Patients needing admission to hospital stuck in ER longer, report says

Emergency department wait times in Canada are continuing to rise, particularly for patients needing a bed in inpatient wards, the Canadian Institute for Health Information says.

Toll is greatest on elderly patients, doctors say

Seniors waited almost five hours longer in 2016-2017 in emergency departments for an inpatient bed than they did the previous years. Most waited up to 36 hours, according to new data from the Canadian Institute for Health Information. (CBC)

Emergency department wait times in Canada are continuing to rise, particularly for patients needing a bed in in-patient wards, the Canadian Institute for Health Information (CIHI) said in a report released Thursday

The majority of Canadians who go to emergency departments get the care they need there and then go home, the report said. Among those patients, nine out of 10 spent less than eight hours in emergency rooms in 2016-2017 — an increase of about 20 minutes from the previous year. 

The bigger problem, the report said, is among patients who are elderly or very sick and need to be admitted to an in-patient ward for further acute care. Most of those patients spent up to 32.6 hours stuck in the emergency department waiting for an in-patient bed — more than three hours longer than in 2015-2016. 

Seniors (age 65 and older) waited even longer — up to 36 hours. That's almost five hours longer than the previous year. 

That's particularly concerning, emergency physicians say, because seniors are especially vulnerable to deteriorating health as they lie in busy hallways. 

"They are subject to delirium and deconditioning, increased complications and rates of inability to return home when their needs are not met in hospital, and they're vulnerable to hospital-acquired infections," wrote Dr. Howard Ovens, chief medical strategy officer for the Sinai Health System in Toronto, in CIHI's report summary. 

Hospitals 'bursting at the seams'

Although they're concerned, emergency staff aren't surprised by CIHI's findings. 

"Hospitals are bursting at the seams," said Dr. Blair Bigham, an emergency medicine resident at McMaster University Medical Centre in Hamilton, Ont.

For years, emergency doctors and health policy experts have said that the problem of emergency department wait times isn't primarily an emergency department problem, but the consequence of backlogs in other parts of the health-care system.

When patients can't be discharged from acute-care wards in hospitals because they're waiting for home care or a space to open up in a long-term care home, they remain in those beds even though they no longer need hospital-level care. That in turn means that bed isn't available for another patient waiting in the emergency department to be admitted to that ward. 

That's why it doesn't make sense for people to suggest increasing emergency department capacities before they first address the number of available beds elsewhere in the hospital, said Dr. Anil Chopra, emergency medicine director at  University Health Network (UHN) in Toronto. 

Dr. Anil Chopra, head of emergency medicine at Toronto's University Health Network, says CIHI's report is no surprise to anyone who lives with emergency department overcrowding issues every day and especially worries about the impact on elderly patients. (University of Toronto)

Patients waiting in emergency department hallways to be admitted aren't getting the care they need, Chopra said.

"There are a lot of signals that the outcome for these patients are not as good as they could have been had they been shunted away from the emergency department to the appropriate in-patient area," he said. 

It's also simply an experience people shouldn't have to go through, he said. 

"How would you like your friends or your relative to be lying in a hallway in emergency with a six-inch mattress for 24 hours after the emergency care is done and you've been admitted?" Chopra said. "There's little privacy, there's constant noise, there's inadequate infection controllabilities."

"What about the human experience?"

With files from Christine Birak