Emergency room waits are long in Canada

A shortage of nurses is one reason for the problem.

TORONTO GLOBE AND MAIL

More than 1 million Canadians annually are admitted to hospital after a visit to the emergency department. But that transition, from ER gurney to hospital bed, is rarely seamless and all too often involves a hideously long wait, according to a new report.

The data show that:

UOne in 25 patients waits more than 24 hours for a bed.

UOne in 10 patients waits at least 15 hours.

UOnly one in 10 patients is admitted immediately.

Over all, the average waiting time is a little less than two hours.

“These waits are happening after a decision to admit has been made and, at that point, patients shouldn’t really be waiting at all,” Michael Schull, an emergency room physician at Sunnybrook Health Sciences Center in Toronto, said in an interview. “There are things that need to happen, but they shouldn’t take 17 hours.”

The new report, published by the Canadian Institute for Health Information, also shows the wait for a bed is longest in big teaching hospitals, and that waiting times are longest during weekdays and in the winter.

The data also show that, while the gravely ill or injured are admitted immediately, those who wait the longest in hallways are elderly patients with multiple chronic conditions.

Notably, the longer patients wait for a bed, the longer they end up spending in hospital. “There’s a real human price being paid,” Schull said.

The report does not delve into the causes of the bottleneck that occurs between ER and hospital admission, but the contributing factors are well-known: a shortage of hospital beds, particularly general medical beds; a shortage of health professionals, nurses in particular; lack of places in such alternate settings as nursing homes, rehabilitation programs and home care; a dearth of community-based care for people with chronic illnesses; and a lack of a centralized, organized admissions policy.

“We have pretty antiquated systems for flowing patients through hospitals and through the health system, and that results in big problems in ER,” Schull said.

Greg Webster, director of research and indicator development at the Canadian Institute for Health Information, said the data suggest that every hospital has particular issues with patient flow but “this problem requires a system-wide solution.”