Emergency Departments in Crisis — Dr. Elyse Berger Pelletier and David Gagnon

Alya Niang
Emergency rooms across Canada are under extreme pressure.
According to the most recent data, there are over 15 million emergency room visits per year, with longer wait times for those needing a bed, resulting in overcrowding.
Studies show that longer wait times lead to poorer results, with a higher risk of death. In today’s episode, we’ll take a closer look at this national emergency care crisis with 2 people on the front line. First, we’ll talk to David Gagnon, a paramedic.

David Gagnon
What really jumps out is the crowded waiting rooms. We’re seeing a lot of people waiting for care. We’re also seeing a lot of people on stretchers, waiting several hours to get care.

Alya Niang
Then, we’ll talk to Dr. Élise Pelletier from the Capitale-Nationale region about what she’s seeing on the front line, and the solutions needed to ensure that Canadians receive timely care.

Élise Pelletier
Between starting my practice in 2011 and now, I’ve seen a drastic increase in patient traffic, acuity, the extent to which patients are coming in increasingly sick and with several pathologies, and the extent to which seniors are increasingly frequenting emergency rooms in Canada.

Alya Niang
Hello, and welcome to the Canadian Health Information Podcast. We call it the CHIP for short. I’m your host, Alya Niang. Please bear in mind that the opinions and comments of our guests do not necessarily reflect those of CIHI, but this is a free and open discussion. This episode is about emergency care, the last line of defence when we’re injured or seriously ill, a safety net that some think is eroding.
Joining us today is David Gagnon, paramedic and Vice-President of the Fraternité des travailleurs et travailleuses du préhospitalier du Québec (FTPQ). Hello, Mr. Gagnon. Welcome to the podcast.

David Gagnon
Hello. Thank you very much.

Alya Niang
So, you’ve been a paramedic on Montréal’s South Shore for 15 years?

David Gagnon
Yes, I started 15 years ago. Christmas marked 15 years.

Alya Niang
So, I imagine you’ve seen it all. Today, we’re talking about emergency care in Canada. Mr. Gagnon, how many times a week do you find yourself in hospital emergency rooms with patients?

David Gagnon
The number of patients can depend on where you work, especially the operating sector you’re called upon to work in. I work in the suburbs of Montréal. And in the operating sector in which I work, there aren’t any hospitals. So we always have to leave our sector to go to a hospital. Roughly speaking, a call will take us about 2 hours on average, from the moment we receive the call to the time we finish and are free to leave the hospital.
At that point, when you’re working roughly 12-hour days, you can expect between 4 and 6 calls per shift.

Alya Niang
So, you have a good overview of what’s happening at this entry point into the health care system?

David Gagnon
Yes, I’d say we have a fairly unique perspective on this entry point into the health care system, which is the emergency room. We certainly spend a lot of time there, interacting with almost everyone who works in the emergency room, from the receptionist to the people in charge of security and to the people in charge of maintenance. Of course, we talk to the doctors, too. The people we interact with the most are often the nurses and orderlies, who give us a hand. So, we’re fortunate to have a rather unique perspective of emergency rooms, both from the outside and the inside.

Alya Niang
And how would you describe the changes you’ve seen at this entry point over the 15 years you’ve been a paramedic?

David Gagnon
There have been many changes in 15 years, but the process by which we transfer responsibility for our patients to the emergency room staff has stayed more or less the same. What we’ve noticed, though, is that the timeframes are much longer now. So, from the moment we get to the hospital, to the emergency room, to when we transfer responsibility for our patient to the hospital, that’s changed the most. That timeframe has gotten much longer.

Alya Niang
Can you tell us a bit more about that? We all know what’s going on in emergency rooms these days. They’re in crisis. You bring in a patient on a stretcher and go through the sliding doors. What do you see more of now when you go in?

David Gagnon
What really jumps out is the crowded waiting rooms. We’re seeing a lot of people waiting for care. We’re also seeing a lot of people on stretchers, waiting several hours to get care. Unfortunately, these patients aren’t necessarily there by choice. They either don’t know about any other way into the system, or those entry points aren’t available to them for all sorts of reasons. What stands out, more than the process itself, which has changed very little, is how patients are treated. There’s a sense that patients don’t really know where to go anymore. And the only option left is the emergency room.

