some patients at royal victoria hospital stay stuck in er for days
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some patients who need to be hospitalized in a cardiology ward at the royal victoria hospital end up receiving less appropriate care in its emergency room on a stretcher for nearly three days — a situation that underscores the medical risks of er overcrowding.
in other cases, patients who need to be sent up to an internal medicine ward at the royal vic stay on stretchers for almost six days in the er, where the capacity often exceeds 200 per cent, the montreal gazette has learned.
although the ers at maisonneuve-rosemont hospital in the east end and the lakeshore general on the west island have made headlines in the last six months for being short-staffed and overflowing with patients, the situation at the royal vic is also among the worst in quebec. the royal vic is based at the glen site in notre-dame-de-grâce in the centre of the island of montreal.
quebec’s health ministry makes public statistics on average wait times for patients on er stretchers. at the royal vic, those averages often surpass 48 hours. but the montreal gazette has examined wait times of individual patients in the er (without reviewing their medical files or identities), and on one particular date in april, a patient who needed to be admitted to an internal medicine ward ended up languishing on a stretcher for at least 135 hours and 44 minutes.
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in fact, on the date in question in april, 14 patients remained in the royal vic er — a rate that is nearly half its 33-bed capacity — for at least three consecutive days instead of being admitted to hospital wards, where they should have been treated. it’s not unusual for some patients who are supposed to be on a hospital ward to spend their entire stay instead in the er, where they are not receiving the care that is optimal for their medical needs, a source told the gazette.
“yeah, it’s not an ideal place for any patient” to stay for prolonged periods in the er, explained the source, who spoke to the gazette on condition of anonymity because they were not authorized to give interviews to the news media.
“i think it’s an even worse place if you’re older and frailer and subject to delirium, or deconditioning, losing strength — it’s not resourced like a (hospital) floor would be.
“there are a variety of advantages to getting them out of the emergency department into a real bed,” the source explained. that is the case “particularly (for) older people who are at risk of losing strength from lying on a stretcher for four days, because you can get them up and moving almost right away in a controlled way (on a hospital ward), and particularly for people who are kind of prone to becoming confused or delirious in the hospital.”
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continued the source: “the beds down in the emerg, they’re not beds — they’re like cots, stretchers, hard and uncomfortable.”
the source contacted the gazette because it has been reporting a series of articles on the dangers of er overcrowding. in a four-part investigation published last winter, the gazette documented six er deaths at the lakeshore that clinical sources at the pointe-claire hospital insist were the result of systemic negligence amid overcrowding, a shortage of staff and lax oversight.
in contrast, the royal vic is affiliated with mcgill university’s medical school and its state-of-the-art er opened in april 2015. yet like nearly every hospital in quebec, the royal vic is beset by a severe shortage of medical staff — made worse during the pandemic — with the result that its er is chronically overcrowded.
beyond the eye-popping er occupancy rates of more than 200 per cent that are often reported by the news media, the clinical sources wanted to convey to the gazette the real medical risks involved for patients.
“bed sores, blood clots and pneumonia,” another clinical source said of the possible medical complications of remaining too long in an er. some of those complications are potentially fatal if not addressed in time, added the source, who does not work at the royal vic.
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compounding matters is the fact that the royal vic no longer has a geriatric ward. it used to before the hospital moved to the glen site in 2015 from university st. downtown.
“like a lot of hospital centres, we don’t have inpatient geriatric beds,” the royal vic source said. “when the move to the glen happened, we lost beds.”
officials at the muhc did not respond to a query about why the hospital network decided to discontinue its geriatrics unit at the royal vic.
what’s more, the royal vic closed a 12-bed unit, c10 south, in march because of a shortage of nurses. as a result, patients routinely end up staying in the er much longer than they should from a medical standpoint.
when the er overcrowding soars above 200 per cent, some patients who have been stabilized (and who don’t require oxygen) are sent to stay temporarily in conference rooms elsewhere in the hospital.
