20-hour waits: Canadian doctors group reports overflowing emergency rooms

The Canadian Medical Association is calling on provinces and territories to rebuild the health-care system to provide more access for patients amid reports of overflowing emergency rooms across the country.

Both patients and health-care professionals are suffering under the current state of affairs, and that changes need to be made to overhaul the entire system, the organization said in a statement on Thursday.

“Despite the tireless efforts of physicians, nurses and other health providers, testimonies from around the country illustrate that patients in some jurisdictions are waiting as long as 20 hours or longer to receive care,” Kathleen Ross, president of the CMA, wrote in the statement.

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“Staff shortages and hospital overcrowding combined with poor access to high-quality team-based primary care are leaving hospital emergency departments woefully under-resourced for the avalanche of patients with influenza, COVID-19 or respiratory syncytial virus (RSV) at this time of year.”

Many hospitals are currently struggling with an influx of patients. In mid-December, a Kingston hospital announced it was “bursting at the seams” with COVID-19 and RSV patients, operating at a 120 per cent occupancy rate. On Wednesday, B.C. hit a record for its inpatient hospital population, with more than 10,000 patients.

“Our health system has collapsed,” Dr. Lisa Salamon, a Toronto-based ER physician, told CTV News Channel on Thursday. “It’s only getting worse.”

RENEWED CALLS FOR TEAM-BASED CARE

A potential solution is team-based primary care, which CMA suggests that parliamentarians bring up during the winter session in the context of a health-care overhaul.

Team-based primary care is a strategy that allows health-care professionals to work together in an interdisciplinary team, allowing them to focus on their specialties and refer patients to another expert in the team quickly depending on their medical needs.

A study published in 2022 found that patients receiving team-based primary care had lower rates of emergency department visits than patients receiving non-team-based care. A Manitoba panel included a shift to team-based models as one of their recommendations in a December report on overhauling the health-care system.

Team-based care exists in a few places in Canada including Alberta, Ontario and Quebec, according to CMA, under different models and names, but it hasn’t been widely implemented.

CMA previously called for more team-based primary care in a report this summer, which recommended that governments establish care teams to cover 50 per cent of the Canadian population within the next five years, and 80 per cent within ten years.

“No one wants to spend 20 hours waiting for the care they or their loved ones need,” the Thursday statement reads.

“The Canadian Medical Association (CMA) believes it is well past time to transform and rebuild the health care system, including investing upstream in team-based primary care.”

EMERGENCY DEPARTMENTS STRETCHED THIN

The CMA noted that emergency departments run the risk of being treated as an alternative to primary care when patients don’t have that option—but the influx of patients being seen right now in emergency departments are ones who belong there, according to Salamon. She says the issue of emergency departments overflowing is caused by systemic issues beyond the lack of primary care.

“We have problems because patients are admitted to the hospital, we’re short on inpatient beds, and so what ends up happening is that the patients who are sick and require admission end up staying in the emergency department, often for days, and what that leads to is then patients in the hallways and longer waits,” she said. “And that really is the root cause when we’re talking about emergency overcrowding.”

Being short on hospital beds can mean a lack of physical beds due to occupancy, but also can mean there’s a lack of proper staff to manage those beds, so there’s not a quick solution.

She noted that 20-hour waits aren’t common in her experience, but that wait times are an increasing problem.

“The patients who come to the emergency departments that I work at often are being seen within two-and-a-half hours, obviously people who are much sicker are being seen right away. That being said, there are many hospitals … across the country where I’m hearing that patients are waiting four, five, six hours.”

Salamon added that those numbers track how long it takes for a patient to see a physician after seeing a triage nurse.

“That doesn’t account for the time when a patient walks into the emergency department and is waiting to see a triage nurse,” she said.

Patients have told her they sometimes have to wait a couple hours before even being assessed by a nurse.

"So I think the waits are even longer than the data we’re seeing.”

From the emergency department perspective, the issue boils down to a lack of long-term care beds and a lack of home care, Salamon said, which causes patients to stay longer in hospital than they should.

“Many patients could be at home if they had the proper home care,” she said.

“I remember when the Ford government in Ontario came in, they said their mandate was to end hallway medicine. And then through the pandemic (to) basically now it went from hallway medicine to waiting room medicine.”

When asked for comment, a spokesperson for the Minister of Health told CTVNews.ca that Ontario has some of the shortest wait times in Canada and added more than 17,000 new nurses and 2,400 new physicians to the workforce “while investing an additional $44 million this year (23/24) to reduce emergency department wait times through local, innovative solutions.”

“Ontario has one of the largest publicly funded healthcare systems in the world, a system we have invested over $80 billion in this year,” spokesperson Hannah R. Jensen wrote in an email. “We also understand that a key part of this plan is to ensure all Ontarians who want access to primary care are able to, which is why we are investing tens of millions of dollars to create new interdisciplinary primary care teams across the province, including nurse practitioner led clinics.”

As the most populated province, Ontario has one of the largest health-care budgets. However, a report from the Financial Accountability Office of Ontario in March 2023 found that the province had allocated $21.3 billion less for 2022-23 to 2027-28 than will be needed to fund its current health sector programs and deliver on its commitments.

The report suggested that this chronic underfunding in comparison to the projected growth in demand will mean that by 2027-28, Ontario will have less hospital capacity and less long-term care capacity than it did in 2019-20.

RECKONING NEEDED TO PROMPT REAL CHANGE, EXPERTS SAY

The CMA’s statement is far from a new call—health-care experts have been raising the alarm about the need to patch the massive holes in the health-care system for years now. The COVID-19 pandemic caused a huge amount of strain to the system, health-care professionals said, leaving it overstretched and understaffed.

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But despite the calls for change, the situation has continued to worsen. Currently, a fifth of Canadians do not have access to a family doctor, meaning they can’t access timely care for small problems or receive quality care for chronic issues, according to the CMA.

According to a recent report by the Ontario College of Family Physicians, there could be 4.4. million people without a family doctor by 2026. And the lack of primary care can have an often unmeasured impact on emergency departments; when chronic problems aren't addressed when they first emerge, it increases the risk that a patient might end up in the emergency department.

“We really need a pan-Canada meeting with all the health ministers,” Salamon said, echoing CMA’s call for provinces to step up.

“Without concerted collaboration and focus, we will continue to endure endless cycles of deterioration of our health systems and the people working within it,” Ross wrote in the CMA statement.