Alya Niang
Have you ever seen patients in unusual places in emergency rooms? I think they’re called “unconventional spaces.”

David Gagnon
On occasion, and we sometimes see spaces that have been converted to receive patients. Yes, we see patients who don’t know where to sit when they’ve been waiting for hours and hours. Sometimes, patients sit near electrical outlets. That’s fairly common. The outlets aren’t always next to a chair, so they’ll sit in the hallway.
We reported on a situation that shocked us in a hospital on the South Shore, where people often died because they were left in unsuitable spaces. In that hospital, as we went through the ambulance entrance with our patients, we literally came across stretchers on which people had, unfortunately, died. That was the most difficult thing to experience.

Alya Niang
I can imagine. I went to the emergency room, and I had to wait hours. During that time, I saw patients in beds in the hallway because, I imagine, there weren’t rooms available yet.

David Gagnon
I wish I could say that it was unconventional, but I can tell you that in the health care system, unfortunately, unconventionality can quickly become the norm. So, yes, when it comes to stretchers in hallways, what was meant to be a temporary measure has become a permanent one. We even install curtains to give them a little privacy. But these aren’t suitable spaces. That’s for sure. Many emergency rooms in Quebec are dilapidated. When there are renovations, when emergency rooms are refurbished and when new emergency rooms open, these are usually things that the people in charge of the projects have thought about. We’re seeing it less often, but it still happens.

Alya Niang
Can you tell us about the staff? We hear that all the doctors, front-line workers and nurses are working very hard. What are you seeing?

David Gagnon
We consider them our co-workers, and they’re often worn out, working extremely long hours, sometimes 16 hours in a row rather than the standard 8. We’re seeing people who are at the end of their rope, but who are still welcoming, still dedicated to the important work they have to do.
Without the emergency room staff, I think the system would collapse because they’re really the safety net. In the emergency room, you can’t turn people away. You don’t want to tell anyone you can’t treat them. You can’t close down the emergency room, like they do for hospital floors and beds. In an ideal world, we wouldn’t close emergency rooms. Unfortunately, in Quebec, we sometimes close them, but these are people who are truly devoted to their patients, to the care they give, and have an exemplary sense of professionalism.

Alya Niang
That’s reassuring to hear. So, I’d like to know what should happen. How should it work in an ideal world so that you can do your best work and manage emergencies efficiently?

David Gagnon
This goes back to what I said earlier. In an ideal world, I think we would use paramedics’ expertise more effectively, in a much broader way. This is something that the FTPQ is fighting for. Among other things, we’re advocating for broadening the spectrum of what we can do in the health care system. Unfortunately, what we often realize is that we’re up against a kind of private system.
What people rarely realize is that in Quebec, outside of Montréal and Laval, where the public corporation Urgences-santé manages ambulance services, everywhere else in the province, private companies provide this service. These companies are very lucrative because, in essence, they have a monopoly in the area in which they operate. No other ambulance companies are allowed in a given area. In addition, 100% of their funding is public. Clearly, this is a model that all too often leads to a dead end for us. There is major health care reform on the horizon.
Once again, prehospital emergency care has remained virtually untouched, despite the fact that we’re a front-line resource. We’re a front-line resource that could be doing more and isn’t at the moment, because we’re with... My employer is a private company, and private companies, in every area in which they operate, are a bit siloed from the rest of the health care system.
We think better integrating prehospital emergency services through nationalization — we’re not shy about saying this — really is the solution to make the whole prehospital emergency care system much more efficient, integrating us into the public system. That would enable us, as I said, to expand our scope. It would give us access to what we call advanced care, for example, to paramedics who are specialized, who have even more skills and can take even better care of the patients who need it.
We’re also continuing to push for community paramedicine, which we believe is something that should play a major role and could really help relieve overcrowding in Quebec’s emergency rooms.

Alya Niang
Thank you very much, Mr. Gagnon, for your observations and for helping people understand the point of view of front-line paramedics. Thanks again.

David Gagnon
Thank you. It was a pleasure.

Alya Niang
Now, for a glimpse of what it’s like to work in these overwhelmed emergency rooms, Dr. Élise Pelletier, emergency physician and Director of Professional Services at the Centre intégré universitaire de santé et de services sociaux de la capitale nationale, joins us from the Capitale-Nationale region. Hello, Dr. Pelletier. Welcome to the podcast.

