Quebec’s ED wait times the worst in Canada, report says

MONTREAL – An independent study concludes that Quebec has the longest emergency wait times in Canada, and among the longest in the industrialized world.

Robert Salois (pictured), Quebec’s health and welfare commissioner, says 35 percent of patients in Quebec – one in three – waited five hours or more for help in an emergency department while the average in the same category in the rest of Canada is 19 percent. In Ontario, 15 percent waited five hours or more.

The healthcare watchdog’s findings were released in a 106-page report earlier this month, and reported in the Montreal Gazette.

In Holland, the percentage who wait five hours or more in an ER is zero, the report said. In Switzerland it’s two percent. In no western European nation is the percentage higher than 11.

Montreal hospitals actually have among the best wait times in the province. The hospitals with the best scores are St. Mary’s where the wait time is 109.7 minutes and the Jewish General where the wait to see a doctor is 121.5 minutes.

But in his final report as commissioner – his post is being abolished as part of Liberal cost cuts – Salois says despite years of election promises, action plans and millions spent, the problem of endless waits in emergency rooms is not going away.

Poor hospital organization is part of the problem, but so is a lack of flexibility on the part of doctors. While 90 per cent of hospitals can easily add nursing staff to cope with overflows, 75 per cent are unable to adjust doctor schedules on short notice, the study concludes.

Health minister Gaétan Barrette is currently battling Quebec’s doctors to get them to work more hours and more weekends.

The situation is so bad, one patient in 10 who goes to an emergency room leaves having failed to have seen a doctor or being directed to another establishment.

Barrette downplayed the report, saying its conclusions are nothing new to him and he’s already acted on most of its recommendations. “The report does not say things are deteriorating,” Barrette said. “Things are actually improving in Quebec.”

The opposition, however, wasn’t buying his explanation, describing the fresh numbers as alarming, heaping the blame at Barrette’s feet. The minister has only his “arrogant contemptuous attitude” to blame for a lack of co-operation from doctors to fix the mess, Parti Québécois health critic Diane Lamarre said.

“It’s time to change the motto on our licence plates to say ‘J’attends’ (I’m waiting),” added Coalition Avenir Québec health critic François Paradis.

The average stay in a Quebec emergency room, including triage and time spent on a gurney, is about nine hours, which is double the international norm of four.

You are really out of luck if you need to see a medical specialist. In two thirds of Quebec hospitals (64 per cent) the average wait time to see one of them is four hours. The average provincial wait time for a specialist in a hospital is about eight hours.

Overall, of the 3.2 million visits Quebecers made to emergencies in 2015-2016, 1.5 million were beyond the health department’s stated norms. Nearly half of all waits, 45.5 per cent, exceeded maximum waiting norms set by the health department.

“We’re talking 13 million hours of over-waiting in emergencies,” Salois said adding all that thumbtwiddling comes at a cost to society.

Based on average salaries in Quebec, the lost hours are the equivalent of $300 million and that doesn’t include other costs to the system.

And visits deemed not really urgent, meaning they could be handled elsewhere, represent 60 per cent of visits.

Salois said it doesn’t have to be this way. “Long waits in emergencies are not an inevitability,” Salois said. “Most countries in the world don’t have a problem.”

He had an upside. Some hospitals in Quebec — with the same limited resources as others – have shown wait times can be curbed. In all, 20 have exemplary track records, the study says.

Their secret? For one thing they have made cutting wait times a priority, a part of the hospital’s operating culture. Some have adopted strict performance standards, which pay off in the long run.

Salois argues the good ones should be rewarded financially as “an incentive and inspiration,” for others to pull up their socks.

There are other solutions. Studies by the Commonwealth Fund show jurisdictions that created a report card system, which allows nurses and doctors to see how their efforts stand up compared to others, have improved results.

Quebec doctors, however, have traditionally resisted any form of performance evaluation, Salois said.

Ironically, Salois said, hospitals with the best wait times are nervous about seeing their success become public because it leads to a flood of new patients desperate to see a doctor.

It happened recently at the Jewish General, Salois said, where hundreds of people from outside the city came knocking after media reports on the hospital’s impressive wait times.

“There are plenty of good ones (emergencies),” he said. “It’s proof the solution exists here in Quebec.

“Instead of organizing care based on the restrictions or needs of professionals and services in the hospitals, the best emergencies have focused their care on the needs of patients.”