Doctors, nurses call for reforms to prevent overcrowding in Canada’s emergency rooms

Overcrowded emergency rooms are frustrating patients and staff in parts of the country as respiratory illness season exacerbates long waits for care. 

Combined with bed shortages, an aging population and a lack of community care, it’s converging to create a crisis, health professionals say.

“Wait times are through the roof,” Erin Ariss, president of the Ontario Nurses Association, said Wednesday. “Nurses are beginning their shifts in the morning and coming on to emergency departments that are full or over capacity with admitted patients.”

Packed emergency rooms are also a major concern in Quebec, where Health Minister Christian Dubé said Wednesday that the public should avoid going to ERs altogether if they can, and instead seek care at family medicine clinics, or clinics led by nurse practitioners. He made the announcement after a group representing chief doctors in the province’s ERs sent a letter saying overcrowding is “out of control.”

Dr. Judy Morris, head of an association of emergency room doctors in Quebec, said earlier this week that occupancy rates were as high as they’d ever been and some hospitals regularly have twice as many ER patients as they can handle. Health data website Index Sante said the average emergency department occupancy in Quebec on Thursday morning was above 120 per cent. 

Emergency rooms in other parts of the country are also crowded. In Nova Scotia, for example, the health authority’s website listed expected ER wait times of up to six hours on Thursday in some hospitals, including Cape Breton Regional Hospital. And in Winnipeg, three out of four hospitals were reporting average ER wait times of between seven and nine hours on Thursday morning. 

Earlier this month, Dubé said the recent deaths of two people in a Montreal-area ER were “completely unacceptable,” though he defended his government’s actions to reduce wait times. Quebec’s coroner’s office and the local health authority in Chateauguay, Que., are investigating the deaths.

Hospitals in Saskatchewan’s major cities have also been over capacity due to a lack of space for people needing long-term or alternative care, combined with staff shortages. In Regina, two hospitals recently violated the fire code by crowding hallways with patient beds, according to a leaked email chain. The Saskatchewan Health Authority said Thursday that it will work to add more staff and discharge patients in a timely manner to free up space.

Dr. Michael Howlett, president of the Canadian Association of Emergency Physicians, said the group is expecting to convene a national forum next year that would bring together policymakers and health-care professionals to discuss how the health-care system could be reformed to deal with pressures that end up affecting ERs.

That includes a lack of hospital beds for patients who need to be transferred from ERs, a lack of long-term care beds and home-care staff for patients who remain on hospital wards, and staff recruitment and retention issues.

Howlett said he could not find any home-care staff for his own mother after she was to be discharged from hospital.

“She stayed in hospital for six months,” he said. “All across the country you’ll find anywhere between 10 and 25 per cent of hospital beds are taken up by people who need an alternate level of care, besides acute-care hospitals, but they can’t be accommodated.”

Much of the action that needs to be taken is for the sake of patient safety, Howlett said.

“We don’t want to be just complainers that say it’s all broken and you guys have to fix it. We have lots of people in the country with great expertise in health systems,” he said.

“I mean, it’s a fairly critical point in Canadian health-care history and so I’m not sure how long we should really wait to implement solutions.”

Ariss, the head of the Ontario nurses’ group, said nurses are overwhelmed after enduring long working hours at the height of the COVID-19 pandemic, which forced some to leave for jobs in public health or with agencies that gave them more balance.

Ontario alone needs 24,000 more registered nurses, but working conditions aren’t exactly attracting new recruits, said Ariss, who worked as an ER nurse for 20 years in Kitchener, Ont., before leaving in December 2020.

Making matters worse is that emergency rooms in some rural areas have been temporarily closed or shut down because of staffing shortages, leaving patients to travel further for care, Ariss added.

“There’s a feeling of hopelessness at this point, that there’s no help coming,” she said.