Quebec to open two nurse-run clinics in Montreal to ease emergency room crisis

Quebec's health minister on Tuesday promised that his new three-point plan to ease emergency room overcrowding will show results in a few weeks, as ER doctors warned that the network has reached a "breaking point."

Christian Dubé said his 20-member health-care "crisis unit" has been meeting frequently, adding that he toured several of the province's hospitals last week to listen to workers' concerns. His plan, he said, is to quickly open two clinics in Montreal run entirely by nurse practitioners, to extend the 811 health-care hotline to pediatric patients, and to free up hospital beds more quickly.

The solutions aren't new, Dubé said, but they just haven't been implemented over the years for a variety of reasons.

“Our challenge is to implement them throughout the network; it's all in the execution,” Dubé said, adding that while the situation in Quebec's ERs isn't unique in Canada, it's "not an excuse for not having done what we should have done."

Dubé announced his plan the same day a letter was leaked to several media outlets, authored by a group representing the heads of Quebec's emergency departments, who stated bluntly that ERs in the province have reached a "breaking point." It was addressed to several people in the Health Department, including Dubé.

The emergency chiefs said that for several months, they had been raising concerns about overcrowding and shortages. "The finding is distressing: the emergency situation in Quebec has reached breaking point," said the letter, penned by a group calling themselves Regroupement des chefs d’urgence du Québec.

"We have not received the support of our management to better distribute the pressure between the different network structures to mitigate the impact on emergency services and on patient care safety."

The letter, dated last Friday, said emergency rooms are "the victims of a failing system."

"Indeed, the persistent and recurrent closures of hospital beds force emergency departments to disproportionately bear the burden of hospital overcapacity," the letter read. "Emergencies are now condemned to sacrifice their primary mission, which is to treat in a timely manner people whose clinical condition is unstable, or even potentially deadly."

The ER doctors said hospitals need better protocols to manage overcapacity and the management of resources, such as hospital beds. As well, they said the public should have easy access to data about emergency room capacity and wait time expectations.

Dubé on Tuesday said he agreed with the letter, adding that he was scheduled to meet with some of its authors on Wednesday in Quebec City.

"I think we all appreciate what they're saying because they're right: we should act on certain things," Dubé said. "I'm just saying to those doctors that have signed this letter that we agree with those recommendations."

According to IndexSante.ca, a website that tracks hospital occupancy, emergency rooms Tuesday afternoon across the province were above capacity in many regions, with the average provincewide occupancy at 125 per cent. Dubé said one out of two patients who end up in an ER could be treated outside the hospital system.

Dubé said he planned to open "in the coming weeks" a pair of clinics in Montreal run entirely by nurse practitioners. The hope, he said, is that such clinics can be widely used to accommodate patients who do not have a family doctor.

The second part of his plan is to extend service of the 811 health-care phone line to pediatric patients, allowing parents to obtain a consultation and avoid going to the emergency room. The new service, based on a pediatric phone line that was operational during the height of the COVID-19 pandemic, is only available in Montreal at the moment, but Dubé said it will be extended soon across the province.

"When in doubt, when you don't know what to do, 811 is the place," Dubé said. On Tuesday, Montreal's two children's hospitals — Sainte-Justine and Montreal Children's — were at 163 and 175 per cent capacity, respectively.

Dubé said the third part of his strategy involves moving patients out of hospital who can't be returned home and don't have a spot in a long-term care facility.

The government, he said, has put out a call for tender for 1,700 beds outside the hospital network, adding that 58 per cent of that extra bed space has already been found. Dubé said the Health Department is also looking to discharge patients more quickly to their homes, with access to home care. Doing so, he said, would allow people to recover in a familiar, comfortable environment, adding that it would also free up hospital space.

This report by The Canadian Press was first published Nov. 1, 2022.