海角社区官网

They all got the care they needed, eventually. But the long waits they had to endure are illustrative of a disturbing trend happening in Ontario emergency departments, borne out by data that has never been made public.

According to an internal provincial report obtained by the Star, Ontario patients visiting EDs in the past three years waited longer than they did in the previous 13 years.

The report, prepared by Ontario Health but not made public, provides sweeping, multi-year data for key performance indicators going back to 2008, offering a long-term overview of the health of Ontario鈥檚 EDs under successive provincial governments.听

Health care in Ontario has become a big provincial election issue. Despite Progressive Conservative Leader Doug Ford鈥檚 2018 election promise to end hallway medicine, the data shows that wait times for ambulance offloads, initial physician assessments and admissions to in-patient beds became notably worse in the last three years, while patients spent more time overall in EDs.

In a response to the Star, the Ministry of Health said the province鈥檚 ED landscape, along with patient demographics, have evolved 鈥渋n particular from the pandemic experience.鈥澨�

The ministry said it invested $134 million in 2023-24 to improve ED services in 165 hospitals, provided $14.7 million for a strategy to train and upskill emergency nurses, and launched a program to support physicians in small and rural hospitals. It added that it is also working to connect all residents with a family doctor through its 鈥淧rimary Care Action Team,鈥� led by former federal health minister Dr. Jane Philpott.

鈥淲ait times are really much more of a symptom than the disease itself, and more reflective of the stresses on our hospital system and our health-care system writ large,鈥� said Dr. Michael Herman, an Ottawa-area emergency physician. 鈥淲e鈥檙e trying to do the best with what we can, but it鈥檚 an increasing struggle to try and meet the demands on our system.鈥�

The new data paints a picture of EDs across the province still struggling to recover from system-wide cracks exposed by the COVID-19 pandemic, from professional burnout, nurse shortages and increasingly complex patients, to insufficient numbers of in-patient beds, primary care options and long-term-care spaces.

Here we break down some of the most striking data from the confidential report.听

One of the clearest trends in the data, presented as measurements of the 90th percentile, is that between 2021-22 and October 2024 (the most recent month captured by the report), patients across Ontario spent more time in EDs compared to the previous 13 years.听

The data show that patients at the 90th percentile were spending anywhere from about seven-and-a-half hours to just over 10 hours in EDs between 2008-09 and 2020-21. This means that 90 per cent of patients stayed in the ED for these lengths of time or less. But that also means 10 per cent of patients stayed longer.

During the last three years, the 90th percentile length of stay jumped to a range of about nine-and-a-half hours to a high of nearly 13 hours (January 2024). As of October 2024, length of stay at the 90th percentile was 11.7 hours.听听

Ottawa-based emergency physician Dr. James Worrall said most long wait times are related to what he calls the 鈥渂ack door鈥� 鈥� getting patients out of the ED 鈥� rather than the number of people showing up at the front door. The problem, he said, is that when beds are full elsewhere in the hospital, admitted patients have to stay in the ED until space is available. The result? Stretchers in hallways.

鈥淪o the knock-on effect is crippling the efficiency of the emergency department, which drives up the wait times for everybody,鈥� Worrall said.

Worrall uses the analogy of someone washing the dishes at their kitchen sink who can鈥檛 put the clean dishes in the drying rack.

鈥淰ery quickly your sink fills up with dishes that have already been washed and it鈥檚 really challenging to wash any new dishes,鈥� he said. 鈥淭hat鈥檚 basically what we鈥檙e dealing with.鈥�

听

The data shows that in the 13 years prior to 2021-22, most ED patients at the 90th percentile waited between about three and four hours for an initial assessment by a physician. That range rose to between four and just over four-and-a-half hours between 2021-22 and October 2024. Dr. Raghu Venugopal, an emergency physician who works the overnight shift at three busy 海角社区官网EDs, said longer waits for an initial assessment are attributable to several causes: patients who are more elderly and medically complex; patients with lower-acuity problems but with no other option but to visit the ED; and fewer places to see patients due to overcrowding.

鈥淎n elderly patient with cognitive impairment who cannot speak for themselves and is found on the ground needs a trauma, cardiac, neurological, metabolic and infectious work-up,鈥� Venugopal said. 鈥淭he share of these patients is increasing and that takes physician time. An ER visit for such a patient is pretty much a compressed admission to hospital. This makes others wait.鈥�

He added that he is seeing an increasing number of patients come to the ED with less urgent needs because they have nowhere else to go. This could include patients seeking ODSP food voucher signatures, insulin and hypertension medication and prescription refills.听

鈥淏ecause they have no physical complaint, they will wait.鈥�

In 2021-22, the 90th percentile for time to an in-patient bed began around 20 hours. This means that 90 per cent of patients spent 20 hours or less in the ED waiting for an in-patient bed once a decision was made to admit them.听

While 20 hours is no doubt a long time to wait for a bed, this time was more or less in line with the trend of the previous 13 years.听

