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Emergency wards are so overcrowded, patients have had heart attacks, miscarriages and, in at least one case, even died while in the care queue, prompting doctors to call on provincial governments to implement waiting-time targets and to stop using the hospital department as a patient "dumping ground."

Brian Rowe, professor and research director in the University of Alberta's department of emergency medicine, who has done considerable research in emergency-department overcrowding, describes current conditions as the worst he's seen in 22 years of practice.

"We've had people have heart attacks in the waiting room, we've had sepsis [blood poisoning] in the waiting room, people seize in the waiting room and patients have miscarriages in the waiting room," Dr. Rowe said in an interview. "It's like a Third World country. And this is not unique to Edmonton. This is right across the country."

The Canadian Association of Emergency Physicians is calling on the provinces to adopt a plan in which patients are triaged, admitted or discharged within four to six hours, depending on the severity of their condition, 95 per cent of the time. Once a decision is made to admit a patient, she or he should be transferred out of the emergency department within two hours.

"When we decide that someone needs admission, we don't understand why they are waiting 16 hours," said Alan Drummond, the chair of public affairs at CAEP. "We just don't get it. All that speaks to is that the emergency department is a dumping ground."

With Canadians making more than 14 million visits to emergency departments each year, the need to remedy the system's ills has never been more urgent. That was sadly evident in September when Brian Sinclair, a homeless man and double amputee, died after sitting 34 hours in a Winnipeg emergency room. His death - of a preventable bladder and abdominal infection caused by a blocked catheter - will be the subject of a provincial inquest, while the Health Sciences Centre where he died has announced it is hiring round-the-clock staff to meet incoming patients to avoid such tragedies.

Meanwhile, Kevin Smith, who heads Ontario's alternate-level-of-care expert panel, has an ambitious and novel plan to move as many as 2,800 Ontario patients into nursing homes, retirement centres - possibly even hotels and motels - to free up desperately needed space and reduce lengthy waits in emergency wards.

There is no question that Canadians' confidence has been shaken in a health-care system where the emergency department is supposed to be a last, reliable resort for patients who have exhausted all other avenues.

On a blazing hot summer day at Royal Victoria Hospital in Barrie, one of the busiest emergency wards in Ontario, a sign posted in the waiting room warned that patients who have non-emergencies were facing waits of five to six hours - but that didn't stop people from coming.

In one cubicle was 53-year-old Ed Elson. Complaining of chest pain as well as numbness in his face and left arm, he waited five hours to see a doctor. Emergency physician Andre May ordered more tests.

Mr. Elson, a prostate-cancer patient, spent a full eight hours there that day. Weeks later, doctors had still not determined the cause of his symptoms, said his wife, Lynne.

"When we see patients, the care is good, the diagnostic services are better than when we came," Dr. May said. "We just can't see people in a timely fashion."

Overcrowded emergency wards are a symptom of hospital congestion. They cause operations to be cancelled because there are no beds for recuperating patients. Ambulances stay parked outside for hours, unable to offload patients for the same reasons. Some patients, tired of waiting, leave before being seen by physicians, sometimes with dire consequences. Doctors, nurses and other health-care workers scrounge every bit of space they can find.

"Certainly we have examined patients in hallways and in clean utility rooms," said Halifax-based Mary-Lynn Watson, a former president of the Canadian Association of Emergency Physicians, "because there is physically no other place to put them."

Across the country, provinces and hospitals are trying to repair the problem.

David Levine, president and chief executive officer of the Montreal Health and Social Services Agency, is overhauling services with an eye to reducing the number of emergency-room visits by half.

British Columbia is opening more beds and has done a pilot project that has paid four hospitals more money if they see patients in a targeted period of time, echoing a practice in England.

"Have we solved the problem? No," said B.C. Health Minister George Abbott, answering his own question. "Have we improved the situation? I believe we have. This is a work in progress."

In Ontario, 23 emergency departments are subject to performance goals, where patients must be triaged, admitted or discharged within four to eight hours, depending on the severity of their condition. Those hospitals that do not meet a series of specific goals, which includes reducing queues for care, are subject to financial clawbacks from the province. The initiative is likely to expand to more hospitals next year, said Michael Schull, head of Ontario's expert panel for ER waiting times.

Those moves alone, however, are not enough, and that's where Dr. Smith comes in. His plan to unclog emergency rooms by moving hospital patients to other facilities is based on troubling statistics: Roughly one in five patients in acute-care hospitals is ready for discharge but has nowhere to go.

"There is enough of a logjam that we do need to open some transitionary capacity," said Dr. Smith, who is also president and executive officer of St. Joseph's Healthcare in Hamilton. "...That includes beds, day programs, modified homecare - alternatives to being in a hospital." Dr. Smith stressed that patients moved out of hospital will receive appropriate care.

Some alternate-level-of-care patients are already being moved to other facilities, but Dr. Smith said the next phase, starting in April, 2009, is subject to government approval. The key, he said, is trying to care for patients at home as long as possible.

"This agenda is not one of efficiency," Dr. Smith stressed. "It's an agenda of patient safety."

Tom Closson, president and chief executive officer of the Ontario Hospital Association, which has been gathering the data from its members, found that on any given day in July of this year, 2,800 patients were in acute-care beds waiting to be placed elsewhere. And 694 patients on average were waiting in emergency wards for an acute-care bed.

"They can't get into the inpatient unit," Mr. Closson said. "...It's a clear indication why something needs to be done."

The Canadian Association of Emergency Physicians thinks so, too. It is also asking that more acute-care beds be added so hospitals can operate at 85-per-cent capacity; many currently operate at 95-per-cent capacity and beyond.

Dante Morra, an internist and director of the clinical teaching unit at Toronto General Hospital, helped found the Centre for Innovation in Complex Care at the city's University Health Network. It identifies problems and seeks solutions for complicated patients who come to emergency wards.

"It's undignified when you're well, but when you're really sick, it's overwhelming," said Dr. Morra of patients who wait in hallways. "It's nobody's fault, but it's just that someone has to have this on their radar."