In some provinces, more than two-thirds of emergency rooms have closed at some point in the past six years, data show.Jeff McIntosh/The Canadian Press
Emergency rooms across Canada are closing with increasing frequency and duration, especially in small towns.
We know this anecdotally. But for the past several months, a trio of Globe and Mail journalists – Kelly Grant, Tu Thanh Ha and Yang Sun – has tried to collect some hard data on this subject.
Their efforts have resulted in some important revelations.
Firstly, the available data are truly alarming. In some provinces, more than two-thirds of ERs have closed at some point in the past six years. Many rural ERs are closed more often than they are open.
Second, most provinces and territories don’t collect this crucial information in any systemic fashion, let alone use it to improve care.
As part of the Secret Canada project, a years-long investigation into Canada’s freedom of information laws and, more broadly, the impact of governments’ penchant for secrecy, Ms. Grant, Mr. Ha and Ms. Sun asked each jurisdiction to provide data on ER closures for the past six years – since the COVID-19 pandemic began.
Canadian ERs closed their doors for at least 1.14 million hours since 2019, records show
Some provinces, such as Manitoba, provided extensive data, revealing that 70 per cent of their ERs have closed at some point. One hospital ER, in Eriksdale, was closed 323 of 365 days in 2023.
Nova Scotia improved its temporary ER closure numbers by permanently closing a number of emergency rooms and turning them into urgent care centres.
B.C. initially provided data showing there were 8,600 hours of unplanned ER shutdowns in the province in 2024, an utterly useless bit of information. The province eventually provided a set of incomplete data seven months after an access-to-information request was filed. It came two days before publication, so it couldn’t be included in The Globe’s analysis.
There’s a common saying in the public policy field: “If you don’t count it, it doesn’t count.”
But counting in a way that is not useful or actionable is much worse. It’s willful ignorance, and an abdication of responsibility.
Canada’s ERs are in crisis. They are routinely and often dangerously overcrowded. The waits for care are, too often, interminable. Increasingly, emergency departments are affixing “closed” signs on the doors so patients don’t even have the opportunity to get into a queue.
Yet, in response, many of our politicians and policy makers have chosen shoulder-shrugging.
The data we do have are informative, but do not solely explain why small-town ERs are closing, nor the solutions for this problem.
However, we do know that the fundamental problem is staffing. Most ERs close because they don’t have enough nurses, and to a lesser extent, doctors. Attracting staff to small-town hospitals is not a problem that will be easily or quickly resolved.
In other words, the frequency and duration of ER closures will continue, and that needs to prompt some uncomfortable discussions.
If an ER is closed 80 per cent of the time, is it really an ER? In fact, if an ER is not open 24/7, 365 days a year, is it an ER?
In small towns plagued by ER closures, virtual emergency care helps keep the doors open
Permanently closing some of these emergency-rooms-in-name-only is a better solution than pretending they are offering a useful service.
Canada is an enormous country – 80 per cent of the population lives in urban areas, close to hospitals (and ERs). But the other 20 per cent is pretty spread out.
It is not realistic to expect that everyone will live within spitting distance (or even an hour’s drive) of an emergency room.
Sure, hospitals are a point of pride – and important economic drivers – in small towns. But hubris is costly. Some of these facilities provide essential care, but many are inefficient, and patient volumes don’t justify their existence.
Having a building with a big neon “H” on it is not a guarantee of good care. If we’re being frank, emergency rooms in small towns are often little more than glorified walk-in clinics. If you have a life-threatening condition, you will almost certainly be referred to a larger hospital with specialized nurses, physicians and equipment.
Instead of yearning for the so-called good old days, when every tiny town sustained an often second-rate ER, we should be focusing on improving access to care with a three-pronged strategy: 1) Ensure every Canadian, regardless of where they live, has a primary care provider; 2) Establish a network of first-rate urgent care centres that serve geographic regions, and; 3) Bolster that base of primary and secondary care with advanced paramedics who can transport patients in need of real emergency care to tertiary care hospitals in larger centres.
The numbers we have about ER closures tell us that the current situation is untenable. We need a better approach, no matter how politically unpalatable it may seem on the surface.