An Ontario doctor says ERs are more stressed than ever — the data backs it up

Patients in Ontario emergency rooms are waiting record time to be admitted to the hospital, a situation that medical professionals say only seems to get worse.

The trend is particularly concerning for hospitals because it comes despite declining numbers of COVID-19 cases and because it comes at a time of year when the load on emergency departments typically eases.

More than two years into the pandemic, the wait times are a sign of how chronically strained the province’s hospitals have become.

“Our emergency departments are under more stress than ever in my career,” said Dr. Howard Ovens, who has worked in the emergency room at Toronto’s Mount Sinai Hospital for nearly 40 years and chairs the emergency services advisory committee. from the province.

Have you or someone close to you recently endured a prolonged stay in an emergency room in Ontario? Email CBC News to tell us about your experience.

“The patient-related workload we’re seeing is at a record level,” Ovens said in an interview.

Nurses in the emergency department at Scarborough General Hospital. Staff shortages as a result of illness, exposure to COVID-19, and burnout are some of the reasons behind increased wait times in Ontario emergency rooms. (Evan Mitsui/CBC)

The key factors driving long wait times are largely secondary effects of the pandemic:

  • High rates of staff calling in sick or unable to work because they have been exposed to COVID-19.

  • Patients whose illnesses are more severe, often because they delayed seeking treatment during large pandemic waves.

  • Hospital wards have been filled to capacity trying to catch up with backlogged surgeries and procedures, making it a challenge to squeeze in emergency patients who need to be admitted.

This adds to long-standing problems in the system that extend far beyond the ER doors, including discharge bottlenecks caused by a shortage of long-term care slots and home care support.

The issues underlying rising emergency department wait times are issues that existed in Ontario’s health care system long before COVID-19 emerged, and never really went away: Hospitals were so routinely stretched beyond their capacity caring for patients in the corridors became the norm.

Mix it all up with what officials say is a record number of patients being admitted by ambulance and a record number of emergency patients requiring admission, and it’s resulting in wait times in the ER that have never been seen before. At this time of year. .

Paramedics are pictured outside the Toronto Western Hospital emergency department on June 15. Health system officials say Ontario hospitals are seeing record volumes of patients being brought to emergency rooms by ambulance. (Esteban Eduardo Cuevas Gonzalez/CBC)

the latest stats published by Ontario Health shows that patients who went to an emergency room in April and were admitted to the hospital spent an average of 20 hours in the emergency department before getting a bed in a ward.

That figure is the longest wait time Ontario has ever recorded in April. That’s 42 percent higher than in April 2021, and just a fraction of the record average wait time of 20.1 hours seen at the peak of the Omicron wave in January.

While the most recent wait time statistics aren’t publicly available, administrators and medical professionals with direct knowledge of the system say the situation in emergency rooms hasn’t improved since April.

“Emergency departments are on fire,” said Amie Archibald-Varley, a registered nurse who works in the emergency room of a large hospital in the Greater Toronto Area.

“Everyone is operating under a very, very high level of acuity and stress,” said Archibald-Varley, who also co-hosts the Gritty Nurse Podcast. “The emergency department has always been a fast-paced area … but now we’re at the limit of our capacity.”

Archibald-Varley is one of several insiders who say the shortage of specially trained nurses is the most acute human resource challenge facing emergency rooms today.

“Really what we’re trying to do is keep our heads above water,” he said. “But it’s a very, very stressful time and a very, very difficult time right now in emergency departments.”

Amie Archibald-Varley is a registered nurse who works in the emergency department of a large hospital in the Greater Toronto Area and co-hosts the Gritty Nurse Podcast. (Danielle Blanche)

High demands on staff mean a less than ideal ER experience for patients. In some particularly overburdened hospitals, admitted patients must wait, on average, more than two days in the emergency room before getting a bed.

Those patients often spend that waiting period on a gurney in a hallway or repurposed room, and their continued presence contributes to a kind of gridlock in the emergency department.

The paramedics are stuck waiting next to someone brought in by ambulance because there is no nurse available to take care 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 patient-to-staff ratio is growing dramatically.

“I don’t think people in Ontario really know what’s going on in emergency rooms,” said Hoy, whose union represents 68,000 nurses and other health professionals across the province.

A paramedic checks on a patient waiting in the corridor of the emergency department at Humber River Hospital in Toronto on January 13, 2022. (Evan Mitsui/CBC)

“Our existing staff shortage is actually getting worse. There’s burnout. They’re sick. They’re very stressed,” Hoy said in an interview.

Physicians are describing what is happening in emergency rooms in terms of the record.

“These are quite difficult and 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 level of disease of our patients is much higher than ever. And probably the most dramatic thing is that our hospital is running well above 100 percent capacity almost every day.”

As a result, Arcand says, patients who need to be admitted remain in the ER while they wait for a bed, while the staff tries to keep up with new patients coming into the ER.

“That’s on a level that we’ve never seen before in the history of our department,” he said.

Dr. Andrew Arcand is chief of emergency medicine at Markham-Stouffville Hospital. (Michael Charles Cole/CBC)

Dr. Kashif Pirzada, an emergency room physician in Toronto, says the combination of staffing shortages and high patient demand is creating unprecedented wait times for patients and taking a heavy toll on staff.

“We’re basically stretched out like never before in my career, and that goes back 15 years,” Pirzada said in an interview.

“Each wave of COVID causes a wave of admissions that puts stress on the system,” he said. “That’s chronic stress that the system just wasn’t designed to handle.”

Still, doctors urge people to go to the emergency room if they’re sick enough to need urgent care. They also say staff drop everything to provide immediate care for people who arrive in life-threatening circumstances, such as traumatic injuries or a heart attack.

“I’m very proud of my colleagues … giving their best in difficult conditions,” Ovens said.

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