In Saguenay and Quebec, hospitals have adopted a new emergency pre-triage mode. The first contact is now made virtually, with a nurse who is on the screen.

The newspaper Le Quotidien this week recounted the surprise of a patient who suffered a head trauma who, on arriving at the emergency room of the Chicoutimi hospital, first found herself faced with a “pre-triage” virtual by Teams. An initiative to reduce waiting, explains the CIUSSS du Saguenay–Lac-Saint-Jean in the article.

Currently, two emergency rooms at the Quebec University Hospital Center (CHU) are doing the same and those of the three other hospitals in this network will follow shortly.

Mylène Ferrand, who is the emergency critical care coordinator there, was at the forefront of the implementation of this approach.

Where is the virtual nurse located? A little apart, in an office. If someone collapses in front of the screen, it will not be her who will rush to help the patient. A code will be triggered immediately so that the staff next door can take charge.

Because the nurse who is placed in the pre-triage, at the CHU, is pregnant or immunosuppressed.

One of the advantages of this initiative, says Ms. Ferrand, is precisely the contribution of this nurse “who cannot do the groundwork”, but who can nevertheless contribute.

“That gives us one more nurse in the emergency room,” Ms. Ferrand continues.

Since a virtual nurse performs the pre-triage, Ms. Ferrand assures that the wait to be seen at the next stage, at the triage, never exceeds an hour, “whereas in peak hours, it could go up to three or four hours “.

Recognizing that not everyone is comfortable with first seeing a nurse on a screen, patients have the option of seeing a professional in person upon arrival, says Ms. Ferrand.

Since it still takes several hours to see a doctor, a nurse must, at repeated intervals, reassess patients. This task is now also assigned to the virtual nurse, who also keeps an eye on the waiting room at all times.

Quebec welcomes this project, which has also been implemented in vaccination centers, says Antoine de la Durantaye, press officer for Christian Dubé, Minister of Health.

In Montreal, no hospital contacted said they had a virtual pre-triage project in the pipeline.

Julie Bouchard, president of the Fédération interprofessionnelle de la santé du Québec (FIQ), says her union will have “an open eye on current experiences [to] see if it would not be worth exporting the practice to other emergency room “.

Dr. Judy Morris, president of the Quebec Association of Emergency Physicians, finds the idea “super interesting”, particularly because it allows a member of staff to contribute even if their condition of health does not allow him to be on the field punctually.

She stresses, however, that the virtual nurse will have to remain an “additional help” and that this must never result in the withdrawal of a person from the field, because all hands are necessary, among other things when someone a bit aggressive shows up at the hospital.

Dr. Morris adds that pre-triage should be done by an experienced nurse who knows the environment well, as this task requires great skill.

Dr. Alain Vadeboncœur, emergency physician at the Montreal Heart Institute who participated in the late 1990s in the development of an emergency triage scale, also sees no problem with the new practice in place in some establishments.

In the ER, people often expect to “feel cared for”, so care should be taken to assess whether patients are comfortable with the concept. But a priori, that the first basic questions are asked by a nurse who is at a screen rather than behind glass as is currently the case, this is the same logic, according to Dr Vadeboncœur.