One in 10 Canadians who arrive at an emergency room sick enough to be admitted wait more than 27 hours for a bed, according to fresh data that reveal hospitals are missing by a wide margin a new target set by the country’s emergency physicians.
Statistics on emergency-room use from the Canadian Institute for Health Information released on Thursday show that 90 per cent of patients who need to be admitted are checked into a bed in 27.9 hours or less – more than twice the 12-hour target the Canadian Association of Emergency Physicians suggested when it called for national standards last fall.
The median wait for patients to be admitted to a bed was 8.8 hours, meaning half waited less than that and half waited longer. The CAEP target is eight hours.
The news is better for people who do not need to stay: Hospitals are meeting or exceeding the CAEP’s proposed goals for treating and discharging less seriously ill patients.
For example, the median wait for patients with less- or non-urgent ailments was 1.6 hours, below the CAEP’s two-hour goal.
In the three jurisdictions that CIHI has tracked longest, time spent in the emergency room overall is down slightly over the past three years, thanks chiefly to improvements in Alberta and Ontario.
Still, the disparity in the ER waits of patients who need to be admitted and those who can be discharged highlights a problem in Canada’s hospitals: a shortage of acute-care beds.
“We’re so crunched for acute-care beds in Canada that if five or 10 or in some places 15 per cent of the beds are occupied by patients who are ready to go to chronic care or nursing-home care, that’s a big loss,” said Howard Ovens, director of the emergency centre at Toronto’s Mount Sinai Hospital.
In 2009, Canada had 1.7 acute-care beds for every 1,000 Canadians, putting it second last in a ranking of 34 OECD countries. The OECD average is 3.4 beds per 1,000.
Dr. Ovens co-wrote a position paper for CAEP last November that called for nationwide standards on emergency room waits, a call Ottawa has not heeded, at least publicly.
The paper lamented that Canada does not even have a common definition of an emergency room wait time, let alone standards that can be measured and compared across 13 disparate health-care systems.
“We’re flying blind,” Dr. Ovens said. “I can’t say how many patients are experiencing waits that are much longer than what we call for. Without data, we can only speculate.”
The new CIHI figures underscore that challenge. Drawn from the National Ambulatory Care Reporting System, they include results from every hospital in Ontario, Alberta and Yukon, some hospitals in B.C., Saskatchewan, Nova Scotia and PEI, and none in the remaining jurisdictions.
That’s an improvement over previous years: This year is the first in which NACRS received information from jurisdictions other than Ontario, Alberta and Yukon.
CIHI data crunched at the request of The Globe and Mail show small but steady improvement in those jurisdictions since 2010-2011.
When it comes to length of stay in the ER – which the CIHI defines as the time elapsed between registering and being discharged or checked into a bed – Ontario’s hospitals admitted nine out of 10 patients in a maximum of 29.6 hours in 2012-2013, down from 30.6 and 32.4 in the two years previous.
The median waits for admitted Ontario patients were 10.1 hours in 2010-2011 and 9.8 hours in 2011-2012 and 2012-2013.
The latest CIHI report also reveals who uses the country’s emergency rooms. Children under the age of five were the most frequent visitors, accounting for 8.7 per cent of total visits. Adults aged 20 to 24 made up 7.6 per cent of visitors.
Adults aged 65 to 69 accounted for 4.5 per cent of visits.