Quebec ERs 'on the verge of a breakdown' and need help, emergency doctor says

A growing number of emergency rooms in Quebec are struggling to care for patients as hospitals deal with severe staffing shortages caused by nurses fed up with pandemic working conditions.

Across the province, several ERs have been forced to curtail their opening hours, doctors are warning about the potential for medical errors and patients are facing longer wait times.

Doctors working fortheCIUSSS de l'Est-de-l'le-de-Montral saybeleaguered hospital ERs in Montreal's east end are on the brink of collapse. Theywarned of a possible closure of services in an open letter addressed to the Ministry of Health on Monday.

"We see the situation is getting worse and worse over time, and we're on the verge of a breakdown," said Dr. Bernard Mathieu, an emergency physician at Maisonneuve-Rosemont Hospital, who penned the letter.

The signatories blame deteriorating work conditions exacerbated by the pandemic such as "stratospheric amounts"offorced overtime, competition from private nursing agencies that offer better pay and hours, and insufficient salaries for the lack of staff.

"This is something that makes people very angry, very tired and what happens then is that you quit. You can't go on like this all summer long," Mathieu said.

A provincewide problem

The precarious situation at Maisonneuve-Rosemont Hospital, where Mathieu says half the nursing and three-quarters of the respiratory therapistpositions are vacant, is just a drop in the bucket compared to the rest of theprovince.

WATCH | ERs in Quebec pushed to limit amid nursing shortage:

Nursing shortages push Quebec ERs to breaking point

3 years ago

Duration 3:09

A group of Quebec doctors is sounding the alarm about a nursing shortage in the province that has stretched some emergency rooms to the breaking point. Some have temporarily closed and others are operating at more than 200 per cent capacity.

As of Tuesday, the average occupancy rate in emergency rooms across Quebec was106per cent, with several in the Montrgieregion onthe South Shore of Montreal nearing ortopping 200 per cent. Alarm bellshave been going off in the form ofclosures, curtailed hours and capacity noticesfor several weeks.

In June,Baie-Saint-Paul Hospital's emergency room in the Charlevoix region near Quebec City announced it was scalingback hours due to a lack of nurses. Hospital staff had to juggle shifts and push back vacations to keep the department open at all.

A few days later,Gatineau Hospital's emergency room closed entirely for several days intheOutaouais region amid anursing shortage something a grieving family blames for how theirloved one was treated two days before she diedin hospital.

Within the past two weeks,Quebecershave beenasked to avoid emergency rooms at Maisonneuve-Rosemont and Santa Cabrini Hospital in eastern Montreal, while theCIUSSS de l'Estrie-CHUS asked the population to "choose wisely" where they received care, due to capacitylimits atthe Granby Hospital and the Brome-Missisquoi-Perkins Hospital.

TheCISSS des Laurentidesalso asked people withnon-urgent health problems "to opt for other solutions"than going to emergency due tohigh occupancy rates, particularly at the Saint-Eustache Hospital.

On Monday, theCoaticook emergency room in the Eastern Townshipssaid it will only be open during the day from July 14 to August 16 due to a lack of personnel.

Staffing issues, high demand

Dr. Richard Fleet says there are multiple contributing factors to currentovercrowdingin emergency rooms, includingpeopleseeking care after avoiding hospitals during the height of the pandemic andsurgical activities back to running at pre-pandemic rates.

This increased demand without adequate staffing levels creates"a perfect storm" for risk ofmedical errors, according tothe emergency room physician and research chair in emergency medicine at Laval University.

For Dr. Judy Morris, president of the Association des mdecins d'urgence du Qubec,the influx of patients hasn't changed much."It's really the capacity of the system that has changed."

That puts "immense pressure" on the staff that are left, she says.

"They have to work overtime. They're tired or discouraged. They're thinking to themselves of leaving, rightfully so, because they have such hard work conditions."

Mathieu from Maisonneuve-Rosemont says departures of nurses have outpaced arrivals at the hospital since the onset of the pandemic, in part due to exhausting working conditions, which createsa vicious cycle for other nurses who need to pick up the slack.

"We're over 100 per cent occupation and we have less than 50 per cent staff available. There's no match there," he said.

The elastic can only stretch so far.Emergency rooms are losing nurses to retirement, to private agenciesand even to stress throughout the pandemic, which has left many on sick leave, according to Morris.

Need for concrete solutions

The doctors at Maisonneuve-Rosemont are urging Health Minister Christian Dubto reduce the use of private nursing agencies byimmediate governmentdecree, allowing these workers tofill positions at tough-to-fill hours only, among other requests regarding working conditions and recruitment and retention of staff.

Morris says serious incentives, such as a pay increase, the promise of flexible schedulingand no forced overtimeare required to get adequate personnel back into hospitals. "Make it really interesting to come and work in the hospitals in those acute care settings."

Fleet, who is also the research director for a leadership and innovation program called Living Lab Charlevoix, which seeks to implement solutions for improving rural emergency care, says his team of medical students hascome up with some citizen-based solutions.

These include bringing in retired nurses to mentor senior students, creating a program to assess the quality of life at work, and a pilot projectbringing together nursing students and residents of seniors' homes.

Dub, for his part, acknowledged that "time is running out" for several hospitals in the provinceand vowed towork on these "various short-term issues"during the summer in order to ensurea "much more favourable fall in [the] health network."

Morris highlighted that in order toavoid a wave of emergency room closures, a lag on surgeries and quite possibly a return to cutting non-essential activities, Quebec must take immediate action.

"We've lost too many members of our teams," said Morris. "We're in real trouble right now."