ER wait times down, but visits up

Report finds people going to the emergency department are sicker and getting older
Report finds people going to the emergency department are sicker and getting older

By Graeme McNaughton/Active Senior’s Digest

It’s good news and bad news for hospitals.

According to a new report from Health Quality Ontario (HQO), the average wait times in the emergency room have gone down, with 89.9 per cent of low-acuity patients – or those with low-level medical needs – being seen and discharged within a four-hour window. For those with more complex needs, or high-acuity patients, 85.7 per cent will be in and out within eight hours.

However, according to Dr. Joshua Tepper, the president of HQO, this still means that there is a long way to go in improving the province’s healthcare system.

“To have more people, sicker people, going into the (emergency department) and still be able to not just maintain but improve our wait times is good,” he says.

“I think where we see areas of concern is that, first of all, the wait times are still not insignificant and are particularly significant for people who have been admitted to the hospital that are still waiting in the emergency room to go upstairs, as we say, to get admitted to a bed. That wait is still very long.”

Another area of concern for Tepper is the type of patients that are coming to the province’s emergency departments – most notably, they are sicker, “and we predict it to only get worse going forward,” he says.

According to the HQO report, the number of visits to the ER by high-acuity patients has gone up 44.1 per cent in the past seven years. The report also states that visits made by patients 65 and older, who tend to require more complex care, has gone up by 29.1 per cent in the same timeframe. In total, 52.7 per cent of patients admitted to hospital via an unscheduled visit to the ER were aged 65 and up.

And with an aging population on the horizon – Statistics Canada says that the number of seniors will be larger than the number of children by next year and will make up approximately a quarter of the country’s population by 2036 – Tepper says the province’s healthcare system needs to be looked at in order to make it work for everyone.

One way to fix that, he says, is not to look at the hospitals and its emergency rooms, but at other parts of the system.

“One of the reasons people go to the emergency room is it is a place where they can get a lot of access to resources in a short time. If we can empower our primary care system and our homecare system to have some of those accesses to resources, it will provide an alternative,” Tepper says.

“I am a family doctor, and I also work in the emergency department. I know that as a family doctor, sometimes at four in the afternoon…there’s no other option for me to get an x-ray done or an ultrasound done in a timely way, and I’m stuck saying, ‘I’m sorry, you have to go to the emergency department.’ If I had access to specialty or imaging or laboratory resources, I might be able to handle it differently.”

The president of HQO adds that if general practioners were to have access to these more specialized services, it would help people get the care the need and reduce the number of people that have to go to the emergency room because they have nowhere else to go – the HQO study finds that 47 per cent of adults who went to an emergency room in Ontario said they went there for something that could have been taken care of by their family doctor, but that they were not available.

Another issue facing seniors in Ontario’s hospitals, the report finds, is a shortage of beds. Tepper, however, says that the issue is more complicated than just having more beds available.

“A reason they don’t have beds is that a lot of people in the hospital who are not sick enough that they need a hospital-based care, but they have no place else to go, outside in the community,” he says.

According to the HQO report, nine out of 10 admitted patients spent up to 29.4 hours in the emergency department last year, with a vast majority of that time – 22.5 hours – spent waiting in the ER to go to an inpatient ward. On average, 13.7 per cent of the days that a bed in a hospital is occupied, it was for patients awaiting access to an alternative level of care, such as a long-term care home or a rehabilitation facility.

“The more we could do to figure out how to move these patients out into the community, into long-term care, out into the community faster, would allow us to move patients out of the emergency room faster and really shorten that wait time that can be hours or days in some cases.”