A treatment room in the emergency department at Peter Lougheed hospital is pictured in Calgary.Jeff McIntosh/The Canadian Press
The Canadian Institute for Health Information has released its annual report on emergency department wait times, a litany of data that is as mind-numbing as it is depressing.
One in 10 people who head to their local ED wait more than 14 hours for care. For the sickest of the sick, those who need to be admitted to hospital, the waits are three times longer. One in 10 wait more than 48 hours, languishing on stretchers in hospital hallways. Individually, it can be much worse, like the 79-year-old man in Edmonton with severe influenza, who waited 90 hours for a bed.
Most of those admitted to hospital are treated and discharged within four days. But about one in 12 patients remain hospitalized for 44 days or more – not because they need treatment, but for lack of home care or long-term care.
ED waits are not only uncomfortable. They can be fatal. About one in 1,000 patients who come to the emergency department die – about 16,000 people a year. Those deaths occasionally make headlines, such as the case of Prashant Sreekumar, 44, who died of a heart attack after waiting eight hours in an Edmonton hospital ED. Deaths are likely underestimated, attributed conveniently to underlying illness rather than a lack of timely care.
Waits are so bad that about one in 13 patients who come to emergency leave without getting care. ED overcrowding has been a persistent challenge in Canada for more than three decades. The Canadian Association of Emergency Physicians (CAEP) says it “should be considered a public health emergency.”
In the 2023 report, “EM: Power: The Future of Emergency Care,” CAEP warned that Canada’s EDs were “on the verge of collapse,” and things have only gotten worse since. Yet, the response is largely a lot of tongue-clicking and shoulder-shrugging, with a bit of muttering of excuses about the aging population and staffing shortages, and some patient-blaming thrown in for good measure.
The root causes of ED overcrowding and related waits are complex. What is clear, though, is that the solutions lie principally outside the ED.
The principal driver of the ever-worsening ED wait times is what researchers call “access block” – the chronic inability of hospitals to move patients out of the emergency department to where they belong, be it a hospital ward, a long-term care home, or back home with supports.
A lot of the backlog also involves waiting for tests, from blood tests to imaging, and follow-up consults with medical specialists, physiotherapists, family doctors and more. The ED operates 24/7, but most of those other services are delivered on bankers’ hours, leaving patients in medical limbo.
In public discourse, we focus largely on inputs (the 16.1 million people who come to EDs each year) and not enough on the outputs (where they end up.) We like to blame overflowing EDs on patients who come in with minor ailments. Governments even urge patients to avoid going to emergency, especially during Christmas and summer holidays.
The data show the “patient with a hangnail” is largely a myth. About two-thirds of patients who present in the ED are severe, unstable cases, including one-third who have multiple chronic conditions, and an increasing number with severe mental health and substance misuse issues. Ensuring everyone has a primary care provider is important, but it’s not a panacea for emergency department overcrowding.
Senior with influenza waited 90 hours in Edmonton emergency department, family says
One in eight people who come into an emergency department on any given day are admitted to hospital. But that’s where they run up against the blockage – a lack of available beds. EDs are designed to deliver acute care over a period of a few hours. Patients should be in and out quickly. When the sick become boarders, for days on end, their care suffers, and so does their health. Not to mention their dignity, lying in hallways without access to toilets, privacy or proper nursing care.
Canada has fewer hospital beds per capita and higher hospital occupancy than almost every other developed country. A shocking large number of beds, 15 to 30 per cent, are occupied by patients who don’t require hospital care but have nowhere else to go.
“Every system is perfectly designed to get the results it gets,” management consultant W. Edwards Deming famously said. It’s a reminder that emergency department overcrowding is a problem we’ve created, and that we can solve – by looking beyond the ED.
We have to stop blaming patients and care providers for structural failures, and actually fix the structure.