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WHERE ARE PATIENTS MOST LIKELY to GIVE up and GO HOME? 2020 Ranking of ER Overcrowding in Quebec

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WHERE ARE PATIENTS MOST LIKELY to GIVE up and GO HOME? 2020 Ranking of ER Overcrowding in Quebec RANKING HEALTH POLICY SERIES APRIL 2020 WHERE ARE PATIENTS MOST LIKELY TO GIVE UP AND GO HOME? 2020 Ranking of ER Overcrowding in Quebec By Patrick Déry, with the collaboration of Daniel Dufort Last year, nearly 380,000 Quebecers—or over Table 1 − Proportion of patients having left an 1,000 patients a day—left a hospital emergency emergency room before seeing a doctor, 2019-2020* room without having been attended to by a doc- RANK CISSS/CIUSSS/CHU % FRACTION tor, and without having been redirected, accord- 1 12-Chaudière-Appalaches 4.1% 1/24 ing to the data from Quebec’s Department of 2 06-Centre-Ouest-de-l'Île-de-Montréal 5.4% 1/19 Health. In all, more than one in ten patients who 3 02-Saguenay - Lac-Saint-Jean 7.6% 1/13 visited an emergency room gave up on receiving 4 04-Mauricie et du Centre-du-Québec 8.0% 1/13 care. Even worse, one fifth of these patients had 5 06-Nord-de-l'Île-de-Montréal 8.4% 1/12 been classified as “very urgent” or “urgent” dur- 6 11-Gaspésie 8.6% 1/12 ing triage (Priority 2 or 3), which indicates that 7 01-Bas-Saint-Laurent 9.2% 1/11 1 their condition could put their life in danger. 8 08-Abitibi-Témiscamingue 9.5% 1/11 However, there is significant variance within the 9 06-Ouest-de-l'Île-de-Montréal 10.0% 1/10 province, and even from hospital to hospital, as 06-MONTREAL - OVERALL 10.2% 1/10 we shall see. 10 13-Laval 10.2% 1/10 PROVINCE OF QUEBEC 10.9% 1/9 THE SNAPSHOT AND THE LONGER VIEW 11 03-CHU (Québec) 10.9% 1/9 The overcrowding of Quebec emergency rooms 11 06-CUSM 10.9% 1/9 can be quantified in two ways. The first is to take a 03-QUEBEC CITY - OVERALL 11.2% 1/9 static picture or “snapshot” of the current situation: 13 16-Montérégie-Est 11.3% 1/9 What proportion of patients, in a given hospital or 14 06-Est-de-l'Île-de-Montréal 11.5% 1/9 region, return home without having seen a doctor 15 05-Estrie 11.6% 1/9 after having gone through triage? The second is to 16 11-Des Îles 12.4% 1/8 measure its evolution: How has this percentage 17 14-Lanaudière 12.5% 1/8 varied over the past five years? Has it risen, re- 18 06-Centre-Sud-de-l'Île-de-Montréal 13.0% 1/8 mained stable, or fallen? 19 03-Capitale-Nationale 13.1% 1/7 20 09-Côte-Nord 14.2% 1/7 Looking at these two kinds of data provides a more 16-MONTÉRÉGIE - OVERALL 14.3% 1/7 complete picture of the situation. Certain regions, 21 16-Montérégie-Ouest 14.4% 1/7 and certain hospitals, can fare somewhat better in 22 07-Outaouais 15.8% 1/6 terms of the proportion of patients who turn back, 23 06-CHUM** 16.3% 1/6 but their situation has deteriorated over the past 24 16-Montérégie-Centre 17.1% 1/6 five years and so is trending downward. Conversely, 25 15-Laurentides 18.0% 1/6 in other places, important progress may have been * Data for the first ten periods out of 13, namely from April 1st, 2019 to January 4, 2020. ** Combined data for CHUM and hospitals that used to be a part of it. made, even if significant challenges remain. Source: Request for access to information, Quebec Department of Health and Social Services, March 2020. This ranking was prepared by Patrick Déry, Senior Associate Analyst at the MEI, in collaboration with Daniel Dufort, Senior Director of External Relations, Communications and Development at the MEI. The MEI’s Health Policy Series aims to exam- ine the extent to which freedom of choice and entrepreneurship lead to improvements in the quality and efficiency of health care services for all patients. The MEI is an independent public policy think tank based in Montreal. Through its publications, media appearances, and advisory services to policy-makers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship. It neither solicits nor ac- cepts any government funding. MEI 1100 Avenue des Canadiens-de-Montréal, Suite 351, Montreal QC H3B 2S2 T 514.273.0969 F 514.273.2581 iedm.org Where Are Patients Most Likely to Give Up and Go Home? 2020 Ranking of ER Overcrowding in Quebec Which emergency rooms do the best job of meeting Table 2 − Variation in the proportion