Élise Pelletier
Hello. It’s an honour to be with you today.

Alya Niang
Thank you. Dr. Pelletier, how many years you been an emergency physician? And if you had to choose one word to describe the situation today compared to a few years ago, what would it be?

Élise Pelletier
I’ve been practising emergency medicine for 12 years, and if I were to try to sum it up in one word, unfortunately, it would be “deterioration.” Between starting my practice in 2011 and now, I’ve seen a drastic increase in patient traffic, acuity, the extent to which patients are coming in increasingly sick and with several pathologies, and the extent to which seniors are increasingly frequenting emergency rooms in Canada. In terms of the day-to-day life of an emergency physician or emergency care provider, we thought we were bogged down in 2011, but it was nothing compared to early 2020.

Alya Niang
Why are patients having to wait so long? We’ve heard from paramedics about people waiting 48 hours or longer for a bed and awful problems that are ongoing. Why?

Élise Pelletier
There are several reasons. When I explain it, I try to create a bit of a dichotomy. There are 2 types of patients in every emergency room in Canada. There are the walk-in patients, i.e. those who are trying to gain access or have an issue they feel is urgent. They come in, go to triage, and they’re directed to the waiting room. We call them ambulatory patients, versus the ones you mentioned with the paramedic, patients who come in with more acute problems, who arrive by ambulance and are put on stretchers.
These 2 types of patients, the overcrowding of emergency rooms, the reasons why it’s difficult for these 2 types of patients, the wait times are very different. For those in the waiting room, i.e., ambulatory patients, it can sometimes seem like a very long wait. But often, it’s because the doctor is busy treating people on stretchers. And in certain hospitals in Canada, there are so many patients waiting for hospital beds, the so-called “cubicles,” spaces where patients are examined in the waiting rooms are filled with people lying down, versus patients on stretchers who have to wait for a hospital bed. The current problem in Canada is access to hospital beds, the capacity of hospitals to admit these patients, who have pneumonia, appendicitis and similar issues that can’t be treated anywhere but in a hospital.
That’s why there are so few hospital beds in Canada right now, and why everything flows back to the emergency room. And that creates a vicious circle, because at that point, there’s a real bottleneck. And that’s why people are waiting longer and longer in Canada, year after year.

Alya Niang
I personally experienced it, about 4 months ago. I spent over 10 hours in the emergency room with my husband and my three-and-a-half-year-old daughter. When I got there, I was initially treated fairly quickly, as I had chest pains. But frankly, after that, to see a doctor, I really didn’t expect to wait 10 hours for that. The wait was just painful.

Élise Pelletier
That’s unfortunate, but it’s also helpful. We need people like you to explain what they’ve been through, so we can say to ourselves: “That makes no sense. What can we do about it?” Should we provide access to wait times, for example? Just knowing that I’ll have to wait 5 more hours would be reassuring. Not that it’s fun to wait 5 hours, but not knowing can cause a lot of anxiety. In other words, I don’t like being in the dark, and all of us are like that.
It takes people like you, who have a seat at the table, decision-makers and care providers, to say: “This really doesn’t make sense. How can we change it?” And if we put ourselves in patients’ shoes, we’d say: “Anyone would want to know. No one wants to wait for an hour.” Or: “Your tests all came back normal. Would you like to go home?” There are many ways to redesign the system and the ways in which we deliver care so that it’s better quality. And it takes users like you to tell us about these unreal situations for us to commit to trying to improve things. We’ll never get it 100% right. There’s the whole risk management aspect that I didn’t get into, but which is also very important. But having said that, it will take partnerships with users. It’s about saying: “I’ve experienced it, and it was really unpleasant. Can we change how things are done?”

Alya Niang
We wouldn’t argue with that. In fact, when you ask how much longer it will be and you’re told there are 2 or 3 people ahead of you, those people seem to take forever. They take hours and hours. At some point, you understand how people can lose their patience. But you need to try and stay calm and respect the staff. That’s very important, too. So I can imagine that there’s a lot of tension for everyone, the patients and the staff.

