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Emergency: Jewish General Hospital in Montreal victim of its success

rapidite-traitement-urgences-lhopital-generalLast year, the Jewish General Hospital in Montreal has registered almost 85 000 visits in its emergency, or the highest volume of the province. Attracted by the performance of the institution, which shows an average of 12.6 hours of stay, more and more patients from outside of Montreal come to receive treatment today. So much so that the hospital management fears that its emergency reach their saturation point.

“We receive 250 to 300 patients a day. constantly our record is beaten. But one wonders how long it will last, “says the director of professional services of University Centre Integrated health and social services (CIUSSS) Central West Island of Montreal, Dr. Louise Undermine.

At the launch of its new emergency room in 2014, the Jewish General Hospital announced that patients would see a doctor within 20 minutes. To achieve this, the establishment, the only Quebec to do, set up a triage doctor. “This is one of the keys to success. It can offer a much better service to patients, “says the general manager of CIUSSS Central West Island of Montreal, Dr. Lawrence Rosenberg.

The doctor triage can quickly assess patients and to redirect some medical clinics. “Yesterday, we refocused and 78 patients,” says Dr. Marc Afilalo, chief of emergency at the Jewish General Hospital.

“IF THE PATIENT MONEY followed …”

Timely processing emergency was quickly rumored, increasing suddenly the number of visitors to the hospital district Côte-des-Neiges. “Today 54% of our emergency patients come from outside of our territory,” notes Dr. Miner. “Sometimes I see patients of St. Jerome, or even of St. Agatha …” illustrates Dr. Afilalo.

The direction of CIUSSS Central West Island of Montreal to be a victim of its good performance. Because even if the volumes of patients are constantly increasing, funding is not increased accordingly. “If the money followed the patient, it would improve the situation of our teams. But we are not there yet, “says Dr. Miner.

“Our nurses work really hard. They are weak. It is unclear how long it can last. ”
Dr. Marc Afilalo
Dr. Rosenberg believes that all network facilities could imitate his emergencies. “It’s a matter of will,” he said. But in the circumstances, the team of the Jewish General Hospital wonders what institution would improve its performance and risk seeing its ridership increase while funding is not adjusted accordingly.

Three times in the last month, the CIUSSS Central West Island of Montreal addressed the Ministry of Health for more funding. Without success.

84919
Number of visits to the Jewish General Hospital in 2015-2016
12.6
hours
Average length of stay of patients on stretcher
1.8
hour
Average time of medical care
“We must recognize the performance and quality of care,” says Dr. Lawrence Rosenberg, CEO of CIUSSS Central West Island of Montreal

A REFLECTION OF THE HEALTH SYSTEM

For Dr. Afilalo, the performance of emergencies reflect the entire health system. He notes also that the number of patients of “alternate level of care” at the Jewish General Hospital continues to increase. These patients, who occupy a bed in the hospital, are waiting for a place in the Residential and long-term care (nursing homes), intermediate resource, rehabilitation, convalescence, palliative or health care mental elsewhere in the network. “We normally had 30 to 40 beds occupied by these people. Today we are at 65. It clogs emergencies, “says Dr. Miner.

She said improvements to emergencies at the Jewish General Hospital were made “for patients.” “Do not expect too much, this is what people want. We had to become more efficient. But today, with days to 339 patients, one wonders how long it will take before reaching the limit, “she said.

Waiting in hospital emergency rooms in Quebec: 2.3 hours before seeing a doctor
A majority of patients cared for in less than two hours

Approximately 60% of patients seen in emergency Quebec are supported by a doctor in less than two hours, show recent data of the Ministry of Health and Social Services (DHSS). In 2015-2016, it took an average of 2.3 hours between the time a patient was seen in triage in Quebec emergencies and when it was taken over by a doctor.

Dr. Bernard Mathieu, president of the Quebec Association of Emergency Physicians, said he was “surprised” by these data which suggest that the ER wait is “least worst we think.” “But we do not have a great history for these data. And it must always be interpreted with caution averages. Because an average can be highly distorted by the extreme, “he said.

Delays in medical care by region (hours)

Bas-Saint-Laurent: 1.8
Saguenay-Lac-Saint-Jean: 2.3
Quebec 1.7
Mauricie-Centre-du-Québec: 2.7
Estrie: 2.9
Outaouais: 2.9
Abitibi-Témiscamingue: 2.3
North Shore: 2.2
Gaspésie: 1.8
Chaudière-Appalaches: 1.4
Laurentides: 3.3
Montérégie: 2.9
Lanaudière: 3.0
Laval: 3.3
Montreal: 2.1
The “real” waiting

Until 2014, Quebec was compiling only the average length of stay in the emergency, the number of hours spent on a stretcher before obtaining his leave or be hospitalized. But since then, the MSSS also compiles the decision within medical care, the time that elapses between the time a patient is seen in triage and when he meets a doctor.

