Understanding the emergency room patient journey in Quebec: processes, waiting times and associated costs

As a family doctor and medical director who practiced in France before settling in Quebec, I've often noticed that newly arrived French people struggle to understand how Quebec's emergency services work. Here's a practical guide to help them better understand the patient's journey in this context, the reasons behind the sometimes very long waiting times, and the associated costs, especially for those without Régie de l'assurance maladie du Québec (RAMQ) coverage.

1. Arrival at the emergency department: prioritization through triage

When a patient arrives at the emergency department, the first step is an assessment by a triage nurse. This step is crucial: it's not based on order of arrival, but on the severity of symptoms.

Quebec uses theCanadian Triage and Acuity Scale (CTAS) to classify patients into 5 levels:

-Level 1: Resuscitation (e.g. cardiac arrest) - immediate intervention.

-Level 2: Very urgent (e.g. suspected infarction) - recommended waiting time: less than 15 minutes.

-Level 3: Urgent (e.g. severe pneumonia) - recommended waiting time: less than 30 minutes.

-Level 4: Less urgent (e.g. moderate abdominal pain) - recommended waiting time: less than 1 hour.

-Level 5: Non-urgent (e.g. prescription renewal) - recommended waiting time: less than 2 hours.

2. Prioritization through medical referral

An important point often overlooked: patients who arrive at the emergency department with a referral from another doctor (e.g. after a clinic or telemedicine consultation) are often given higher priority.

A medical referral means that a healthcare professional has already assessed the situation and concluded that your case requires urgent hospital care. This prior assessment makes it possible to:

- Reduce sorting time.

- Speed up access to care, as triage is also based on information provided in the referral.

That's why it's often best to consult a doctor before going to the emergency room, whenever possible.

3. The role of expectation: a complex issue

Waiting times in Quebec's emergency rooms can seem interminable, especially for non-urgent cases. Here are the main reasons for these delays:

-Lack of medical resources: emergency doctors and nurses often have to juggle critical cases and patient overload.

-Limited access to alternatives: many patients don't have a family doctor or can't get a quick appointment at a clinic. So they turn to the emergency department.

-Regionalization of services: in less populated areas, resources are even more limited, which means longer lead times.

4. A typical day in the emergency room

Here's what it often looks like for a patient deemed "less urgent":

1Registration and triage: on arrival, a symptom questionnaire is completed. A nurse assesses your condition and assigns you a priority level.

2Initial wait: depending on your classification, the wait can range from a few minutes to several hours.

3Medical consultation: once you have been called in, you will be seen by a doctor who will carry out a clinical examination and may order tests (blood tests, X-rays, etc.).

4Results and follow-up: waiting for results can also be long if laboratories are overcrowded.

5Discharge or hospitalization: depending on the diagnosis, you will be discharged home with recommendations or admitted for more intensive treatment.

5. Deadlines in figures

In 2023, average waiting times in Quebec emergency rooms reached record levels in some regions:

-Level 4 or 5 patients: 6 to 14 hours waiting time before seeing a doctor.

-Level 3 patients: approx. 4 to 8 hours' waiting time.

-Level 1 or 2 patients: usually treated immediately.

6. Costs associated with emergency room visits

For residents covered by RAMQ:

- Emergency care is generally covered by RAMQ. However, certain services or medications may entail additional costs that are not covered.

For people without RAMQ coverage:

-Cost of an ER visit: Patients without Quebec health insurance are responsible for the cost of consultation. For example, a visit to the emergency department can cost around $1,160 CAD, not including diagnostic tests or doctors' fees.

-Payment: Facilities may require payment prior to consultation, or bill for services after the fact. It is advisable to check the policy of the establishment concerned.

7. Alternatives to emergencies

For less serious cases, there are alternatives that can save you long waiting hours:

-Guichet d'accès à la première ligne (GAP) Available for patients without a family doctor, but appointments can take a long time.

-Walk-in clinics: some clinics offer time slots for quick consultations, but space is limited.

-Private services: clinics such as Allodocteur.ca offer same-day home consultations or telemedicine. This type of service can be useful for health problems that don't require a trip to the emergency room.

8. A few practical tips

-Be prepared: if you have to go to the emergency room, bring a list of your medications, your medical history and a snack in case of a long wait.

-Consult before you go: if your symptoms are not serious, call your clinic, a hotline (811) or explore private consultation options.

-Think prevention: having a family doctor or regular check-ups can prevent complications requiring a visit to the emergency room.

Conclusion: understanding and adapting to the Quebec system

Emergency departments in Quebec operate differently from those in France, with strict prioritization of serious cases. While waiting times are often frustrating, they reflect a healthcare system under pressure. Exploring the alternatives available and gaining a better understanding of how emergencies work can help you make informed choices for your health.

If you need a quick consultation for non-urgent cases, Allodocteur.ca offers solutions to avoid long waits and provide you with care in the comfort of your own home.

You can :

-Book an appointment online directly on our website: Allodocteur.ca

-Call 438-942-8479 to speak to a member of our team and arrange your consultation.

We're here to make family medicine faster and more accessible, with same-day home visits available.