Emergency rooms are ground zero for the crisis in Canada’s health care system. This is where Canadians, desperate for medical assistance, are confronted by the harsh realities of crowded hospitals, overburdened staff and excruciating wait times.
The anecdotes are by turns maddening and tragic. Millions of Canadians do not have a family physician, forcing some to seek help at ERs. Some of those units have been shuttered on weekends over a lack of resources. In a handful of extreme cases, people have died as they waited hours for urgent care that wasn’t provided.
It’s obvious that something is deeply wrong in our emergency rooms, one symptom of the ailments of the broader health care system. But to solve a problem, you need to diagnose it. And a proper diagnosis depends on solid, timely information – a clear gap in Canadian health care.
An unhealthy debate
This is part of a series on our health-care system, and the challenges in diagnosing and fixing its problems, as explored in The Globe’s Secret Canada project.
Broken promises: The ‘universal’ model is anything but
Lessons from abroad: Health care, Australian-style
Lessons from the past: Jane Philpott’s prescription for change
Justice: Defining the duty of care
Accountability: What patient power can achieve
The Globe and Mail recently asked the provinces and territories for basic information on ERs – for instance, average lengths of stay for admitted patients – for all of their hospitals. The results were predictably discouraging.
Several provinces declined to share this information or could not provide data at the hospital level. B.C. said it was unable to send statistics, citing the provincial election campaign. Ontario offered the most comprehensive figures – but for a $720 fee.
Canadians’ ability to learn about the performance of their local hospitals varies wildly, depending on where they live, and if they know where to look. This is unacceptable.
Canadians should have access to a variety of statistics on all hospitals, including wait times for emergency care and various procedures, such as major surgeries. This information should be hosted on a website that allows people to compare figures across hospitals. To hold the system accountable – whether as patients or taxpayers – Canadians need access to timely and detailed numbers.
The Canadian Institute for Health Information (CIHI) offers a trove of data through its National Ambulatory Care Reporting System. The most recent annual numbers are based on more than 15 million unscheduled ER visits over the 12 months through March, 2024.
In Ontario, 90 per cent of patients with less urgent cases were treated and discharged within 5.7 hours, according to CIHI figures. In Quebec, it was 10.9 hours. When patients are admitted to hospital, their stays are longer: Nine out of 10 ER visits across the country are completed within 48 hours.
CIHI, a nonprofit organization, says its system accounts for more than 85 per cent of ER visits in the country. There are, however, some glaring omissions.
What are wait times like in New Brunswick and Newfoundland? It’s unclear. They don’t participate in the CIHI program, nor do the Northwest Territories and Nunavut. There is only partial coverage in five provinces, including B.C. and Manitoba.
Even where data exist, they are not always accessible to the public. CIHI publishes an online tool called Your Health System. If someone looked up ER wait times for Toronto General Hospital, they would get statistics for the broader University Health Network – for the 2022-23 fiscal year. (The Globe was able to obtain more detailed and timely figures through a freedom of information request.)
ERs have gone through a brutal stretch. There was a brief time when people avoided them, early in the pandemic, but visits have since shot up. Burnout among hospital staff is a growing concern.
Some health units have pleaded with Canadians to avoid ERs unless absolutely necessary, although some commentators have pushed back on this argument. Earlier this year, two emergency physicians in Ottawa wrote in The Globe that most of the resources in ERs are being used by people who have already been treated, but are waiting for in-patient beds.
These complex problems bolster the case for better data, which should be comprehensive, timely and shared with the public. There are obvious upsides for policymakers, who can test solutions and track progress in raising standards at ERs. For citizens, they can learn about the shortcomings of health care – and demand better.