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Question: I recently took my elderly father to a hospital emergency department because he was suffering from severe stomach pain. A doctor saw him fairly promptly and decided to admit him. But my father then had to wait more than a day in the emergency department before he was moved to a bed in a hospital room. That was just unbearable for him. Why did he have to wait so long?
Answer: What happened to your father can best be described as hospital “gridlock.” And, unfortunately, it’s not uncommon for people to wait a long time for a bed when a hospital is nearly full of patients.
Hospitals follow standard procedures for assessing all patients when they arrive in the emergency department to determine the severity of their ailments. Those with potentially life-threatening conditions – such as heart attacks and strokes – are normally treated right away.
But once the decision is made that a patient requires further care in the hospital – to be admitted – this individual may have to wait on a stretcher in the emergency department until a bed becomes available in one the hospital wards.
If all hospital beds are already full, the length of time that a patient lies on an emergency department stretcher is going to increase, says Dr. Jeffrey Tyberg, Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre.
As more and more patients wait for beds, the emergency department will become increasingly crowded, which can be uncomfortable for them, and may delay care for newly arriving patients because staff and stretchers are occupied with the admitted patients and their care needs.
In some ways, moving patients through a hospital can be compared to travellers checking into a hotel.
“The process of registration at the hotel front desk may be very efficient, but if the customers haven’t left their rooms, then people in the lobby can’t go upstairs,” explains Dr. Howard Ovens, Chief of the Department of Emergency Medicine at Mount Sinai Hospital in Toronto.
Once customers from the previous night finally do leave, then hotel staff can start cleaning the rooms for the new arrivals.
Similarly, hospitals rooms must be cleaned and disinfected before patients can be moved in. But the job of freeing up hospital beds is further complicated by the fact that some patients must be transferred to other health-care institutions. These patients no longer require the medical care of a hospital, but they are not well enough to go home. They may need to go into a rehab centre, long-term care facility or nursing home. If there are no free spots in these institutions, then the patients will remain longer than necessary in hospital.
Studies suggest that hospitals should be operating at 85 to 90% occupancy for an efficient turnover of beds. Higher occupancy levels tend to lead to gridlock. But faced with tight financial budgets, many Canadian hospitals frequently have more than 90 per cent of their beds filled, say Dr. Ovens. And, at times, occupancy can exceed 100 per cent – with patients lying on stretchers in the hallways.
Of course, different hospitals face different demands and get a different mix of patients. In some communities, a relatively high proportion of patients may go to the local emergency department because they don’t have a family doctor or can’t get a timely medical appointment.
But the problem of limited access to family doctors doesn’t actually put an onerous burden on hospitals, says Dr. Tyberg. “There has been a long-standing myth that wait times are long in emergency departments because they’re crowded with people with minor problems who shouldn’t be there. That’s incorrect.”
These patients tend to be in stable condition. They don’t usually need a lot of tests and don’t use up a lot hospital resources, although it may take quite a while for them to be seen by a doctor. (Hospitals use a triage process so that patients are seen in the order of the severity of their condition.)
Dr. Tyberg says the major reason for emergency department overcrowding really boils down to one key issue – the availability of acute-care beds.
In fact, Canada has relatively fewer hospital beds than many other industrialized countries. There were 2.7 beds for every 1,000 Canadians, according to 2012 figures from the Canadian Institute for Health Information. By contrast, the average number of hospital beds was 4.8 per 1,000 people in 2012 for countries in the Organization of Economic Co-operation and Development (OECD). Overall,Canada ranked 30th out of 34 OECD countries in the hospital bed category.
In recent years, many Canadian hospitals have adopted various measures to reduce the time that patients must wait for care. “Hospitals are working to become more efficient – which is a good thing,” says Dr. Ovens. But, he adds, there are limits to what can be achieved through efficiencies alone.
As the Canadian population increases – and grows older – demand for medical services is expected to rise. Some provincial governments have been focused on providing more home care and long-term care – and that’s certainly a worthwhile effort. “I think, eventually, we are also going to need more acute-care beds,” says Dr. Ovens.
That doesn’t necessary mean the health-care system needs more public funding. According to some estimates, up to 30 per cent of tests, treatments and procedures done on patients are actually unnecessary. If that waste could be pinpointed and effectively eliminated, there may be enough savings to meet the needs of patients – and reduce emergency department overcrowding.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.
The comments section is closed.
Obvious analysis. The real question is….what is being done to solve hospital over-crowding?
Number of beds is, indeed the issue. And an obvious one at that.
Given the profit off the healthcare industry, what is being done to improve access by way of increasingly capacity?
