Patients in emergency rooms around Ontario are waiting record lengths of time to get admitted to hospital, a situation medical professionals say only appears to be getting worse.
The trend is particularly worrisome for hospitals because it’s happening despite a diminishing COVID-19 caseload, and because it comes at a time of year when the burden on emergency departments usually eases.
More than two years into the pandemic, the wait times are a sign of just how chronically strained the province’s hospitals have become.
“Our emergency departments are under more stress than I’ve ever seen in my career,” said Dr. Howard Ovens, who has worked in the ER at Toronto’s Mount Sinai Hospital for nearly 40 years and chairs the province’s emergency services advisory committee.
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“The workload related to the patients that we are seeing is at a record high,” said Ovens in an interview.
Key factors driving the long wait times are largely spin-off effects of the pandemic:
High rates of staff calling in sick or unable to work because they’ve been exposed to COVID-19.
Patients whose illnesses are more severe, often because they delayed seeking treatment during the big pandemic waves.
Hospital wards filled to capacity by trying to catch up on backlogged surgeries and procedures, so that it’s a challenge to squeeze in ER patients who need to be admitted.
This comes on top of long-standing issues in the system that extend well beyond the doors of the emergency room, including discharge bottlenecks caused by a shortage of long-term care spaces and home-care support.
Underpinning the rising emergency department wait times are problems that existed in Ontario’s health-care system long before COVID-19 came along, and never really went away: hospitals so routinely stretched beyond their capacity that caring for patients in hallways became the norm.
Mix it all in with what officials say are record-high numbers of patients being brought in by ambulance and record-high numbers of ER patients requiring admission, and it’s resulting in emergency room wait times that have never been seen before at this time of year.
The latest statistics published by Ontario Health show that patients who came to an ER in April and were admitted to hospital spent on average 20 hours in the emergency department before getting a bed in a ward.
That figure is the longest wait time Ontario has ever posted in April. It’s 42 per cent higher than it was in April 2021, and only a fraction off the record-high 20.1 hours average wait time seen at the peak of the Omicron wave in January.
While more recent wait time statistics are not publicly available, administrators and medical professionals with direct knowledge of the system say the situation in emergency rooms has not improved since April.
“The emergency departments are on fire,” said Amie Archibald-Varley, a registered nurse who works in the ER of a large hospital in the Greater Toronto Area.
“Everybody is operating under a level of very, very high acuity and high stress,” said Archibald-Varley, who also co-hosts the Gritty Nurse Podcast. “The emergency department has always been an area where it’s been fast-paced … but we are now stretched beyond capacity.”
Archibald-Varley is one of several people involved in the system who say a shortage of specially trained nurses is the most acute human resource challenge currently facing ERs.
“Really what we’re just trying to do is keep our heads above water,” she said. “But it’s a very, very stressful and very, very difficult time right now in the emergency departments.”
Heavy demands on staff mean a far-from-ideal ER experience for patients. In some particularly overstretched hospitals, admitted patients face waiting, on average, more than two days in the ER before they get a bed.
Those patients often spend that waiting period on a stretcher in a hallway or a repurposed room, and their continued presence contributes to a kind of gridlock in the emergency department.
Paramedics get stuck waiting alongside someone they’ve brought in by ambulance because there isn’t an available nurse to take charge of the new patient.
Cathryn Hoy, president of the Ontario Nurses’ Association, says some emergency departments are operating without filling large numbers of vacant nursing positions, and the ratios of patients to staff are growing dramatically.
“I don’t think the people of Ontario really know what is going on in the emergency rooms,” said Hoy, whose union represents 68,000 nurses and other health care professionals across the province.
“Our existing staff shortages are actually getting worse. There’s burnout. They’re sick. They’re highly stressed,” said Hoy in an interview.
Doctors are describing what’s happening in the ERs in record terms.
“It’s pretty difficult, challenging times,” said Dr. Andrew Arcand, chief of emergency medicine at Markham-Stouffville Hospital.
“We are seeing more [patient] numbers, more volumes than ever before,” Arcand said in an interview. “The acuity or the sickness level of our patients is far higher than it has ever been. And probably the most dramatic thing is our hospital is running well over 100 per cent capacity pretty much every day.”
As a result, Arcand says patients who need to be admitted remain in the emergency department while waiting for a bed, while staff try to keep up with new patients coming into the ER.
“That is at a level that we’ve not seen ever before in our department’s history,” he said.
Dr. Kashif Pirzada, an emergency room physician in Toronto, says the combination of short staffing and high patient demand are leading to unprecedented wait times for patients and taking a heavy toll on staff.
“We’re basically stretched like no time I’ve ever seen in my career, and that’s going back 15 years,” said Pirzada in an interview.
“Each wave of COVID causes a wave of admissions that causes stress on the system,” he said. “That’s chronic stress that the system just wasn’t designed to deal with.”
Still, doctors are urging people to come to the emergency room if they are sick enough to need urgent care. They also say staff drop everything to give immediate attention to people who arrive in life-and-death circumstances such as traumatic injuries or a heart attack.
“I’m very proud of my colleagues … doing their best under difficult conditions,” said Ovens.