“there are only certain patients who can go in these rooms because there are no toilets in them,” the source noted. “so if they have to go to the bathroom, they have to walk into the hallway and go to the public toilet. there’s no real monitoring of patients in these (conference rooms).”
gilda salomone, a spokesperson for the muhc, confirmed the closing of c10 south.
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“we intend to reopen c10, provided we are able to hire sufficient staff,” salomone said in an email. “we are, as always, actively recruiting.
“in general, we have thankfully managed to keep as many beds open as possible,” she added. “finally, we encourage people with non-urgent health problems to consider other options before going to the emergency.”
when elderly er patients — for example, an 80-year-old woman who has fractured her leg — are transferred to an internal medicine ward, they benefit from a physiotherapist or an occupational therapist who is part of the medical team. the nurses on the ward turn the patients regularly on the beds to prevent painful sores on their buttocks, and they elevate their legs to reduce the risk of a blood clot. those are simple tasks that harried er nurses sometimes can’t find the time to do as they run from patient to patient in a packed emergency department.
unlike the er, some patients on hospital wards are given an inspirometer, a hand-held device that they breathe into to expand their lungs in order to avoid pneumonia. there are other pieces of medical equipment that are not available in the er, like an electric power lift to safely raise a patient from a bed.
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“there’s no doubt that the rate of adverse events (or medical complications) is higher in the emergency room,” the royal vic source said.
“the situation at the muhc is very difficult, and it’s getting worse.”
dr. eddy lang, a former montreal emergency room specialist who is now scientific director of the alberta health services emergency strategic clinical network, reviewed the royal vic’s er stats.
this is “very troubling data, but the numbers don’t tell the whole story,” lang said.
“there is a lot of suffering associated with these prolonged (emergency department) stays, often for frail, elderly patients who deteriorate in circumstances that lack dignity and contribute to deconditioning and bad outcomes. this is occurring as a result of the ed being treated as the overflow department of the hospital. we know that for every 82 patients waiting longer than six to eight hours for (a hospital bed) admission, there will be one additional death.”
“the royal vic compares poorly to other teaching hospitals as well as the rest of montreal,” lang added, noting its delays in transferring er patients to a regular hospital bed are nearly twice the national average.
on some days, it can take an average of more than seven hours for patients who have been triaged to be examined by an er doctor at the royal vic, according to the government’s own statistics. the least urgent er patient should be seen by a doctor within two hours of triage under national guidelines.
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“there’s a bunch of physicians who over the last five years … have said, ‘i’m not really interested in working in the emergency department anymore,’” the royal vic source recalled, quoting the comments by some doctors. “they say, ‘it’s too intense, it’s too challenging, i’m afraid of liability, i’m afraid of bad things happening to my patients despite my best efforts.’ it’s tough.”
the gazette sent the health ministry a series of questions about the royal vic. although a ministry spokesperson responded, health minister christian dubé took the time to reply as well, even though he was not directly queried.
“the situation at the royal victoria hospital is of concern,” antoine de la durantaye, dubé’s press attaché, said on his behalf. “the ministry is monitoring the situation closely with the people on the ground.
“we are seeing an increase in the number of patients coming into the emergency room lately,” he added. “there are also currently close to 2,000 beds on the floors that are closed in quebec hospitals due to a lack of staff, which creates capacity issues.
“we must therefore increase capacity in our emergency rooms through other measures in order to deal with these increases in traffic.”
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among those measures have been the deployment of a pediatric 811 info-santé phone line as well as two nurse practitioner clinics in montreal. dubé also set up a crisis cell to monitor er overcrowding across the province nearly six months ago.
still, despite all those measures, the er situation in april proved to be worse than during the corresponding period last year, as 1,400 fewer nurses in quebec (out of nearly 59,000, many of whom are burned out) treat older and sicker patients following the acute phase of the pandemic. in that context, the current er crisis in quebec is unprecedented: er occupancy rates have exceeded 200 per cent in the past, but this time around there are fewer nurses on hand and the medical conditions of patients are more complex than ever.
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