Whenever overcrowding pushed the Sault Area Hospital to the brink, administrators used to call a "Code Burgundy," triggering a co-ordinated effort to find extra room for patients at the Northern Ontario hospital.
At the start of this year, the hospital scrapped its Code Burgundy – not because crowding had eased, but because the designation had become meaningless. "We used to be there every day," said Ron Gagnon, the chief executive officer of the Sault Ste. Marie facility. "People had just become immune to it."
The Sault Area Hospital's acute-care section has had the second-highest average occupancy rate of any hospital in Ontario over the past five years, according to figures obtained through access-to-information laws and analyzed by The Globe and Mail.
The hospital's average occupancy rate was just over 106 per cent between 2012 and the end of last year; it peaked at 120.8 per cent in the winter of 2015.
It was one of six hospitals in Ontario whose acute-care beds – which includes all in-patient beds except mental health and chronic care – averaged occupancy rates over 100 per cent in the last five years, and one of 89 in the province whose acute-care occupancy rates were on average above 85 per cent, the threshold that many experts describe as the ideal for preventing the spread of infection and accommodating unexpected surges of patients.
Most of those hospitals saw at least one-quarter of the year in which occupancy topped 100 per cent. When the rate tops 100 per cent, that often means the facility must accommodate patients in places such as hallways, TV rooms, family lounges and physiotherapy gyms.
The figures show that – despite all the attention hospital overcrowding and hallway medicine received during a difficult flu season this winter – jam-packed emergency rooms and medical and surgical floors are nothing new: They have become a daily reality for doctors, nurses and patients at many urban and suburban hospitals in Ontario.
Community hospitals are feeling the pressure, too. Some of the most crowded hospitals in the province are in smaller centres, including Trenton, Exeter, Dryden and Huntsville.
"I think it is a ubiquitous problem," said Avery Granger, the president of the Canadian Medical Association, which represents physicians across the country. "Do we have enough beds? I think we can't answer that until we've really perfected our team-based care between hospital and the community."
Doctors and health-policy experts say that a lack of co-ordination between primary care, hospitals, home care and long-term care in Canada's fractured health-care system is certainly part of the problem, but there are other factors at play, too.
A rising tide of seniors – they now outnumber children under 15, according to the latest census – is filling hospital beds with elderly patients who no longer need acute care but have nowhere else to go, contributing to overcrowding elsewhere in hospitals. Canada already has fewer hospital beds per capita than most other developed countries.
Ontario's Ministry of Health and Long-Term Care divides its hospital occupancy statistics into three bed types: Mental health beds; chronic-care beds for those who require long stays in hospitals; and acute-care beds, an umbrella category that generally denotes the rest of the beds in the hospital.
The Ajax and Pickering site of Lakeridge Health, east of Toronto, had the highest average occupancy rate in its acute-care section at 107.4 per cent over five years leading up to the end of 2016.
Among the other hospitals that averaged more than 100-per-cent occupancy in their acute-care beds were the Englehart and District Hospital, north of Sudbury; Trenton Memorial Hospital; Oakville Trafalgar Memorial Hospital and the London Health Sciences Centre (LHSC).
LHSC has been at or above 100-per-cent capacity for both its acute-care and mental-health beds in every quarter since the beginning of the 2012-13 year.
"In our mental health capacity, we've been experiencing significant pressures," said Julie Trpkovski, a vice-president who oversees mental health, emergency services and access and flow at LHSC.
On one particularly challenging day, the hospital hit 146 per cent capacity on its mental-health unit, she said. When that happens, LHSC activates a regional surge protocol and asks nearby hospitals if they can "deliver care sooner, rather than having patients wait for a bed in our emergency department, which can sometimes take several days, Ms. Trpkovski said.
Both Ms. Trpkovski and Murray Glendining, LHSC's chief executive officer, said the extra money that Kathleen Wynne's government promised in its most recent budget will help to relieve some of the capacity pressure. The province promised an additional $518-million for hospitals, or an average increase of 3.1 per cent after freezing hospital's base budgets in four of the five preceding years.
Even before the budget announcement, the Sault Area Hospital was tackling its overcrowding problem. Along with replacing its Code Burgundy protocol with a three-level warning system designed to catch problems earlier, the hospital opened 25 new beds and dedicated its entire second floor to a "restorative care" approach that Mr. Gagnon said has already helped more frail, elderly patients make it home again.
Wait times in the emergency department for patients sick enough to be admitted have dropped dramatically, he said.