of patients having left an the demand for care? Where are patients most likely to emergency room before seeing a doctor, 2014-15 to 2019-20* % give up and go home? And how has the situation RANk CISSS/CIUSSS/CHU VARIATION 2014-15 2019-20* evolved over the past five years? The current ranking 1 04-Mauricie et du Centre-du-Québec -32.2% 11.8% 8.0% presents a picture of ER overcrowding in Quebec, 2 06-Nord-de-l'Île-de-Montréal -26.3% 11.4% 8.4% grouped in three ways: first, a regional ranking, which 3 14-Lanaudière -19.4% 15.5% 12.5% compares the general situation in each of Quebec’s 4 02-Saguenay - Lac-Saint-Jean -17.4% 9.2% 7.6% Integrated Health and Social Services Centres (CISSS 5 11-Gaspésie -16.5% 10.3% 8.6% and CIUSSS) and University Hospital Centres (CHU); 6 01-Bas-Saint-Laurent -13.2% 10.6% 9.2% next, a detailed ranking of each of the 117 emergency 7 13-Laval -9.7% 11.3% 10.2% rooms listed by Quebec’s Department of Health and 8 03-Capitale-Nationale -7.1% 14.1% 13.1% Social Services; and finally, a second ranking of hospi- 9 16-Montérégie-Est -4.2% 11.8% 11.3% tals, this time grouped by the region served. 10 05-Estrie -4.1% 12.1% 11.6% The general situation leaves much to be desired: No 03-QUEBEC CITY - OVERALL +0.9% 11.1% 11.2% emergency room in Quebec manages to respond to 11 16-Montérégie-Ouest +3.6% 13.9% 14.4% +5.1% patients’ demand for care. Yet the picture is far from 12 12-Chaudière-Appalaches 3.9% 4.1% PROVINCE OF QUEBEC +5.8% 10.3% 10.9% uniform: Some hospitals see fewer than 5% of their pa- 13 09-Côte-Nord +6.8% 13.3% 14.2% tients turn around and go home, while for others, it’s 14 15-Laurentides +10.4% 16.3% 18.0% nearly one in four who give up on receiving care, nota- 15 03-CHU (Québec) +12.4% 9.7% 10.9% bly in the Outaouais and Laurentian regions. If we look 16-MONTÉRÉGIE - OVERALL +18.2% 12.1% 14.3% instead at the change over the past five years, the situ- 16 07-Outaouais +22.5% 12.9% 15.8% ation improved significantly for certain hospitals locat- 17 06-Ouest-de-l'Île-de-Montréal +29.9% 7.7% 10.0% ed in the Mauricie region and in the Lower St. Lawrence 06-MONTREAL - OVERALL +34.2% 7.6% 10.2% region. 18 08-Abitibi-Témiscamingue +37.7% 6.9% 9.5% The regional picture shows, for its part, that the portion 19 06-Est-de-l'Île-de-Montréal +45.6% 7.9% 11.5% of the province located north or east of Quebec City 20 11-Des Îles +49.4% 8.3% 12.4% generally fares better than the western part of the prov- 21 16-Montérégie-Centre +54.1% 11.1% 17.1% ince, except for the North Shore. Quebec City, Greater 22 06-Centre-Sud-de-l'Île-de-Montréal +66.7% 7.8% 13.0% 23 06-CUSM +67.7% 6.5% 10.9% Montreal, and the Outaouais—basically, the urban 24 06-Centre-Ouest-de-l'Île-de-Montréal +74.2% 3.1% 5.4% regions—are the places where patients are most likely 25 06-CHUM** +81.1% 9.0% 16.3% to give up and go home. The dynamic picture accentu- * For the 2019-2020 year, data for the first ten periods out of 13, namely from April 1st, 2019 to January 4, 2020. ates these trends: A part of eastern Quebec has im- ** Combined data for CHUM and hospitals that used to be a part of it.. proved over the past five years, as has the Lanaudière Source: Request for access to information, Quebec Department of Health and Social Services, March 2020. region, and—surprisingly—the northern part of the Island of Montreal. However, many Montreal emer- needs, and a general improvement of the performance gency rooms, in particular those located close to down- and the efficiency of our health care system all while town, are increasingly overcrowded. maintaining its universality,2 so that everyone can be treated when the need arises. To paraphrase a former Taken individually, the data must be contextualized. Supreme Court judge’s famous quotation, access to a Certain very efficient hospitals—notably Montreal’s waiting room is not access to health care.3 Having to Jewish General Hospital and the Centre Paul-Gilbert on return home untreated when one is ill is even less so. the south shore of Quebec City—remain very highly ranked, even if their performance has slipped some- what over the past five years; by itself, the variation in the proportion of patients who left their ERs does not paint a fair picture of their situation.
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