But by January 2022, that time had reached 35 hours. For the next two-and-a-half years, wait times for an in-patient bed at the 90th percentile were between about 27 hours and just over 40 hours.听

Herman, a听member of the Canadian Association of Emergency Physicians’ public affairs committee, explains that a certain percentage of beds in hospitals will be occupied by alternate-level-of-care (ALC) patients who are waiting to be discharged to long-term care or home care. But when there aren鈥檛 enough spaces in the community, these patients remain in hospital, creating backups that trickle down to the ED, which, Herman said, 鈥渋s the one place in the health-care system where we can鈥檛 say 鈥榳e鈥檙e full.鈥� 鈥�

This has the unfortunate result of patients waiting in ED hallways, alcoves and even in front of nursing stations bustling with activity, said Erin Ariss, a registered nurse and president of the Ontario Nurses鈥� Association.听

鈥淵ou can imagine being a patient in front of a desk where it is chaos. There鈥檚 phone calls, consultations between nurses and physicians,鈥� she said. 鈥淭here鈥檚 an inability to have any dignity or privacy in those spaces.鈥�

The Health Ministry said it has made 鈥減ermanent investments鈥� to support the creation of additional beds in regions struggling with this issue, increasing funding to the sector by four per cent in the last two fiscal years. It also says it has introduced 鈥減atient-flow initiatives鈥� across the province.

The data shows that ambulance offload times 鈥� the amount of time it takes for a patient to be transferred from paramedics to the care of a hospital emergency department 鈥� at the 90th percentile began to rise noticeably in 2021-22 from a low of about 40 minutes to a high of nearly 70 minutes.听

The following year, offload times rose even higher, reaching almost 110 minutes in October 2022, a far cry from what the province says should take 30 minutes at the 90th percentile. In 2023-24, times dropped slightly but in some months offload times reached higher than 80 minutes.

For the first 10 months of 2024, concerted efforts by paramedic services and hospitals to target delays began to pay off, with offload times falling back to levels seen before the pandemic.听

Why is this indicator important? Ambulances waiting to offload patients at hospitals are not able to respond to 911 calls, which can result in what some paramedic services call 鈥淟evel Zero,鈥� when no ambulances are available to respond to calls.听

In 2023, the Ottawa Paramedic Service, for example, was at Level Zero 1,672 times. That same year, Ottawa paramedics spent 102,105 hours in offload delay, an increase of 8.6 per cent from 2022.

Ottawa paramedic chief Pierre Poirier notes that offload times in Ottawa have improved significantly since October 2024 as a result of mitigation efforts, such as reducing patient transports and diverting patients away from EDs.听

Offload delays remain stubbornly high in some areas. In Toronto, for example, in-hospital wait times for paramedics at the 90th percentile from Jan. 1 to Feb. 12 this year were 111 minutes. During that time, 海角社区官网paramedics spent more than 800 hours in hospital each day on average, up from an average of 750 hours a day during the same time frame in 2024, according to 海角社区官网paramedic chief Bikram Chawla.听

鈥淎s with other paramedic services across Ontario, in-hospital wait times for paramedics remains a significant challenge negatively impacting ambulance availability,鈥� Chawla said.听

Worrall said that because EDs are often full with admitted patients, there aren鈥檛 any resources available for patients who arrive in ambulances, meaning the patients must remain with the paramedics.听

鈥淚 can go and talk to patients who are still with the paramedics, but I can鈥檛 do a proper examination and I can鈥檛 get any tests or treatments started until there is a bed available for the patient to be offloaded,鈥� he said. 鈥淪o that鈥檚 obviously a real problem.鈥�

For its part, the ministry says it has increased funding for a dedicated offload nurse program to allow hospitals to hire nurses and other health professionals whose focus is on transferring patients. This program, along with partnerships between paramedic services and hospitals, has helped contribute to a reduction in offload times by more than 50 per cent since Oct. 2022, the ministry said, with some regions seeing offload times drop by close to 90 per cent.听

The number of patients coming to Ontario EDs saw modest increases in the past 17 years, with fluctuations in volume ranging generally between about 400,000 and 500,000 annually.听

In October 2024, ED volumes reached 516,295, about six per cent higher than October 2023. The report notes that this increase can be attributed primarily to seriously ill patients who came to hospital but didn鈥檛 need to be admitted.

While there has been a slight increase in the number of patients visiting EDs in recent years, volumes, on the whole, have not seen massive deviations for over a decade. So why are wait times getting longer?

In addition to an increase in the number of complex elderly patients presenting to the ED, as well as an insufficient number of in-patient beds, many patients arrive with multiple complaints stemming from a lack of access to family doctors, specialists or diagnostic imaging, said Venugopal.听

As a result, getting in front of an ED doctor is an opportunity for a patient to have multiple problems addressed.

鈥淧eople have legitimate problems piled up,鈥� Venugopal said. 鈥淵ou can see a patient with three to seven medical problems, easily.鈥