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Nurse Sue Thorne is seen in the Emergency Room at Sunnybrook Health Sciences Centre in Toronto, Ontario Friday, November 15, 2013.

Kevin Van Paassen/The Globe and Mail

This is part of The Globe's months-long series on the challenges facing Canadian hospitals. All of our published material has been reported with permission from staff.

Sue Thorne glances at her computer screen, hoping to see a blue bar. Right now, the name of every patient being admitted to the hospital from the emergency department is highlighted with a red bar, which means they are stuck in emergency until a bed is available. When a blue bar appears, they can move on.

Around Thorne, the emergency department at Sunnybrook Health Sciences Centre hums with activity in the midst of controlled chaos.

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It's been a bad three weeks in the department. An unusual crush of new, sick patients is arriving daily, despite the fact that there is little room to accommodate them in the already-crowded hospital. Thorne, the charge nurse who co-ordinates staff and keeps the department functioning – not unlike an air-traffic controller – is tethered to her desk in the nursing station, fielding phone calls and answering questions from staff.

Nurses, doctors, social workers and other staff hurry past the station on their way to check the many patients that are lying on the stretchers that surround the perimeter of the "green zone," one of four separate pods that make up the department.

Dr. Brian Cuthbertson, chief of the critical-care department, approaches Thorne's desk to inquire about the newly admitted patients who are under his care but still don't have hospital beds. A social worker comes by to update Thorne about a 14-year-old girl whose mother started slapping her when she learned her daughter was depressed and cutting herself. Security was called to physically remove the girl's mother from the hospital; the social worker has serious concerns about the girl's safety if she is sent home.

As these crises unfold, just a few steps away the emergency department's waiting room is nearly filled to capacity with patients and family members who are waiting to be seen.

It's not just about managing space. Resources are also in short supply. The department only has two rooms with the equipment to resuscitate patients. If both are in use – often a daily occurrence – there is nowhere for a new patient to go. And at any given moment, an ambulance may arrive with a gravely ill patient, or the trauma team could be called into action to save the life of a critically injured individual.

For Thorne, the critical challenge is flow: ensuring patients move through her department and into the right spot so staff can continue seeing incoming people. When the department is full and the hospital has no spare beds, the emergency department starts to back up very quickly.

"It is anxiety-provoking all day long," Thorne says. Her computer screen is still a solid block of red.

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