Caroline Gingras, spokesman MSSS says that these new data provide a more accurate glimpse of the “real” waiting to emergencies. In 2015-2016, he was well up on average 7.7 hours between when a patient was seen in triage in the halls of Quebec emergencies and when it came out.

“It takes an average of 2.3 hours before a patient is supported by a doctor. For the sickest patients, who are on stretchers, the average length of stay after 15.7 hours. But for ambulatory patients, the average length of stay is just 4.1 hours. These patients are much more numerous, and that’s what makes greatly decrease the total ED wait, “she said.

2015-2016 data emergencies

Delay means support: 2.3 hours
outpatients: 2.5 million
Average length of stay: 4.1 hours
Stretcher patients: 1.2 million
Average length of stay: 15.7 hours
Average stay in emergencies: 7.7 hours
From before seeing a doctor

While 3.7 million people came to the emergency in 2015-206, only 3.2 million have been supported by a doctor. Where have gone the other? Ms. Gingras explains that some patients “are referred elsewhere than emergencies, such as in medical clinics” and others “make the decision not to wait to see the doctor.” These data coincide with a compilation made by the Journal de Montreal in early May and revealed that a tenth patient leaves the emergency before seeing a doctor.

The situation in Montreal

The period of medical treatment in emergencies of Montreal is slightly lower than the provincial average and reached 2.1 hours. Instead, the management of time in almost all hospitals in the Montreal suburb is much higher, shows the data of the MSSS. Dr. Mathieu is not surprised by this. “The emergency traffic is very high in the suburbs for a while. Sometimes there are exceptional cases waiting about 24 hours, increasing the average, “he said.

Time management in hospitals in Montreal (hours)

CHU Sainte-Justine: 1.5
Montreal General Hospital (MUHC): 1.5
Hospital of St. Mary: 1.6
Hotel-Dieu (CHUM): 1.6
Montreal Heart Institute: 1.7
Jewish General Hospital: 1.8
Verdun Hospital: 1.9
Montreal Children’s Hospital (MUHC): 1.9
Lakeshore Hospital: 2.1
Notre-Dame Hospital (CHUM): 2.1
Hospital of the Sacred Heart: 2.2
Royal Victoria Hospital (MUHC): 2.2
Saint-Luc Hospital (CHUM): 2.4
Fleury Hospital: 2.5
Santa Cabrini Hospital: 2.6
Hôpital Jean-Talon: 2.7
Maisonneuve-Rosemont Hospital: 2.7
Lachine Hospital (MUHC): 2.7
LaSalle Hospital: 2.9
In suburban Montreal
Anna Laberge Hospital: 4.2
Hospital of St. Jerome: 4.1
Pierre-Boucher Hospital: 3.7
Pierre-Le Gardeur Hospital: 3.6
Cité de la Santé de Laval: 3.3
Hospital Saint-Eustache: 3.1
Hôpital du Suroît: 2.8
Charles-Lemoyne Hospital: 2.4
Hôpital du Haut-Richelieu: 2.5
Successful institutions

Despite strong attendance, some hospitals are able to support their patients very quickly. With a delivery period of 1.7 hour to 76 938 visits, the Hospital of the University of Laval (CHUL) is very efficient. Pierre-Patrick Smith, director of the Emergency Centre hospitalier universitaire de Québec, says the CHUL trafficking of children, and the care of pediatric patients is generally shorter. He still believes that the success of its emergency facility was due to a “multitude of factors”. Notably, physicians and administrators practice “co-management”, which solves problems faster. Reorganization of outpatient emergency following the LEAN process has also been established there two years and is bearing fruit, says Dupont.

The busiest and delays in medical care establishments (hours)

Jewish General Hospital: 84 919 visits (1.8)
Charles-Lemoyne Hospital: 83644 (2.4)
CHU Sainte-Justine: 82978 (1.5)
Cité de la Santé de Laval: 81910 (3.3)
Montreal Children’s Hospital: 81137 (1.9)
Hospital of Laval University: 76938 (1.7)
Maisonneuve-Rosemont Hospital: 72021 (2.7)
Hôtel-Dieu de Lévis 68 916 (1,1)
Pierre-Le Gardeur hospital: 67846 (3.6)
Anna Laberge Hospital of the pack

Of all hospitals in the province, it is the Anna Laberge Hospital that the period of medical treatment is the longest, with 4.2 hours. Last year, this period was 5.6 hours. Chantal Huot, integrated Centre spokesman for health and social services Montérégie West says that the establishment realized last year that there was “lax data entry emergency” which artificially increased the support period. Changes in making ways have been made. “But with a delay of 4.2 hours, it would mean that our highest priority patients are not seen within a reasonable time, which is not the case, says Ms. Huot. There is still work to do to get our data in real time. ”

Institutions where medical care is the longest (hours)

Anna Laberge Hospital: 4.2
Gatineau Hospital: 4.2
Regional Hospital St. Jerome: 4.1
Pierre-Boucher Hospital: 3.7
Hospital of Rouyn-Noranda: 3.6
Pierre-Le Gardeur Hospital: 3.6
Laurentian Hospital: 3.6

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