How Canada’s emergency rooms are faring as major staffing shortages persist

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A group of nearly 200 Calgary emergency physicians released an open letter on Wednesday calling attention to a health care crisis across the province, with dire staff shortages, overcrowding and long waiting times compromising patient care.

Their warning echoes a press release issued earlier this month by a B.C. physicians association that said hospitals across the province are being overrun because of a complex set of factors that has been ignored too long.

And at the end of the month, an Ontario cottage country hospital plans to permanently close one of its emergency departments as a result of staff shortages, creating an outpouring of concern from the community.

Roughly one year after a marked increase in emergency room closings prompted a national outcry, the health care system remains in a state of crisis, according to medical workers and hospital administrators. A critical shortage of health care workers, lack of access to primary care, overcrowded hospitals and lengthy emergency room waits have become the norm. Some health care workers say the situation is so bad that people are no longer receiving timely, high-quality care and that health care workers are suffering from the effects of non-stop demands.

“We routinely see people in the hallway, in the waiting room,” said Shawn Dowling, an emergency physician at Foothills Medical Centre and the Alberta Children’s Hospital in Calgary who signed the open letter. “We are bursting at the seams.”

The problems outlined in the letter from Calgary emergency physicians could be cut and pasted to apply to any region of Canada, Dr. Dowling said. Across the country, too many patients are waiting for hours or days in emergency rooms, struggling to get access to the specialized medical care they need or lacking access to primary care.

“The emergency department is often viewed as the canary in the coal mine,” Dr. Dowling said. “We are seeing more chronic illness, more complex cases, more cancer patients, more addictions patients who need care provided in the community but, unfortunately, the community care has disappeared so we’re left to deal with this in more costly, less supported acute care facilities.”

While some hospitals are trying to be adaptive and plan ahead for this summer, when vacations will make worker shortages even more challenging to navigate, others say providing adequate care under an ever-present array of challenging circumstances is becoming more difficult.

“We just can’t provide the care that we’re used to providing,” said Gord McInnes, an emergency physician in Kelowna and co-president of the section of emergency medicine at Doctors of BC.

Dr. McInnes and his colleagues published a press release earlier this month warning about crises unfolding at emergency rooms across the province. In response, a group of concerned physicians at the busy Surrey Memorial Hospital published an anonymous letter, saying that challenging conditions are leading to worse outcomes for patients and, in some cases, contributing to deaths.

In a statement, Fraser Health spokesperson Nick Eagland said emergency departments are experiencing higher-than-normal patient volumes provincewide, adding that Surrey Memorial is also dealing with a health worker shortage. The statement said Fraser Health is working with the province on recruitment strategies.

In Ontario, the recent announcement that the emergency room servicing Minden, a rural area of cottage country, will close its doors for good has sparked an outcry from concerned community members who say having to rely on the next nearest hospital, which is a 25-minute drive away, will lead to poorer outcomes.

Carolyn Plummer, president and chief executive officer of the Haliburton Highlands Health Services, said the hospital made the difficult decision after months of temporary emergency room closings, which are largely the result of staff shortages.

“Over the last 18 months, it’s been a real struggle to find people,” she said. “We’re at a point now where we can’t continue. It’s not sustainable.”

Alan Drummond, an emergency room physician in Perth, Ont., and spokesperson with the Canadian Association of Emergency Physicians, said that more communities will face tough decisions about closings as they grapple with staffing challenges and limited resources.

“Nothing has changed. We’re about to start the summer season and all we can do is hold our breath and cross our fingers,” Dr. Drummond said.

He said he believes it’s time for a national discussion on what the future of emergency care should look like because it’s unrealistic to expect that each small community will have its own emergency services.

The problems facing the health care system are multifaceted, but medical professionals and hospital administrators say there are a handful of issues – namely staffing, bed and primary care shortages – that, if addressed, would go a long way to alleviating the crisis.

Some of the proposed solutions include: improving working conditions and salaries for nurses so that existing workers and new graduates stay on the job; more funding for long-term care beds in the community; more money being spent on primary care to improve access and help people avoid the emergency room.

Millions of Canadians don’t have a family doctor, which leads to poorer patient outcomes and other health care system issues. Jobin Varughese, president-elect of the Ontario College of Family Physicians, said there are short-term solutions that could quickly resolve some of the issues.

For instance, reorganizing more physicians to work in teams of health providers would help reduce the amount of administrative work many independent physicians have to do and allow them to instead focus on patient care, he said. The system for specialist referrals could also be overhauled and centralized, reducing the timely paperwork facing family doctors and making the system more transparent, he said.

Many hospitals, including Toronto’s University Health Network, the Winnipeg Regional Health Authority and southwestern Ontario’s South Bruce Grey Health Centre, which has experienced numerous emergency closings in the past year, declined to answer questions about hospital capacity issues.

Those that did respond said they are using a mix of innovative solutions to try to operate at full capacity and address pandemic-related backlogs.

Ron Gagnon, president and CEO of the Grand River Hospital in Kitchener, Ont., said the emergency room was designed for 170 people a day, but is averaging 219.

“Over the last two years, we’ve seen a 30-per-cent growth in overall visits to our emergency department,” Mr. Gagnon said. “What we’ve also seen is an increase in the number of people that need to be admitted.”

David Pichora, president and CEO of Kingston Health Sciences Centre, said the hospital has had success in recruiting new nurses, but had to rely on nursing agencies to fill gaps in recent months. Physicians are in short supply and the lack of primary care in the community is a major challenge, he said.

But in cases where patients have a primary care provider, the hospital has had some success at encouraging more of them to see their family doctor for non-urgent issues instead of going to the emergency room. Dr. Pichora said the hospital has reduced non-urgent visits to the emergency room by about 30 per cent.

“We don’t have patients in the hallway every day any more,” he said. “Just some days.”