Quebec pilot project frees up emergency rooms with in-home care

·2 min read

Community paramedic Charles-Martin St-Amour is driving to a patient's home, but his ambulance sirens aren't wailing. The dispatch call is for a non-emergency.

St-Amour, who covers part of the Montérégie, launched a community paramedicine project in January 2019, offering care to patients whose problems don't necessarily require a visit to an emergency room — all in the comfort of their home.

"There's always a home care nurse who comes after our visit, either within 24 hours or sooner depending on the discussions we'll have," St-Amour tells a 78-year-old caller. "If you need a prescription for antibiotics, it's delivered to the pharmacy. If you can't move … I'll go get it for you."

The project is a joint venture between the ambulance service, la Coopérative des techniciens ambulanciers de la Montérégie (CETAM) and the regional health authority, the CISSS Montérégie-Centre.

Its goal is to free up emergency rooms by addressing non-emergency cases for people aged 50 and over.

About half of the roughly 500 calls received over the past year have been resolved at the patient's home, thanks to the pilot project.

With a nurse on the phone during house calls, the paramedic acts as the "eyes and hands" when assessing the patient, said Dr. Sophie Gosselin, chief of the emergency department of the CISSS de la Montérégie-Centre. Nurses follow up with a visit the next day.

In the current health-care system, the law requires an ambulance visit if a caller dials 911 for a medical reason, according to Gosselin.

"Sometimes people can call 911 because their walker is broken and they can't [move] from their bed," Gosselin said. "It doesn't [require] going to the emergency, but it's an emergency for the patient because they need the walker to go around, so the nurse can co-ordinate and make sure an evaluation is made and a new walker is brought in."

Helping hospitals, paramedics and patients

With notoriously long emergency room wait times in Quebec, community paramedic Éric Charland says he hopes the project will expand to other regions.

"This is helping overcrowding in emergency rooms and relieving stress on the paramedic function throughout the province," Charland said. "The patient dialled 911, maybe because he's out of resources."

In the fall of 2019, the Legault government created a committee of experts whose job was to find ways to make pre-hospital care more efficient and give more autonomy to paramedics, among other goals.

The committee has yet to release a report, but heads of the CISSS Montérégie-Est and the CISSS Montérégie-Ouest are already considering extending the project to their territories, said Lyne Marquis, associate director of the CISSS Montérégie-Centre.

Around 400,000 people in the Montérégie region are currently eligible for the pilot program's services.