ER doc suggests more effective solution for Quebec

MONTREAL – After working in Emergency Departments in both Montreal and Calgary, Dr. Eddy Lang (pictured) believes that techniques used to dramatically reduce wait times in Calgary’s ERs could be used with success in Quebec.

“The working conditions for doctors and nurses are so bad in Quebec that you become desensitized,” the veteran emergency-room physician told the Montreal Gazette. “You don’t know how bad it is until you step away.”

And that’s precisely what Lang did when he quit the Jewish General Hospital in June 2010 after 16 years to work in Calgary’s four ERs while carrying out research and teaching emergency medicine. Lang said he didn’t leave Montreal out of frustration, but for career opportunities, and in the past six years he has led revolutionary changes in the way Calgary manages its ER overcrowding, changes he suggests Montreal would be wise to implement.

Back in 2010, both Calgary’s and Montreal’s hospitals were beset by the same grim situation: emergency patients sitting or lying on stretchers for hours in the corridors of the ERs. Today, Montreal’s ER corridors are still lined with stretchers while Calgary’s are virtually empty.

In the last six years, tens of millions of dollars have been spent on new or renovated emergency rooms at the Jewish General, Hôtel Dieu, Ste. Justine, Montreal Children’s and the Royal Victoria hospitals. And after six years, Hôtel Dieu’s ER is slated to close when the CHUM superhospital opens in 2017.

Yet Montreal’s ERs are as overcrowded as ever, with some hospitals reporting occupancy rates as high as 200 per cent. (In early December, for example, the Lakeshore General Hospital’s ER occupancy rate jumped to 177 per cent, according to the latest figures by the Montreal Public Health Department. Of that number, 20 patients had been stuck in its corridors for at least 24 hours waiting for hospital beds to free up in wards on other floors.)

Meanwhile, the Montreal Children’s and Royal Victoria’s ERs are turning away patients for lack of resources.

Calgary, by comparison, did not go on an ER construction blitz. Instead, it took the simple decision not to let ER patients languish on stretchers anymore. On Dec. 20, 2010, Alberta launched what it calls its “over-capacity protocols” – an idea borrowed from a Long Island ER physician who invented the idea in 2001.

Once the emergency department reaches over-capacity by 10 percent, most stable ER patients receiving care in corridors are transferred to wards on other floors, whether or not those wards actually have any free beds. The ER patients might stay in a corridor in a ward for a few hours, but eventually the nurses and doctors free up a bed by discharging another inpatient early.

In contrast, Montreal hospitals have it backward, Lang suggested. The city’s hospitals would rather keep patients in the ER corridors for up to two days than put pressure on wards to release some inpatients early.

“Things changed dramatically when we implemented the protocols,” Lang said, noting that the average length of hospital stay dropped by 10 percent. More impressive, the average length of stay in the ER for admitted patients plummeted to 11.6 hours from 17.2 hours.

“Once a patient gets upstairs, amazingly the ward figures out a way to send someone home earlier,” he added, citing as an example a patient waiting for an MRI scan while taking up a hospital bed, only to be discharged sooner to have the MRI rescheduled as an outpatient.

“It’s a question of fairness in distributing the problem across the whole hospital, rather than concentrating it in the ER,” he explained.

The son of Holocaust survivors, the 51-year-old McGill-trained physician says he feels for his former colleagues in Montreal, some of whom have to work solo overnight shifts in ERs packed with as many as 50 patients.

In Calgary, no hospital allows ER physicians to work alone during the overnight shift. The physicians work in teams of two instead. “I can’t imagine doing that,” he said. “There’s the risk of making errors. And there’s the risk of burnout for the health providers.”