A review of Ontario's hospital emergency departments finds most patients get to see a doctor quicker, but the sickest people can spend hours or even days in hallways waiting for a bed.
Health Quality Ontario says the maximum amount of time most patients waited to see a doctor in an emergency room declined 16 per cent over the past seven years — down to three hours from 3.6.
There was also a 10 per cent drop in the amount of time spent in emergency wards, down to 7.8 hours from 8.7 hours.
But in a report released Tuesday, the agency says many of the sickest patients may spend hours and sometimes days lying on stretchers in ER examination rooms or hallways waiting to be admitted because people who should be in long term care are taking up hospital beds.
"I always think about emergency departments as a bit of a canary in the coal mine," said Dr. Joshua Tepper, president and CEO of Health Quality Ontario.
"When things start to run into trouble in the emergency department, it usually reflects things that are happening elsewhere in the hospital, and elsewhere in the healthcare system."
The Health Quality Ontario report shows overall visits to emergency departments have increased by 13.4 per cent, more than double the rate of the province's population growth, which was 6.2 per cent over the past seven years.
More visits by older, sicker patients
There has been a 29.1 per cent increase in emergency room visits by people aged 65 and over.
"Inevitably as we get older we have more health problems, for the most part," said Tepper is a telephone interview.
"And therefore with a growing older population, we will see a higher level of illness with time, and especially with more chronic diseases," he said.
"People are living longer with diabetes, Hepatitis C, H.I.V., C.O.P.D or emphysema. And this means that people will get sick episodically with these chronic diseases."
Asked by reporters about the report on Tuesday, Premier Kathleen Wynne said her government knows there is a need for even more funding.
"Part of the fall economic statement was about exactly that," said Wynne, referring to $140 million in new healthcare spending announced yesterday, in addition to $345 million included in the latest budget.
"There have been a number of years of constraint, and we've worked with hospitals, and hospitals have done a great job in changing their practices, in improving their triage processes in emergency rooms. But there is a need for more investment. And we understand that, and will continue to work with the system."
As an emergency room doctor himself, Tepper says the government's investments have been effective.
"I think the Premier is right," said Tepper, "I think we should take a lot of pride in the fact that the population has grown steadily, the volumes in emergency departments have grown steadily. And despite that growth, we are actually seeing wait times reduce. We should collectively take pride in that."
Improving care, close to home
But he says strengthening long-term care and home care in communities may be the best way to reduce strain on hospitals, and in turn, emergency rooms.
He points to another recent report on palliative care by Health Quality Ontario, which found a large number of palliative care patients seen in the emergency room are admitted to hospital in their final 30 days of life.
"There are probably opportunities to strengthen our palliative care in the community, to limit the number of visits," Tepper said Tuesday.
"Some of those patients absolutely need to come in," he said "but are there ways of strengthening long-term care and home care, and the models of care we have in the community, to help keep patients closer to home, in the home, rather than in the emergency department?"
The report also said the data indicates that urban residents spent longer in emergency and waited longer to see a doctor than people living in rural areas.
The findings are based on data from the provincial health ministry and the Institute for Clinical Evaluative Sciences as well as accounts from patients and caregivers.