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More Than Half of Emergency Department Visits Classified as “Less-Urgent” or “Non-Urgent”
Latest hospital data show half of emergency department patients see a doctor within an hour—but many are waiting longer
September 14, 2005—More than half (57%) of patient visits to selected Canadian emergency departments in 2003–2004 were for less-urgent or non-urgent conditions, according to a new report released today by the Canadian Institute for Health Information (CIHI). Only 0.5% of patients were considered most severely ill—meaning they needed life-saving interventions. Understanding Emergency Department Wait Times: Who Is Using Emergency Departments and How Long Are They Waiting?, 2005 is the first of three reports focusing on selected Canadian emergency departments, with the bulk of the data provided by Ontario hospitals, but also including participating hospitals in Nova Scotia, British Columbia and Prince Edward Island.
“If we are to understand emergency department wait times in Canada, we must first understand how emergency departments are used,” says Jennifer Zelmer, CIHI Vice-President of Research and Analysis. “This study shows that more than half of the visits to emergency departments are for the less-urgent and non-urgent conditions. Where alternatives are available, this raises questions about whether a portion of these types of patients can be appropriately treated in non-emergency department settings, such as primary health care clinics.”
| The Canadian Triage and Acuity Scale (CTAS) is one method for grouping patients according to the severity of their condition.
CTAS I: severely ill, requires resuscitation
CTAS II: requires emergent care and rapid medical intervention
CTAS III: requires urgent care
CTAS IV: requires less-urgent care
CTAS V: requires non-urgent care
(See figure 1 for further details.)
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As well, Canadians appear to use emergency departments more than people in a number of other countries. According to a 2004 international survey, nearly 4 in 10 Canadians (38%) reported having been to an emergency department in the previous two years, compared to 34% of those surveyed in the United States and approximately 30% of those surveyed in Australia, New Zealand and the United Kingdom. Overall, Canadians make over 14 million visits each year to emergency departments across the country, a number that has remained relatively stable for four years.
Half of All Patients Who Visited Emergency Departments Waited Less Than An Hour To Be Seen By An Emergency Physician
According to records from participating hospitals, half of all emergency department patients were seen by a physician in 51 minutes or less. However, 10% waited 10 minutes or less, and another 10% waited nearly three hours or more. In a 2004 international survey, nearly half of Canadians polled (48%) said they waited two or more hours to see a doctor on their last visit to an emergency department, while only 36% of those surveyed in the UK, 34% in the U.S., 29% in Australia and 27% of those in New Zealand reported having to wait that long.
Time spent waiting to see a physician varied by the severity of the patient’s condition. Those patients considered the most urgent waited the shortest time on average, with half seeing a doctor within five minutes. On the other hand, 10% of the most severely ill patients waited 45 minutes or more. These cases could include conditions such as major trauma, shock or severe respiratory distress, while non-urgent and less-urgent cases could include conditions such as sore throats, diarrhea or chronic back pain.
Patients tended to wait longer to be seen by a doctor in higher-volume emergency departments. For example, in community hospitals with more than 30,000 emergency visits per year, the median wait to see a doctor ranged between 6 and 70 minutes, depending on the severity of the patient’s condition, while in emergency departments with less than 15,000 visits per year, the range in median wait times ranged from 1 to 25 minutes. Median wait times are the point at which half spent less than this amount of time waiting and half spent more.
The study also looked at the length of a patient’s emergency department visit. Nearly half of those who went to an emergency department completed their visit in two hours or less, with 10% of patients finishing in 36 minutes or less, but 10% spending more than six hours in the emergency department. The proportion of patients that spent less than four hours in emergency departments was similar in Canada (76%) and the U.S. (72%). In the UK, however, almost all patients spent less than four hours in the emergency department, following the implementation of a national program intended to shorten emergency department visits.
Rural Areas More Likely To Use Emergency Departments For Non-Emergencies
The data also show that there are distinct differences in the way urban and rural populations use their hospital emergency departments. When looking at the newly established health regions in Ontario, those regions that serve rural areas reported a higher proportion of non-urgent cases seeking treatment at an emergency department. For example, 5% of the emergency department visits in Toronto-Central (urban) were triaged as non-urgent, while 16% of visits in North Simcoe Muskoka (rural) fell into this category.
While these data are mainly from Ontario, a Statistics Canada survey shows that Canadians use emergency departments at about the same rate in most provinces for specific health issues like injuries. Across the country, 13% said their most recent contact with a health care professional or their treatment for their most recent injury had been in an emergency department. Only the Yukon Territory and New Brunswick had significantly higher rates, with 19% and 18%, respectively. Nunavut had the lowest rate, at 10%.
“There is a great deal more to be learned about how our emergency departments are used and how long people wait for treatment,” says Kira Leeb, CIHI Manager, Health Services Research. “This report is just a beginning, and we hope it will help inform future decisions on how to improve access to the right care at the right time.
Other key highlights in the report:
- Most patients return home after an emergency department visit
The vast majority of patients assessed in emergency departments in 2003–2004—more than 80%—were discharged to their home or their place of residence. Only 11% needed to be admitted for further treatment in hospital.
- Emergency department rush hour between eight in the morning and eight at night
Patients were most likely to go to an emergency department between 8 a.m. and 8 p.m., with 11 a.m. recorded as the peak arrival time. The least busy time of day was recorded at 6 a.m. Pediatric hospitals reported a second peak in visits between 7 p.m. and 10 p.m. Visits to the emergency department by the most urgent cases and by the least urgent cases peaked at the same time, between 7 a.m. and 11 a.m.
- Early morning visitors spend less time overall in the emergency department
What time of day people arrived at an emergency department seemed to be a factor in how long their visit lasted. For example, those who arrived in the busy morning tended to have shorter stays than those who arrived in the afternoon or early evening.
- Almost half of Ontario infants went to an emergency department before their first birthday in 2003–2004
Adults accounted for the largest number of emergency department visits in 2003–2004, with 62% of patients aged 16 to 64. However, Ontario children aged 0 to 4 were more likely to visit an emergency department than any other age group (36% did so in 2003–2004). Rates were highest for those in their first year of life.
Canadian Institute for Health Information
The Canadian Institute for Health Information (CIHI) is an independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality health information. CIHI’s mandate, as established by Canada’s health ministers, is to coordinate the development and maintenance of a common approach to health information for Canada. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health.
Figures and Tables
Report
Media Contacts
Jill Oviatt
(613) 241-7860, ext. 4310
Cell: (613) 612-3914
media@cihi.ca
Leona Hollingsworth
(613) 241-7860, ext. 4140
Cell: (613) 612-3915
media@cihi.ca
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