Researchers examine why Ontario ER visits spike when COVID-19 cases drop

Ontario researchers are looking into reasons behind the busiest times in the province's emergency departments to help relieve the extreme burden facing hospital staff.

Patients likely defer health needs during pandemic peaks, they believe

Ontario researchers are digging into the data behind visits to emergency departments across the province. (Trevor Brine/CBC)

Ontario researchers are looking into reasons behind the busiest times in the province's emergency departments to help relieve the extreme burden facing hospital staff.

Within the last year, hospitals in eastern Ontario and across the province have reported reaching or exceeding capacity as COVID-19 cases surge.

"It's been a two-year sprint for us," said Dr. Atul Kapur, who works in the emergency department of The Ottawa Hospital.

He said with COVID-19 protocols and the volume of patients coming through the doors, the hospital's ER is currently "at or very close to our historic peaks."

This wave is different than earlier waves of the pandemic, though, as data shows visits to the emergency room have not coincided with the case peaks of the pandemic, according to Dr. Tara Kiran, a family physician at St. Michael's Hospital and a researcher at the University of Toronto

Kiran said ERs have typically been at their busiest when overall COVID-19 cases were down in the province. Researchers also found emergency department volume was higher in Ontario in the year leading up to the pandemic compared to the pandemic months.

"That was particularly true and pronounced for that first wave of COVID," she said."But it was also there to a lesser degree during the second and third wave of COVID."

Kiran said there is a belief "people actually are really trying to stay at home and they are sometimes deferring non-essential care" when there is more COVID-19 in the community.

Instead, she says, patients flood ERs when they feel it's safer to seek in-person care, which have typically been the summer months when data showed "an overwhelming number of people in the emergency department."

Family doctors busier than ever

Kiran said data shows no correlation between the number of visits to a family doctor — primary care phyisicians have largely moved to virtual care because of the pandemic — and the patient volume inside emergency rooms.

Dr. Alykhan Abdulla is an Ottawa based family-physician and former chair of the general and family practice section of the Ontario Medical Association. He says the combination of virtual and in-person visits means he's busier than ever. (Francis Ferland/CBC)

Ottawa-based family physician Dr. Alykhan Abdulla said virtual visits mean he has been busier than ever.

"The number of visits that happen in family medicine have actually increased more than they have in any other time in history of my 30 years of being a family doctor," he said.

Abdulla said there are limitations to what can be done from his office, though, such as ordering blood-work, X-rays or ultrasounds after hours, which may drive people to the hospital for those services.

Staffing shortages, COVID-19 protocols

Kiran said staffing shortages and COVID-19 protocols have also greatly lengthened the time it takes to treat patients. 

The research is ongoing and doesn't yet show the full picture, she added. Available data currently doesn't include anything after this past summer, so it's difficult to determine the current situation in Ontario's ERs.

For patients that need care, she said "don't wait to reach out to your family doctor." Doctors can provide an initial assessment to determine what type of care a patient needs.

If the matter isn't an emergency, redirecting that patient to care outside the hospital helps the health-care system play catch-up in critical times such as the current wave of the pandemic.

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