Élise Pelletier
When people come to the emergency room, they’re vulnerable. I don’t know anyone who goes to the emergency room on a whim. People think they have something serious. I’m glad you mentioned it because there are some good studies on that too. There really has been an increase in violence in emergency rooms. People are stressed, in need, waiting a long time, and then unfortunately, there’s verbal and physical violence with the staff, with the doctors, which doesn’t make any sense because we’re... I understand that we’re suffering the consequences of all this. But we’re here to help. It always hurts me when I hear about it, and it’s become a daily occurrence. But we know it’s really a symptom. People aren’t violent because they want to be. They’re violent because they’re waiting, they’re worried, they’re afraid, etc. How can we work on it upstream?
It doesn’t excuse the fact that we shouldn’t... I mean, it doesn’t excuse violent behaviour. We shouldn’t do that. But it’s also important to understand the root cause of it, to try and understand what happened. That’s more or less what it’s about. You’re right.

Alya Niang
Indeed. And what are the risks in such a situation?

Élise Pelletier
That’s what’s so fascinating, when you think about it. Because the emergency room is the most dangerous place in a hospital. You never know what might happen. There could be an accident involving a bus full of young children. There could be 2, 4, 8 or 10 ambulances with patients who had strokes or heart attacks. It’s the most critical part of a hospital, where there are more unknowns. But unfortunately, it’s also where the overcapacity is absorbed. In other words, if there aren’t any beds on the hospital floors, patients will stay in the emergency room. A lot of people don’t have access to a family doctor or other care, so they go to the emergency room.
The consequence is... As we can see from scientific studies, there’s been an increase in accidents and incidents with patients. This is also true for the elderly and debilitated population. The more hours spent on a stretcher in the emergency room, the higher the mortality rate. So, it’s not harmless: elderly patients who stay on a stretcher for more than 6 to 8 hours, as we know from studies out of the UK, are at an increased risk of mortality. So, it’s a big deal. We know that every day in Canada, people are likely to die from having been on a stretcher in the emergency room for too long.

Alya Niang
Dr. Pelletier, we’ve seen provincial health officials in Quebec and other provinces write letters warning patients to avoid emergency rooms. What was your reaction to this?

Élise Pelletier
Again, this is a climate where we have the impression that volume is increasing, and we can see that in the statistics. I was looking at statistics from the Institut de la statistique showing that visits in Quebec increased by one million in 2021–2022 and 2022–2023. One million is a lot. Given this high volume, when care providers say that many people are coming to the emergency room for no reason, that’s their perception. A patient who comes in, a human being who thinks there’s something going on, doesn’t think they’re coming in for no reason. They think they need to be there. It was maybe a tactless move, if I may say so, to try and tell the public to “try to see if there are other options.”
It’s also the government’s responsibility to develop what we call literacy. In other words, as a human being who needs medical advice, are my symptoms serious? Do I need to see a doctor first? Maybe not. Can I go somewhere else? How can I educate myself as a citizen? That aspect hasn’t been very well developed in any Canadian province yet. This is really the key to preventing overconsumption in health care.

Alya Niang
Of course, emergency room congestion is a multi-factor phenomenon. But is the shortage of family doctors one of the causes? Because, sometimes, you can find yourself in a tricky situation. You wonder if you’d really need to go to the emergency room if you had a family doctor who could see you fairly quickly.

Élise Pelletier
In fact, as I’ve always said, emergency room overcrowding is a symptom of the Canadian health care system. If they’re overcrowded, it feels like we’re no longer responding well to the public in emergency rooms. There are a lot of factors leading to things not working. I mentioned hospital capacity. Canada is the country with the lowest rate of beds per 100,000 people. So, in today’s highly hospital-centric system, that’s certainly a challenge. Then there’s the shortage of family doctors. The role of family doctors also needs to be redefined. In my new role, I work alongside family doctors who work really hard, but who, in the last 5 years, have had double the number of forms to fill out. Their added value really isn’t being optimized. You’re absolutely right. It’s a factor. And if you turn to Google when you have a headache, you get a diagnosis of meningitis or brain cancer. Information available to patients on the internet and social media is, unfortunately, low-quality and anxiety-provoking. That leads people to seek out care as well.
As a mother, if my child has a fever, and I write about it, people will immediately tell me my child is dying of I don’t know what. So I head to the emergency room. I’m a good mother. As you can see, it’s really... And we have a very specific demographic in Quebec, more so than elsewhere in Canada. The rate of people aged 75 and over is alarming. We know that for this group, 90% of health care is used in the last year of life. The older you are, the more care you need. But things aren’t working. As you can see, it’s highly complex.
You have to think of the emergency room as a symptom of the system, then look at all the parts of the system and try to find solutions in each of those parts, because they all add up to a whole. But it’s very complex. You’re right, access to a front-line doctor is one of the issues behind why emergency rooms are congested. It’s absolutely true.

