Santa Cabrini Hospital adds kiosk to redirect non-urgent cases from ER

An innovative pilot project at Montreal’s Santa Cabrini Hospital to reduce wait times and unnecessary use of Quebec’s overtaxed emergency departments will soon be extended to all hospitals in the province, health officials told the Montreal Gazette Wednesday.

For the past two weeks, people who arrive at the emergency department at Santa Cabrini Hospital in Rosemont have been directed to a small desk in the entryway. Instead of registering with a triage nurse for what could be a punishingly long wait, they are assessed at this new kiosk by a nurse and a hospital administrator who are both specialized in the health-care services available across the region. If their reason for coming to emergency is non-urgent, the patient will be referred to another service.

Quebecers have the right to be seen at the hospital of their choice, and emergency departments will not refuse to see a patient if their needs are not urgent. But the waits can be long, and non-urgent patients do slow down the functioning of emergency rooms, so the Health Ministry mandated the CIUSSS de l’Est-de-l’Île-de-Montréal — the health authority responsible for Santa Cabrini and Maisonneuve-Rosemont hospitals — to explore the concept of an onsite ER kiosk for referrals to other points of service.

“The intention is to be able to deploy (the ER kiosk concept) progressively and according to the realities of each territory, in the most harmonized way possible, across the territory of Quebec,” said Caroline St-Denis, director of multidisciplinary services for the CIUSSS.

The kiosk is a physical version of a phone service the Health Ministry introduced in June: the Guichet d’accès à la première ligne (GAP). It allows Quebecers who are on the waiting list for a family doctor to dial 811, and select Option 3, to get advice from a nurse about whether to go to an ER or elsewhere for medical help.

The service became available across the province in late September, following a pilot project in the Lower St. Lawrence region. There are about 1.2 million people in Quebec who do not have a family doctor.

The GAP line for the CIUSSS de l’Est-de-l’Île-de-Montréal receives 250 to 500 calls per day, according to Coralie Lefebvre, head of GAP for the eastern region. But she said too many people still head to emergency unnecessarily, without calling 811 first.

Lefebvre said the ER kiosk at Santa Cabrini is redirecting 25 to 50 per cent of the people who show up every day, but that does not mean they are being refused care. People will often be given a doctor’s appointment for the same day elsewhere, or they may be sent to a pharmacist or other health professional, depending on their issue.

Delphine Alberto, chief nurse of Santa Cabrini’s emergency department, said the GAP desk is reducing pressure on her department, while also reminding people to call 811 next time if they think they need non-urgent medical attention but don’t have a family doctor.

She said many people show up at the emergency for such non-urgent reasons as ingrown toenails, urinary tract infections or prescriptions they need renewed.

“There is this education factor too that is important — letting people know that they should call 811 and speak to a nurse who can tell them whether they should go to emergency or not,” she said.

The emergency departments of the two hospitals serving Montreal’s populous eastern region have been particularly overwhelmed because of the pandemic and long-standing nursing shortages.

Protests against mandatory overtime by ER nurses at Maisonneuve-Rosemont caused a partial shutdown of the service in January. The office of Quebec’s ombudsperson ordered Santa Cabrini to improve its wait times after a 2021 investigation showed some patients were waiting four to nine days on stretchers to be seen in the ER.

mlalonde@postmedia.com

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