Canadians logged more time waiting in ERs in 2021 than ever before

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Canadians admitted to hospital spent more time waiting in emergency departments in 2021 than in any other year, according to new data from the Canadian Institute for Health Information (CIHI).

The data, posted online this month, show that nine out of 10 emergency department visits for patients who were admitted were completed within 40.7 hours in the 12-month period that ended March 31. That was up from 33.5 hours the previous year.

In British Columbia, 90 per cent of such visits were completed within 47.7 hours in 2021-22, compared with 32.8 hours the year prior, while in Ontario, 90 per cent of emergency department visits for admitted patients were completed within 32.5 hours, up from 29.1. In Alberta, 90 per cent were completed in 27 hours, up slightly from 26.2 the year prior.

The figures come from hospitals that submitted data to the National Ambulatory Care Reporting System, or NACRS. However, cross-jurisdictional comparisons should be interpreted with caution. In B.C., for example, 30 facilities reported to NACRS in 2021-22, accounting for an estimated 73 per cent of emergency department coverage, compared with 178 facilities in Ontario, accounting for about full coverage.

The data reflect a crisis playing out in hospitals across Canada. Staffing issues, barriers to accessing primary care and long-standing pressures on a health care system further strained by the pandemic are leading to sicker patients who end up in emergency.

One children’s hospital in Vancouver is double-bunking patients to accommodate an increase in sick kids, another in Calgary has opened a heated trailer to accommodate overflow, and patients in Edmonton have been treated in the hallways of crowded hospitals. A number of emergency departments across the country have had to close because of critical staffing shortages.

Nicole Loreti, program lead for CIHI’s clinical administrative databases, said the publication of the data is intended to serve as a catalyst for discussion, and to support provinces and territories in exploring best practices and opportunities for improving the health care system.

“Our release mostly includes [emergency department] visit volumes, length of stay, various breakdowns; it doesn’t look at the factors driving length of stay,” she said. “But we know there can be many factors, because length of stay is a complex issue. So it could be related to how complex the patients are, how many patients there are, whether they need to be admitted, but also factors outside the hospital, for example access to primary care or virtual care, or long-term care.”

The data also show that, across Canada, there were 2.4 million, or about 20.4 per cent, more visits to the emergency department in 2021-22, compared with the year prior. This is likely because, during the first year of the pandemic, people avoided hospitals for less urgent conditions and experienced fewer accidents and other illnesses as a result of restrictive public-health measures, according to CIHI.

The roughly 14 million visits in 2021-22 are still slightly below prepandemic levels; there were about 15 million visits across the country in each of the two years before the pandemic.

The recent increase in number of visits was especially pronounced among babies and toddlers. In 2021-22, there were 1,038,994 children under 4 taken to an emergency department – an 83-per-cent increase from the previous year (567,073), and approaching prepandemic volumes.

The top three problems cited at admission were abdominal and pelvic pain, pain in the throat and chest, and back pain, which is consistent with previous years, Ms. Loreti said. However, COVID-19 is now the fourth-most common reason cited, up from 10th place the year prior.

“It has increased quite a bit, and also the acute upper respiratory infections is back on the list at No. 7,” she said. “I think that’s related to changing public-health measures related to the pandemic, and infections coming back.”