Alya Niang
My family doctor retired. So now I’m an “orphan patient,” as they say. And I know there were times when if I needed to see my family doctor, I might call that day, or I could go in that day, or maybe the next day or the day after. But now, I’ve realized that if I need to see a doctor, it takes me like a week to get an appointment. And sometimes, if I ask myself whether I can wait a week, the answer is no, I’d rather go to the emergency room. So that does pose a problem.

Élise Pelletier
All of our consumer habits have changed. The pandemic was huge reason for that. We might have been a little more patient before. We would think, well, one week isn’t a big deal. But now, when we decide we need something, whether it’s food, goods or services — health care is a service — we need it right away. And that’s okay. Sometimes, when I have discussions with people who manage emergency rooms, they say to me: “Élise, you have to stop comparing this to any other good or service.” I say: “Yes and no.” I mean, we have to stop thinking that citizens are in the wrong and should act differently. It’s a habit people have developed. I’m like that too. I’m just like you. When I need to see my family doctor, sure, I could have thought of it last week...

Alya Niang
Right.

Élise Pelletier
... but today is the day I want to see her. Is she available? No. What do I do? But that’s how it is for everyone. And yes, if you break your arm, well, it goes without saying. You go to the emergency room. We know that’s what we’re here for. But when it comes to the semi-acute things, unfortunately, we don’t have much in the way of services. Again, as care providers, we have to look in the mirror, within the system, and ask ourselves what we can do to provide access. A large portion of our emergency room patients are also followed by specialists, such as cardiologists and gastroenterologists.
One day, they might have a complication with their chronic illness, and they try to call their cardiologist, for example. And they’re told they can’t be seen and to go to the emergency room. That’s the advice every good receptionist in the system will give. If there’s a problem, go to the emergency room. But as a society, we can no longer manage our system like that. It won’t work, unfortunately. The bottleneck is getting even worse, and the emergency room is currently the only way in.

Alya Niang
Exactly. Dr. Pelletier, some emergency rooms are closing, many for hours or days at a time, especially in rural areas. And in some cases, the closures have been permanent. Given that emergency rooms are the last line of defence for patients, more than 6 million of whom don’t have family doctors, I think this raises the question of medical errors. And there have also been reports of patients in Quebec dying after waiting for care in overflowing emergency rooms. In addition, as Dr. Worrall from Ottawa said, between 8,000 and 15,000 patients die due to overcrowded emergency rooms. Is this a scare tactic?

