The amount of time most Canadians spend waiting in emergency departments to be admitted to hospital is on the rise, new data from the Canadian Institute for Health Information (CIHI) shows.
The emergency department (ED) length of stay for people admitted to hospital in 2016–2017 was up 11% from the year before and almost 17% from 5 years ago, according to CIHI data, which is based on more than 11.2 million ED visits across the country last year. 90% of ED visits for those admitted were completed within 32.6 hours, which means 1 in 10 people waited longer.
Most people who visit an ED do not need to be admitted to hospital. When looking at all ED visits in 2016–2017, 9 out of 10 people left the ED within 7.8 hours. This means 10% of people had a longer ED visit.
“Achieving timely admissions for all ED patients who need to spend the night in hospital is an area where there have been persistent challenges over the past 10 years, and we’re seeing that for some people in Canada the wait is getting even longer,” says Greg Webster, the director of Acute and Ambulatory Care Information Services at CIHI.
“This is particularly impacting older people, and we’re seeing some noticeable patterns around wait times for evening and weekend admissions.”
The patterns highlighted in this CIHI data confirm concerns raised by some clinicians working in Canadian medical facilities.
“Emergency departments are feeling increasing pressures from rising volumes — overall, of elderly patients, of admitted patients — and capacity pressures that are delaying admitted patient flow,” says Dr. Howard Ovens, the chief medical strategy officer for the Sinai Health System in Toronto and Ontario’s provincial lead for emergency medicine. “Despite all that, emergency departments are doing relatively well at maintaining access and throughput for the patient population, but the waits for beds for elderly and many sick medical patients are very, very concerning and reflect an ongoing and worsening capacity problem in our acute care sector right across the country.”
New data on ED wait times in Canada is highlighted in CIHI’s National Ambulatory Care Reporting System (NACRS) ED Quick Stats, as well as in the Your Health System (YHS) web tool, which includes facility- and region-level results for selected ED indicators. Here are some of CIHI’s key findings:
Admitted patients spent a long time in the ED in 2016–2017. 90% of visits were completed within 32.6 hours — a significant increase from 29.3 hours the year before and 28.3 hours in 2012–2013. Every jurisdiction saw an increase in ED length of stay for admitted patients.
“There has been a focus on trying to improve patient flow through the hospital, with many facilities having initiatives to reduce emergency department wait times,” says Kira Leeb, CIHI’s director of Health System Performance.
“We have seen some change with these efforts, such as in Manitoba. By shining a light on some of the specific problem areas where increases are more evident — seniors and visits late in the day — these initiatives can be even more targeted to improve flow.”
Canadians age 65 and older found themselves waiting longer in the ED last year compared with the year before. 90% of visits were completed within 36.3 hours — almost a 5-hour increase from 31.4 hours in 2015–2016.
“This is really a problem because we know that elderly people don’t fare well in emergency hallways,” says Ovens.
“They are subject to delirium and deconditioning, increased complications and rates of inability to return home when their needs are not met in hospital, and they’re vulnerable to hospital-acquired infections.”
For those age 20 to 64 who were admitted, 90% of ED visits were completed within 31.4 hours last year, a 3-hour increase from 28.4 hours in 2015–2016.
The volume of ED visits for patients age 80 and older increased by almost 3% between 2015–2016 and last year; for patients younger than 80, the volume increased by just 0.8%.
The ED length of stay for admitted patients who registered on a Saturday in 2016–2017 went up 23% from the year before: 90% of ED visits for those who registered on a Saturday last year were completed within 39.5 hours, compared with 32.1 hours the year before. A similar stay on a Thursday jumped 7%, from 27.4 hours to 29.3 hours.
“I think this is a great example of where relatively simple data from CIHI can be tremendously valuable to heath care systems,” says Webster.
“We know that systems can’t be turned on their heads so that everyone’s working at the hospital 24/7, but maybe there are some adjustments to staffing models that can be made in certain areas that could make a meaningful difference.”
The amount of time spent in the ED for 90% of admitted patients who registered between 9 and 10 p.m. increased to 38.1 hours last year from 26.7 hours in 2015–2016. Those who registered between 8 and 9 p.m. didn’t fare much better: that timeslot saw an increase of 40.7%, to 38 hours from 27 hours.
Every hour of the day saw wait times go up for admitted patients.
9 to 10 a.m. saw the lowest increase at 4.3%, jumping from 30.4 hours 2 years ago to 31.7 hours last year.
“I think there are some examples in Canada, but more so in other countries, where they have been much more thoughtful about medical coverage, access to imaging, access to administrative oversight for flow, and have taken out some of these wrinkles and tried to improve care and flow around the clock,” says Ovens. “I think Canada has been relatively slow at this.”
There were 34,515 documented ED visits related to pneumonia last year, up from 33,921 the year before. 9 out of 10 ED stays before admission for pneumonia were completed within 40.7 hours, up from 33.2 hours 2 years ago.
“2 of the main conditions where there’s a high volume of admitted cases with a big increase in length of ED stay are pneumonia and COPD (chronic obstructive pulmonary disease, which was up 19.3%). These are the types of conditions you would expect older populations to get admitted for, which aligns with what we’re seeing in our other indicators,” says Webster.