The new plan to reduce overcrowding in Quebec emergency rooms is paying off, the province's health minister said Wednesday, but a major nurses union said that while the measures are laudable, the situation remains critical.
If it weren't for a series of recent changes to the health network — including new clinics run by nurse practitioners and the expansion of an urgent-care medical line — emergency rooms across the province would be in much worse shape, Christian Dubé told reporters.
"This combination of measures that we have implemented very quickly is making a difference," the health minister said during a visit to a hospital on Montreal's South Shore.
Around 10,000 people visit emergency rooms in Quebec every day, he said, a similar number to this time last year. But were it not for the additional measures, Dubé said, that number would be higher.
"It's hard to say, would we be at 12,000? 15,000? I don't know, but we'd be more than 10,000."
The average occupancy rate in Quebec's emergency rooms was 130 per cent on Wednesday afternoon, according to health data website IndexSanté. That figure, however, only considered the number of patients on stretchers, not people in waiting rooms.
Roberto Bomba, treasurer of a major health-care union, said the situation in emergency rooms remains a "crisis" despite the government's latest changes. The new nurse-run clinics and the expansion of the urgent-care phone line will help, but the number of people visiting ERs won't drop overnight, said Bomba, with Fédération interprofessionnelle de la santé du Québec.
"The needs keep rising, the population is rising in number, chronic illnesses are rising, and we're in the winter period, so you're at a greater risk of viruses," he said in an interview Wednesday, adding that winter weather also leads to falls that can send people to ERs.
With ERs over capacity and Quebec hospitals already short of nurses, Bomba said nurses are being forced to work mandatory overtime and, in some hospitals, face pressure to take overtime shifts, which should be voluntary.
"It's becoming a practice, because of the shortage, because of the crisis, especially in (the ERs) where there's huge pressure put on our health-care professionals by managers to do an extra shift," he said.
Nurses, Bomba added, are made to feel guilty about leaving their colleagues with extra work or are told that patients will suffer if they don't work overtime.
"Some hospitals are doing better than others, for different reasons; some are more able to attract health-care professionals, some are more able to retain health-care professionals," he said, adding that some hospitals treat their staff better than other hospitals do.
Quebec hospitals have been hit by three respiratory viruses: respiratory syncytial virus, influenza and COVID-19. More than 2,100 people were in Quebec hospitals with COVID-19 Wednesday, including 746 people who were admitted because of the disease. On the same day last year, the Health Department reported 415 COVID-19 patients in Quebec hospitals.
"The situation is still very critical with crowding," Dr. Judy Morris, president of an association of emergency room physicians, said Wednesday.
At times, some emergency rooms have neared 200 per cent capacity, said Morris, with Association des médecins d'urgence du Québec. "This can create definitely sub-optimal and potentially dangerous situations for patient care and it's a huge strain on the ER teams; so it's still very difficult on the ground."
Morris, who practises at the Sacré-Cœur hospital in Montreal, said steps have been taken to increase access to outpatient care and primary care outside ERs, adding that it will take time for patients to adapt.
At the Montreal Children's Hospital, the emergency room has been less busy this week than it has been recently, said Dr. Earl Rubin, the director of the hospital's pediatric infectious diseases division.
"I would say cautiously that things are stabilizing and on the trend toward improvement, but things change from day to day," he said in an interview Wednesday. While the number of RSV cases have declined over the past month, the hospital is now seeing more influenza cases, he said.
Quebec's decision to make the flu vaccine free to everyone came too late — after the start of the flu season, Rubin said. The province had initially only made the shot free to certain high-risk groups.
Rubin said the measures to ease pressure in ERs will be put to the test during the holidays, as people gather together and as family doctors' offices reduce activities.
"I'm very concerned. Because even if we're past the peak, all it takes is one person who is infected, who will then gather in close proximity with other people who are vulnerable and not infected," he said.
This report by The Canadian Press was first published Dec. 21, 2022.