Élise Pelletier
That’s a good question. I think many of my fellow emergency physicians are, in fact, trying to find a way to raise awareness among decision-makers. Is it a scare tactic? Yes and no. It’s been scientifically proven. I mentioned the long wait times and similar issues. On the other hand, I don’t like using these techniques, quite frankly. I’m more focused on solutions, such as looking at what we can do to make things work. How can we prevent these kinds of catastrophic events? But having said that, I’m very aware of the issue. And yes, it’s been in the news this summer, all the rural emergency room closures. It’s a very complex issue, because I was talking about emergency room congestion, which is much more of an urban phenomenon in high-volume emergency rooms.
Rural emergency rooms are completely different. Some rural emergency rooms can be crowded, but often, as you say, they’re the last bastion in an area that provides population-based access to a number of small communities. When they announce the closure of a rural emergency room, all those patients have to go somewhere else. But now they have to go somewhere that’s surely already congested, so, unfortunately, we’re creating another problem for ourselves. It’s really complex. Rural emergency medicine is its own specialty, and we really need to think about that. Quebec is a little different from the rest of Canada. We still have a large number of rural emergency rooms that work relatively well. They’re not at risk of closing. It happens from time to time, but there’s been a strong desire on the part of the government so far not to close emergency rooms all over Quebec. We’re lucky in that sense. But it’s also important to understand the situation.
If we do close an emergency room, how do we provide access to the public? And for serious and acute problems, such as a broken leg, a car accident or a heart attack, how do we ensure that someone who now lives an hour and 20 minutes from the nearest emergency room has the same services as someone who lives close by? That’s often what’s lacking: thinking it through. Thinking about the consequences, and then organizing our care in rural areas so that everyone has the same basic access. I think that’s what’s a bit distressing.
So yes, I agree that it’s frightening when you hear the statistics you mentioned, when you hear about real-life experiences and patients who die due to long wait times. That’s where medical errors come in. They’re system errors, in fact. They can easily happen. As an emergency physician, I dread the thought of having someone in my waiting room who might suffer the consequences of waiting too long because they presented atypically or something like that. But you need to understand that no one ever wants that. Everyone wants what’s best for the population they serve. But, of course, it’s dangerous when emergency rooms are closed or at full capacity. That’s when mistakes are made. We’re all aware of it, and we don’t want that to happen. That’s why we have to work upstream. You mentioned family doctors. We need to work downstream, which involves home care, home hospitalization and hospital capacity. After that, fluidity in emergency rooms will improve on its own.

Alya Niang
What do you see happening to nurses and other emergency room staff? Because there’s definitely a lot of tension. What do you see happening to them?

Élise Pelletier
There’s a lot of exhaustion on all sides. While my field is emergency medicine, I can see it with my colleagues in specialized medicine and my friends who are surgeons and family doctors. The pandemic exacerbated all of the system’s woes, and now we’ve reached a point where people are exhausted. And a generational shift is underway, which means that the sectors we call 24-7, i.e. operating rooms, intensive care, hospitalization, emergency rooms, aren’t as glamorous as they used to be. People still enjoy working in critical care, but not at the risk of their lives and their quality of life.
It’s become very demanding in terms of family life and, like I said, quality of life. As a result, there are increasingly fewer workers in these sectors, and the level of exhaustion is very high. We just talked about medical errors. People are afraid that mistakes will be made, that they’ll provide poor care because, basically, everyone gets into the health care system, whether they’re social workers, nurses, orderlies or doctors, because they want to help people. Then they feel that they’re not helping them properly, and it becomes burdensome. They have to take even more on their shoulders, and that becomes difficult to live with on a daily basis. It’s really not an easy situation.
I think that in my role as an emergency physician, and in emergency medicine, something is really changing in terms of teamwork. We’re trying to share responsibilities. When we’re short-staffed, I’ll go and help a nurse change a patient because there’s no orderly, or I’ll direct elderly patients to the radiology room because there’s no one there. We’re sharing all of those tasks. It’s still a wonderful practice. We’re still saving lives and caring for the sick. It’s a great job, but despite that, we shouldn’t put blinders on and insist that everything’s fine. That’s where we need to strike a balance. And that’s where, as I was saying, the generational shift comes in. The younger nurses and staff don’t want to learn the ropes. They don’t want to have a poor quality of life for 15 years, telling themselves that one day, it’s going to be their turn. They’re entering the job market wanting similar conditions to colleagues who’ve been there for 15 to 20 years, and that’s very challenging. It’s very challenging for the teams in terms of how we manage all this. I don’t have the solution. Again, there’s no magic formula, because otherwise, I assume someone would have already used it. But it’s about becoming aware, then verbalizing it. I think that’s the first step in healing. We do the same thing with patients. We tell them to accept the illness, then say we’ll treat it. That’s how it is in the system too. It’s about making observations. And after that, it’s about being non-judgmental, then accepting the situation and asking ourselves what we can do to improve it.
It’s hard to see co-workers crying at the end of their shift or, as I was saying, that everyone’s kind of on their last legs, that the demand is constantly increasing and we’re at full capacity. That’s a bit frightening.

Alya Niang
Your last comment touches on my next question. What has been the damage to staff and their loyalty?

