Montreal City Weblog

Kate 09:21 on 2024-12-10 Permalink Reply  

• mare 10:54 on 2024-12-10 Permalink

  [anecdata about appointments, slightly off topic but potentially interesting] I was in the ER of a small hospital last week, in the evening, a few days after Santé Quebec was launched and noticed a few new things that I hadn’t encountered on earlier visits.

  On the information screens there explained the system of priority assignment P1 to P6. P1 to P3 were red while the lower priorities were green.
  A few screens later people with green priorities were strongly suggested to as for a re-evaluation by the triage nurse who would then ‘get you an appointment in a clinic’.
  There might have been more or fewer categories, I only saw the screens once, and when I was waiting with my phone to take a photo a houseless person (with sleeping bag) installed himself in that area reserved for Covid patients, and turned off the monitor.

  Two things are new here. It suggests that after the triage they tell patients their priority status. In my case that didn’t happen so it might not yet be implemented, but I’ve never ever seen this before on previous visits. My priority status has always been a closely guarded secret. The second change was the fact they promised to find appointments in clinics for the not so urgent cases. I think this is in principle a good idea, but wonder where and when those appointments would be. In a walk-in clinic, in a private clinic? The next day, in the next week?

  Another thing was new. When the night shift started, around midnight a nurse started to walk the waiting room with a stack of files, and did a roll call by shouting names, presumably to check which patients were still present. Then she explained that she was going to re-evaluate the less urgent cases and find them an appointment. In the next two hours people were called and subsequently left the ER. I was never called, probably because I was originally high priority, so I can’t say from experience what the ‘finding a clinic’ procedure entailed exactly. I presume they used ClicSante, and have access to appointments that don’t show up for ‘normal’ people, just like what happened when I’ve called 811 in the past.

  I was waiting all night for the results of my blood tests and a talk with a doctor, but left at 6h00 after I found out that the ER doctor wasn’t even *in* the ER, but upstairs ‘on the floor’ for a real emergency. ‘The floor’ in a hospital with lots of floors and many patients. I hope they weren’t the *only* doctor in the hospital that night, but fear the worst. I had spent 10 hours in the ER. My GP later told me the blood tests were time-stamped by the lab at 10h30, 5 hours after I had left.

• mare 11:01 on 2024-12-10 Permalink

  [on topic] On the ClicSante website there’s a filter option for appointments ‘sans frais seulement’. Of course it’s unchecked by default. The La Presse article could have mentioned it.

• Kate 11:20 on 2024-12-10 Permalink

  I hope you were seen and looked after, mare. Thanks for the report. Was this the MUHC hospital?

• Joey 11:35 on 2024-12-10 Permalink

  @mare I’ve heard for a while that the triage nurse has some kind of super-access to the RVSQ network, and can help you find an appointment within the next X hours at a nearby clinic – apparently the most efficient way to get a decent walk-in urgent care appointment is to go to an ER and ask the triage nurse to find you somewhere else to go. I could see how that power would be reserved to a nurse who can actually at least examine you physically and take your vitals, meaning it would not be appropriate for an 811 nurse to do the same, though the fact that you have to go to the ER nurse to get an appointment elsewhere is a little nuts.

  I am in favour of this kind of approach – a little more transparency about how ‘urgent’ your situation is and some assertive support from the triage nurse to get you an appointment somewhere other than an ER (if appropriate) makes a lot of sense. I think a big frustration for ER visitors is that, largely because of the abuse the frontline workers have suffered at the hands of unruly or mentally ill patients, you are basically told to sit down, shut up and do *not* ask questions, especially about when you might be seen. The system has evolved to a point where we all treat each other like the lowest common denominator. It’s encouraging to see a little more active, patient-focused queue management, even if it’s likely only because the ERs are understaffed and the hospitals can’t admit all the ER patients they should.

  Additional anecdata – like everyone, our household has had some lingering chest/nose/sinus illness for the last five weeks. We’ve used RVSQ four times – in each case, we all got appointments within 24 hours at clinics a little all over the place. The wait time to see the triage nurse and then the doctor was extremely short at three of four (at the last we only waited maybe 45 minutes beyond the appointment time). Ask me again in six months, but the non-ER urgent care part of the system seems to be holding up OK for the time being.

• Ian 11:39 on 2024-12-10 Permalink

  anecdotes = qualitative data. Consistent and reinforcing reported personal experience is one of the main forms of qualitative research. Don’t sell your first-hand experience short!

• Kevin 12:48 on 2024-12-10 Permalink

  Because of the many ‘reforms’ to healthcare we’ve had, the general public has no idea where to go for medical care.
  There are people who manage to scoop up appointments with their family doctor every week (and who frequently cancel appointments hours before they’re supposed to show up). There are doctors who do their best to keep slots open every day they’re allowed to see patients for ‘urgent care’ – when their receptionists don’t screw it up by blocking out those appointments, or filling them every Monday with people who want annual checkups.
  We have privately-run clinics doing pediatric care but nobody pays anything- it’s all covered by RAMQ.

  And I’m firmly convinced that Christian Dubé doesn’t know any of this.

• jeather 12:51 on 2024-12-10 Permalink

  I have been told that at some ERs — I think the Children’s, might have been Ste-Justine — they regularly make appointments for non-ER things within a few days if that is the appropriate move, and they have access to appointments that regular people don’t. Interesting that it’s adults too.