issue it is important to note that ER crowding is a direct function of hospital crowding.  When an admitted emergency patient cannot be transferred to a hospital ward they end up spending hours or days occupying an ER stretcher.  This means that patients in the waiting room cannot be examined because the treatment space is occupied.  On any given day in a Canadian emergency department multiple ER treatment spacers are occupied by patients waiting to be transferred to the ward. 

When a hospital has 85% of its beds occupied, there is wiggle room and ER crowding rarely occurs.  At 95% hospital bed occupancy, crowding is a given.  Many Montreal area hospitals try to function at greater than 120% bed capacity and it simply does not work. 

One particular area of concern is the patient who occupies a ward bed but should be in a nursing home or at home with appropriate supports. These patients quite typically occupy 20% of a hospitals beds. 

Dr. Barrette’s announcement will certainly help the latter group and improve ER flow.  

The question is going to be whether it is enough.  A safe bed occupancy rate is 85%; Montreal hospitals are at 120%.  That is a big number to bridge.

 

Alan drummond mdcm

 

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