Danielle Daigle suffers, like Celine Dion, from stiff person syndrome, a very rare neurological disease that affects the muscles. Every three weeks, she receives intravenous immunoglobulins for a few hours at the outpatient academic medicine unit of the Charles-Le Moyne hospital in Longueuil. She returns home after her treatment. “Thanks to that, I have practically no more spasms,” said the 59-year-old woman sitting in a reclining chair during her infusion. The stiffness is less worse. »
Danielle Daigle walks with a cane or walker due to her illness. Despite her many falls, she was never hospitalized. Physical examination, blood tests, computed tomography, electromyogram: all the tests leading to the diagnosis – which fell in December – were carried out at the outpatient academic medicine unit.
In Quebec, Charles-Le Moyne is a model for ambulatory care (outpatient services that do not require hospitalization). Starting this week, a team from the hospital center is undertaking a virtual “tour” of 14 establishments in order to share its experience at conferences. Quebec wants Charles-Le Moyne to inspire other hospitals. The Ministry of Health wants to avoid stays in the emergency room or on the floors. The beds are counted with the catch-up of surgical interventions.
Ambulatory medicine (or “day hospital”) has existed for twenty years in Longueuil. However, a new unit was inaugurated at the end of December. Modern and bright, the treatment room has 21 stretchers and armchairs, each installed in a large space delimited by blue curtains. When passing the Dutyseveral patients were there for a few hours.
Open 7 days a week, between 7 a.m. and 11 p.m., the unit welcomes around sixty people daily. “We had peaks this winter which reached 95 to 105 patients in one day”, says the Dre Chantal Vallée, head of the specialized medicine department. According to the CISSS de la Montérégie-Centre, nearly 14,000 people were seen in the unit between 1is April 2021 and February 24, 2023.
Everything on the same level
Formerly housed in former rooms on the sixth floor, the new outpatient academic medicine unit is located on the ground floor, a stone’s throw from the outpatient specialty clinics, such as geriatrics, rheumatology and endocrinology. “It’s really the kingdom of specialized outpatient medicine,” says, walking, the deputy CEO of the CISSS de la Montérégie-Centre, Lise Pouliot, who shows the premises at the Duty.
Patients find it easily. No more going up and down in the elevator to do radiology tests: the unit is on the same floor as medical imaging. “It helps to ensure better fluidity,” observes Lise Pouliot.
To be effective, the academic ambulatory medicine unit tries to align its services as best as possible with those of the other units. “When I register an outpatient, the radiology examination, the scan lungs or scan of the abdomen that I request be prioritized as if the patient were in the emergency room, explains the Dre Valley. We don’t send the patient to the emergency room, but we don’t want him to wait three weeks to be able to have his exams. If not, I’ll make it admit [à l’hôpital]. »
Thanks to this approach, “intensive investigations” can be carried out in this unit, according to Chantal Boucher, director of nursing care at the CISSS de la Montérégie-Centre. “Before, people who returned for a risk of cancer, we kept them [à l’hôpital] and we were investigating, she said. We can do all that externally if it’s safe for the patient, to go and sleep at home. »
The Dre Vallée gives as an example the case of a 70-year-old woman she saw recently in the unit. His blood calcium level was high. “She had several comorbidities and her family doctor was very worried,” says the internal medicine specialist. I said, ‘Don’t send her to the emergency room, I’ll see her.’ We got organized with the nurses on the unit and we scheduled exams and blood tests the next morning so that when I went to see her in the afternoon, I would have all the results. The patient was ultimately not hospitalized. “In the emergency room, she would have waited 12 hours”, estimates the Dre Vallée.
In addition to helping to relieve emergency room congestion, these services are beneficial for patients, emphasizes Chantal Boucher. She points out that gestures as simple as answering the phone at home allow people to move and maintain their mobility. “Just come [à l’unité] and going home mobilizes you, she says. Doesn’t want to, patients move less upstairs. They can stay in their bed. It has an impact on recovery. »
Culture change
The establishment of such a unit involves “changes in practice” among doctors, according to the Dre Valley. “The hospital is a very reassuring environment for specialists,” she says. Doctors are always afraid, when patients are outpatients, of missing a report from a scan, of not having seen or read it because it has not been done. In an ambulatory medical unit, nurses act, in a way, as “case managers” to ensure that the files follow their course, she specifies.
At Charles-Le Moyne, medical students and residents at the Université de Sherbrooke are already exposed to this reality. The Dre Vallée, which coordinates the relocated medical training program in Montérégie, is delighted. “It shows them that medicine is not always hospital-centered,” she says. And that it is possible to take care of a patient who lives outside the walls of a hospital. “Everyone wins,” she concludes.