Lakeshore General Hospital reports highest ER death rate in Montreal

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Lakeshore General Hospital's emergency room — one of the province's worst overcrowded and longest wait times for patients on stretchers — also records the highest ER death rate in Montreal, according to the latest data from the Quebec Health Organization. ministry.

In the first 10 months of fiscal year 2023-24, the Pointe-Claire ER posted a death rate of 3.4 patients per 1,000 visits. To put that number in perspective, the average ER death rate in Montreal Island was 1.39 during the same period, compared to 1.2 at Jewish General Hospital, which treats many elderly patients like Lake Shore.

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For additional context, a New Brunswick hospital emergency room audited in 2022 after a 70-year-old man died in the waiting room recorded 1.1 ER deaths per 1,000 patient registrations.

“We lose and lose patients more often on the lake shore than anywhere else,” said patient rights advocate Paul Brunet, responding to the ministry's findings. “I've been commenting on the Lakeshore for years. It's great.”

The newspaper obtained the ministry's details following an access to information request. A year ago, the Gazette published a four-part investigative series documenting six patient deaths at a Lakeshore ER that clinical sources said could have been prevented. They occurred amid chronic overcrowding, understaffing, poor supervision, and broken medical equipment.

The Gazette series follows a report by a labor ombudsman warning that Lakeside is a “ticking time bomb” and warning of rising ER death tolls. In response to the publication, Health Minister Christian Dubé launched an independent investigation into Lakeshore ER, which resulted in 135 recommendations to improve the quality of care.

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Three fiscal years ago (the broker's reporting year), Lakeshore's ER mortality rate was 3.7. It fell to 3.2 a year ago, only to rise to 3.4 this year — hinting at the challenges ER still faces.

Statistics from the Ministry of Health show a wide variation in mortality rates between ERs in Montreal, indicating that the quality of care in the city's hospitals is inconsistent.

For example, at the city's two pediatric hospitals – Montreal Children's and Ste-Justin's ER, mortality was virtually non-existent, with Children's rate at 0.1 and Ste-Justin's at 0.

Among adult hospitals, Sacré-Coeur, which operates a Level 1 trauma center north of Montreal, had reported the highest ER death rate in the city — 4.3 in 2021-22 and 4.1 the following year — but has made progress and lowered the rate. reached 2.9 in the current financial year.

In contrast, the ER at St. Mary's Hospital in Cote-de-Neiges reported just 0.4 this year, one of the lowest in the city. In addition, the figure for the central hospitalization de l'Université de Montréal (CHUM) was 1.1.

The Royal Victoria Hospital ER, run by McGill University Health Centre, fared much worse with an ER of 3.2.

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Lakeside officials declined to comment on the ministry's details.

The MUHC said in a statement that “patients may present to the emergency department with very complex and complex problems, such as cardiac arrest, with paramedics or a terminal illness, usually cancer.

“A few come in with critical conditions and are candidates for the last resort called ECMO. The survival rate of these patients is low. Unfortunately, some patients die in the ED (emergency room) while waiting for a bed in an inpatient unit.

“However, we ensure that this happens in a private room, with the family at the bedside and focus on privacy and comfort. All deaths in the ED are routinely reviewed, analyzed and reported (to the Physicians, Dentists and Pharmacists Board) for final review. This process has been going on for decades.”

Both Lakeshore and the Royal Vic regularly report patients languishing in corridors on stretchers for 30 to 50 hours. This phenomenon is known as ER hospitalization, and a 2021 study in the Journal of Clinical and Experimental Emergency Medicine found that “ED hospitalization time increases mortality and results in longer hospital stays.”

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“The increased risk of death in patients with long (hospital bed) waits is largely due to overcrowding and difficulties in ensuring adequate care, as staff are often busy stabilizing patients who come to the ED or are sick. difficulties in ensuring adequate monitoring and proper timing,” the study added.

The ministry's data did not disclose the number of ER deaths per hospital. However, the total number of ER deaths across the province has been steadily increasing, from 5,904 in 2018-19 to more than 7,000 in 2022-23, according to data obtained following an earlier access to information request.

As the MUHC points out, the aging population is a factor in the increase in ER deaths, and some people who go to the ER are very sick, sometimes near death. But observers expressed concern about the sharp increase in the short term.

Dr. Eddie Lang, scientific director of the Alberta Health Services Emergency Strategic Clinical Network, acknowledged the seriousness of ER overcrowding in patient deaths after reviewing recent Quebec figures.

“I'm sure there are (ambulance) deaths, but that's the result of sending patients home who need to be admitted instead of in the ED,” Lang said.

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