Quebec hospitals prepare for potential emergency drop in overall level of care under new guide

A new guide released Tuesday sets the stage for a temporary drop in the level of care provided to patients in general if the situation in Quebec hospitals continues to escalate under pressure from the Omicron wave.

"We have gone from the objective of zero risk to that of harm reduction," said the president of the COVID-19 Ethics Committee, bioethicist Marie-Ève ​​Bouthillier, during a technical briefing on the all-new short-term hospitalization management prioritization guide.

The guide would serve to ensure that all patients receive care, even if this care may be, in the future, lessened for a while.

For the time being, the measures already taken are around decongesting hospitals, in particular with regard to the "13 per cent of our beds which are occupied by patients in alternative level of care," or in other words, people who are waiting to be able to be transferred to other establishments like CHSLDs, said a Health Ministry official, Lucie Poitras.

She also mentioned that something called bed management teams have been created. These would be responsible for deciding if a patient has recovered enough to be discharged from hospital, should the need arise.

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A LAST RESORT

As for a decrease in the level of care, "we all hope it never comes to that," said the president of Quebec's association of internal medicine specialists, Dr. Hoang Duong, who also participated in writing the guide.

"If I had been asked one day if I would work on such a document, I would have said never, it's inconceivable," he stressed, he recalling the gravity and the exceptional nature of the situation.

"We didn't take this lightly."

He said there are still several alternatives to put in place before crossing this threshold, such as "relaxing the rules for isolating staff and infected patients" or "facilitating the transfer of patients who no longer need acute care."

Bouthillier also mentioned that it will be possible to seek the help of caregivers to "allow health professionals to take care of slightly more specialized tasks."

This approach is the opposite of that of the first wave, where caregivers were refused entry into CHSLDs.

If, despite all efforts, a reduction in the level of care proves necessary, a diabetic patient could, for example, be discharged from the hospital a little earlier than planned, even though his blood sugar level has not yet quite reached a perfect level, the speakers explained.

Instead, the patient would receive an appointment within the next few days for a follow-up with their doctor.

This report by The Canadian Press was first published in French on Jan. 18, 2022.