Quebec solution helps reduce pressure on emergency departments

Quebec’s Ministry of Health and Social Services has found a way to relieve the overcrowding of Emergency Departments (ED) and increase access to primary care. Using Petal Health’s Orchestration Platform, the ministry now has a province-wide, real-time view of primary care appointment availabilities that triage nurses in EDs can fill for non-urgent cases.

By redirecting less urgent patients to other sites, such as nearby walk-in clinics with availability, the EDs are able to focus on more urgent cases.

The ‘magic’ in the Orchestration Platform solution is that it can provide a view of the available time slots at various clinics, regardless of the scheduling platform used, so that patients can be scheduled for care at another location.

The solution, which went live in 2021, has resulted in 191,000 fewer ED visits and 118,000 more ED visits redirected based on a study by consultants from the Analysis Group that compared ministry data from 2018-2019 with data from 2022-2023.

The study found that savings attributable to the Orchestration Platform’s improved access to primary care totalled $73.8 million, said study author and Analysis Group vice-president Marie-Hélène Lafeuille.

Given the full hospital cost of $361 per ED visit and the large number of non-urgent cases that clog EDs – generally estimated to be anywhere between 30 and 50 percent of all visits – the potential savings attributable to the Orchestration Platform are considerable.

“When people aren’t able to find an appointment in primary care, they end up in the ED, so we equipped nurses in triage with access to the system,” said Petal Health CEO Patrice Gilbert. “When someone shows up in the ED and they’re not feeling well but it’s a non-urgent case, the triage nurse will offer them an available appointment at a nearby clinic or pharmacy.

The Orchestration Platform is connected to the scheduling systems in EMRs at more than 900 clinics across Quebec and results in the redirection of between 700 and 900 patients per day to primary care.

Prior to the introduction of the solution, redirections from hospital EDs were at a very low volume and based on one-off agreements between a particular hospital and a nearby clinic. “To do it at scale, you need access to a tech system with all the data,” said Gilbert.

The availabilities in primary care can be cancelled appointments or unfilled time slots a family doctor reserves for emergencies, so the Orchestration Platform fills holes and optimizes physician schedules.

A physician may reserve time slots between 1 to 3 pm for emergencies, but if it’s 11 a.m. and they’re unfilled, the physician can release them to the platform.

Triage nurses will attempt to book unrostered patients with the same doctor or clinic for repeat visits to ensure continuity of care but will book with another primary care provider if necessary.

Family doctors are paid more for appointments made through the platform based on an agreement negotiated with the ministry.

“Quebec is the first jurisdiction in Canada to have real-time data on available appointments in primary care province-wide,” said Gilbert. This allows the ministry to see the demand and supply for primary care appointments by municipality or region.

“Last year, minister of Health and Social Services Christian Dubé was in our office and was blown away when we showed him all the data,” said Gilbert.

By clicking on Montreal or Laval, for example, he was able to see the number of patients who couldn’t be redirected because of a shortage of supply. Armed with this information, the ministry knows where to invest in the healthcare system.

“For example, they can provide short-term incentives to encourage doctors to relocate to regions of insufficient supply,” said Gilbert.

A major cause of ED overcrowding stems from the shortage of primary care clinicians and the high number of patients without a family doctor or nurse practitioner. In Quebec, two million patients are unattached and largely responsible for the pressure on ED services.

The ministry also has an online Primary Care Access Point service that Quebecers without a family doctor or nurse practitioner can use to find an appointment.

They can either call 811 and speak with an agent to find a resource to help them with their health needs or fill out an online form that uses AI to direct them to a healthcare resource based on their symptoms.

For a simple, rash, for example, it may direct them to a pharmacy. If an appointment with a family doctor of nurse practitioner is necessary, the agent will use the Orchestration Platform to find an appointment.

The ministry sent letters to Quebecers registered on the waiting list for family doctors promoting the Primary Care Access Point service, or GAP, an acronym for its name in French – Guichet d’accès à la première ligne.

Another online ministry service called Rendez-vous Santé Québec, helps Quebecers make an appointment with their family doctor. If their doctor is booked up or otherwise unavailable, the system lets them book an appointment with another healthcare professional at their clinic or a healthcare professional practising at another clinic in the patient’s community.

The system is integrated with Petal Health and allows patients to browse the calendar, enter their reason for the consult and select an available date and time. The system directs them to their family doctor’s schedule based on their health insurance card number.

Asked about media reports of Montreal EDs at over 200 per cent capacity in early January this year, Gilbert explained that it’s an anomaly related to the Christmas and New Year’s holidays.
Doctors take time off like everyone else and people get sick, he said, so rostered patients can’t get appointments to see their family doctors and triage nurses in EDs can’t redirect non-urgent cases if there are no available time slots in the Orchestration Platform.

The study, which was sponsored and paid for by Petal Health but independently executed by the authors, identified several additional benefits of the solution, said Lafeuille.
With less congestion in EDs, patients requiring urgent care experience reduced wait times and there is less risk of infection.

Also, with easier access to primary care, patient health concerns can be addressed earlier, resulting in fewer hospitalizations and shorter hospital stays. In the ED itself, less congestion results in improved efficiency and higher levels of staff satisfaction.

For patients and the economy as a whole, there’s an impact on productivity if a patient can see a family doctor or nurse practitioner in a few hours instead of waiting 18 hours in the ED and taking a whole day off work, said Lafeuille.

With the value of the Orchestration Platform confirmed by Lafeuille’s study, Petal Health hopes to bring the solution to the rest of the country and has already had discussions with B.C., New Brunswick, Nova Scotia, Ontario and Alberta.