Emergency rooms in the Montreal metropolitan area are still packed, despite the rollout of a pediatric 811 line and the full deployment of first line access counters (GAPs) for patients without a GP. At the Cité-de-la-Santé, in Laval, a GAP nurse tries to refer patients with less serious problems as soon as they set foot in the hospital. Urgences-santé is also conducting a pilot project to avoid hospital transfers.
Traffic has exploded in the Cité-de-la-Santé from the wave of respiratory viruses. When you pass the MustOn Tuesday morning, patients were installed in the corridors, lying on stretchers insulated by a fabric screen. The occupancy rate was 153%. The emergency room was full.
A bad day, according to Sébastien Rocheleau, deputy director of the nursing care department, operational component. “In the last 24 hours, we’ve had 320 emergency room visits, which is huge,” he says. Our usual capacity is around 260 or 275 people.”
To reduce traffic, the CISSS de Laval has assigned a GAP nurse to the emergency room of Cité-de-la-Santé for three weeks. Her mission? Target non-urgent cases that can be redirected, evaluate them in an office without reviewing them, and get them an appointment at a medical clinic or other department.
“I try to get them as soon as they arrive, or almost,” explains GAP nurse Mélanie Beetz, scrolling through the patient evaluation forms in the emergency room on her computer screen. Yesterday I evaluated 17 and 16 were redirected. »
Many patients are children suffering from a respiratory infection or an ear infection. Their worried parents show up at the emergency room in despair: they have not been able to get a consultation with the family doctor or pediatrician or at an outpatient clinic.
“Many are unaware of the pediatric line [811] which has been implemented, indicates Mélanie Beetz, that The duty accompanied for a few hours on Tuesday morning. I raise awareness. »
Alexandra Desforges-Martel, called the pediatric 811 line last Thursday, but was unable to get an appointment for her one-and-a-half-year-old son, Daymien. Tuesday morning she went to the emergency room. Her son hadn’t slept all night. Not even her. “As soon as she’s in bed, she coughs a lot, a lot,” she explained to the nurse. She coughs until she wants to vomit. »
Mélanie Beetz had a hard time understanding why 811 hadn’t offered the child a medical consultation. Got one from him the same day.
“Really, it’s a record! Alexandra Desforges-Martel said. I got to the ER around 7:30. She left almost three hours later with an appointment in her pocket.
The few patients seen by Mélanie Beetz during our visit obtained a medical consultation on Tuesday afternoon.
Thanks to this new initiative, 33% of less urgent emergency cases were redirected to other services last week, says Sébastien Rocheleau. The ministerial target is 15%, he specifies. “We still want to raise this level to reduce the influx of people, and to be able to treat only people who need to come to the emergency room and not [ceux] who can see a family doctor, a first-line doctor,” he adds.
Other initiatives
Urgences-santé is also trying to unblock emergency rooms in its territory, especially Montreal and Laval. Since September, around 20 paramedics and six nurses have taken part in a pilot project aimed at reducing the transfer of less urgent cases to hospitals.
When a “low priority” patient calls 911, a paramedic is dispatched alone to his bedside. Once there, he co-evaluates the patient’s condition with a nurse over the phone. “The objective of this co-evaluation is to see what would be the best service for this patient,” said Jean-Pierre Rouleau, spokesperson for Urgences-santé. Does he really need to be transported to an emergency room or could he be referred to another service in the health network so that his needs can be met? »
The Dref. Eveline Gaillardetz, Head of Home Intensive Care (SIAD) at CLSC Verdun, cites as an example the recent case of a 92-year-old patient, lucid and living alone, who contacted 911 because she had had a fever for four days . and I didn’t feel well. A nurse from Urgences-santé referred her to her department, which took care of her.
The Dref. Gaillardetz spoke to the patient on the phone and sent a nurse to her home that evening. “We did a blood test for him,” explains the family doctor, who also works in the emergency room of the Verdun hospital. The next day he went to a clinic for an x-ray. I spoke to him again 48 hours later. I couldn’t find any diagnoses other than the flu and she got better. She saved herself long hours in an emergency waiting room.
The SIAD service is also trying to reduce traffic in the Verdun hospital emergency room. For about three weeks now, a nurse from the team has been accompanying patients on stretchers every morning, from Monday to Friday. She determines who could go home with SIAD support. “If we could get two or three patients out a week, that would be a huge success,” says Dr.ref. Eveline Gaillardetz. We must not forget that the elderly are sometimes hospitalized for two or three weeks. It’s huge. »