Élise Pelletier
It’s taken a major toll but, again, we’re working hard on improving things. It’s not that managers aren’t trying. I’m a manager now, and it’s not that we aren’t trying. It’s that we have to completely rethink the situation. It’s like making a 90-degree turn in how we manage our staff, how we manage our services, how we use technology and how we innovate. But clearly, it’s had an impact. In my 12 years of practising in the emergency room, and it’s like this for all the emergency physicians I know in Canada, we used to be a relatively stable team. We knew each other, whether it was in the evening, at night or in the morning. And we pretty much always saw the same people. But now, more and more, we’re seeing people quit or try emergency nursing for a year and a half, for example, and move on to another department because it’s too much for them, they don’t want to work overtime, etc. It’s had quite an impact.
I know there’s a lot of work being done on prevention, on creating a healthy workplace and preventing harassment. A lot has changed for the better, but it’s still something we see from time to time. I heard from colleagues in other areas that in some cases, the most senior staff members have 2 years of seniority. That doesn’t make any sense. Staff used to have 8 to 10 years of experience before they came to the emergency room, but now it’s not like that at all. So, yes, it’s had an impact on team management. However, I think people have good intentions and are trying to improve things. I think we need a fairly profound cultural change in our system if we’re going to build loyalty. We’ve talked about nurses, but it applies to all of our professionals, including doctors. We really need to look at things differently.

Alya Niang
What can be fixed quickly? If you had to make a short list of 3 concrete things to improve the workflow in emergency rooms, what would they be?

Élise Pelletier
Significantly increasing everything that helps elderly patients stay home, which means having mobile family doctors, or any doctors. It doesn’t have to be family doctors. Having doctors who go to their homes, having home hospitalization, having all that type of coverage for, as I was saying, seniors who are slightly debilitated due their acute health problems, but who don’t need the technical equipment a hospital would provide. We really need to develop this. In concrete terms, this would immediately reduce the burden on our number of hospital beds, which means we could operate on more patients and do more elective procedures. For me, it’s a priority to restructure our health care system, not in the hospital, but in the community. For me, working in the community is a very concrete measure, and it will lead to fewer people going to the emergency room, and if they need hospitalization, it can be done at home. That’s the first thing for me.
The second thing is listening to the people who want access to care and looking at how we can provide it to them. In Quebec, there are more and more doors to knock on to gain access. There are a lot of phone numbers, and a lot different ways to access care. It’s gotten complicated. As a mother and as a citizen, if I want to get care, I find it difficult. Make it simple, with one phone number to get an appointment with a health care professional or a doctor. It doesn’t have to be a doctor, but it has to be universal for everyone. And then try to support our family doctors so that they can care for their patients in a holistic way. Those sound like lofty goals, but it’s not that complicated. They can be achieved very easily. So, for the active population, we wouldn’t increase services, but offer a different range of services. For elderly patients, we’d have a way of supporting them, giving them a quality of life, and providing them with hospital care at home. As I said, we would work both upstream and downstream.
After that, in the hospitals, we’d have a way of supporting them and giving them a quality of life. I was looking at statistics on the length of hospital stays. Clearly, we still have work to do when you look elsewhere in the world. In Canada, hospital stays are longer than in many other countries with public health care systems. So I think improving hospital fluidity is going to be a very concrete thing to work on.
Again, it’s a bit of wishful thinking in the sense that it isn’t as easy as it looks. But having said that, we need to measure and demonstrate it. As doctor, I’d like to have a report card and be able to see that we’re hospitalizing people for longer, for example. I’d like to know that. I think that’s part of it. We really need to work in partnership with patients and care providers. It’s the only way we’re going to get there.

Alya Niang
Exactly. Dr. Pelletier, thank you very much for participating in this podcast. We remain hopeful for better days ahead in emergency care.

Élise Pelletier
It was a pleasure. And yes, we have to remain hopeful.

Alya Niang
Indeed. Many thanks again. The CIHI website contains much more data on emergency care, which is updated regularly. Please visit the Canadian Institute for Health Information website at cihi.ca. That’s C-I-H-I dot C-A. We’d also like to hear from you if you’ve been impacted.
Thank you for taking the time to listen to our podcast. Our executive producer is Jonathan Kuehlein, and special thanks to Heather Balmain, our assistant, and Avis Favaro, the host of the CIHI podcast in English. Be sure to subscribe to the Canadian Health Information Podcast and listen to it on the platform of your choice. I’m Alya Niang. Talk to you next time.