Oh and I have to clarify this to. I booked an appointment for 8.30 am for my sister’s vaccines. I left my classes to be with her. And when I went to public health center. They made me wait 1 hour even though i made an appointment. The staff in the front were eating donuts instead of doing their job. So you were saying appointment?
Are you seriously defending your health care system? I cannot understand as a university student what is your purpose to make patient wait! I just need one reasonable answer. Why it took 6 hours to take care of my father when there was only 7 patients in the waiting room at 4.00 am? I brought him to hospital at 3.30am because I knew that canadian hospitals make you wait like 5 hours in average What all the beds were full again. You gotta be kidding me. What is your meaningful answer for this? What are they doing there, finding a cure to cancer? He couldn’t move his right arm. Please, explain me how this works? Why don’t you admit that you have a disgustingly bad health care system and a lazy staff that do not have any emotions and don’t care about other people’s pains. You should be ashamed of your system. I thought Canada is a developed country. Please answer it, I’m really wondering what is your answer gonna be,, so that I can laugh more. :)
I think every patient want to be cured as soon as. Also, hospital and doctor has responsibility to patient. If the hospital bed always full, it mean government or hospital need to solve this issue and situation. “Hospital bed is full ” is not always a reason. How do you think the large population countries? They are always bed full?
The big picture is ‘gatekeeping’ . Physician gatekeeping restricts selected patient populations from a range of primary, secondary and tertiary care interventions. Chronic illness/pain is the number one target of gatekeeping as it takes a large percentage of the health budget. Seniors, terminal care patients, patients with degenerative osteoarthritis are among the most vulnerable populations, adversely affected by gatekeeping. Because of it, patients aren’t able to get community or clinic based urgent care, there is poor continuity of care. Patients decline until they are in crises, and appear at emergency. Here they are still low priority because emerge is for acute care, blood, broken bones, head injuries. I went to emerge because I could not walk, due to nerve root compression and needed pain pills urgently. The doc excused himself to see someone who was ‘really sick’. My GP knew this day was coming, I have a degenerative condition, past C Spine surgery, imaging reports, and so on, but he wouldn’t plan with me, delayed surgical follow up, and prescribed pain meds that I used 16 years ago. I’m past the stage of yoga and turmeric, I’m in acute decline, suddenly having to get a wheelchair. So that is why there are long wait lists, because so many patients are not getting the community clinic treatments and collaborative treatment planning they need. They go into crises and have no one else to turn to. There is a recent UBC research article about how to divert even more chronic care patients away from medical care. There is also a provincial planning document of 2015 outlining the same plan.
Quite frankly this is rubbish! Most of the people who come to emergency could be managed more effectively at home with their frequent visits to emergency for their chronic problems. Mismanagement by the GP with no health team to support these patients makes for poor business. Family doctors are not as accessible as emergency and that is why people go to the emergency department. Family doctors should be addressing and making solid care plans for their patients who go to emergency 4 times per week. Yes, the hospital is backed up, so maybe the gp’s should take care of their patients better instead of writing another script, and shoving people out the door. A more holistic approach with several disciplines and services will provide more comprehensive care.
If you cant get a family doctor or are given wait times which can be 6 months or more for specialists what choice do some people have but to go to the Emergency? What have we been paying a fortune in health taxes for? To wait a year to see a specialist by which time your condition has gotten far worse. I guess the health care system isnt a big believer in “an ounce of prevention”.
Re the high proportion of patients not having a family doctor or not being able to get a timely medical appointment…how about making better use of other health care professionals such as pharmacists, who are well suited and highly accessible, who can relieve this significant strain on hospital ERs. Pharmacists’ management of common yet minor and often self-limiting ailments is currently in place in many other provinces (sadly, not yet in Ontario) and this scope expansion has eased the strain not only on hospitals but also on crowded medical offices and even impersonal walk-in clinics. Canada’s highly trained pharmacists have well-defined relationships with their patients and with their patients’ primary care providers, and so, the interprofessional dialogue that routinely occurs between pharmacists, physicians and nurse practitioners would ensure that the one hand knows what the other hand is doing. And when a patient doesn’t have a primary care provider, continuity of care still needs to be provided, and pharmacists are the most accessible of health providers, often open extended hours….far longer than walk-in clinics. It’s smart, safe, cost-efficient, and convenient healthcare…and it’s about time!
Pharmacists are experts in pharmacology. They have no training in actually diagnosing a disease or physically examining a patient, and hence, have no business practicing medicine.
We should stop dreaming up new tasks for different health professionals to start doing and instead make it easier for different professionals to excel at what they are are experts in (and pay them fairly to do it),
Oh come on now, doctors aren’t hungry.