How long is too long? Assessing wait times in Canadian EDs
While it is unclear how long patients wait to see a doctor in the Emergency Department (ED), one thing is for sure: prolonged wait times do more harm than good and pose a serious threat to Canada’s healthcare system.
In 2018 to 2019, the average wait time for patients across Canadian EDs was three to four hours. This merely represents the time to first assessment by a physician. Since wait times vary from one province to another, some patients are more likely to be impacted than others. Quebec was found to have the longest wait time, at nearly five hours, followed by Manitoba.
Patients taken to the ED are generally in dire situations, hence the name “emergency” department. If they are made to wait for hours prior to seeking medical attention, their health is likely to deteriorate.
When discussing patient satisfaction, an important consideration is the time to medical care that is determined by an assessment of patients’ level of emergency and a lack of clarity on waiting time. Spending hours before seeing a medical expert not only aggravates clinical outcomes, it creates negative perceptions in patients’ minds.
Research shows a stark correlation between the time-to-treatment and mortality risk among patients. Every half hour of stay in the ED can increase the risk of seven-day mortality. At its core, the issue is a lack of access to emergency physicians. As of June 2020, only 45 per cent of all Ontarians were admitted to the hospital, across all emergency departments, within the target time of eight hours.
Under present circumstances, wait times are a trade-off between patients and physicians. While patients want optimal care in the shortest time possible, it is the time-consuming and effective assessment that allows doctors to maximize diagnostic accuracy.
Patients in nearly all Canadian hospitals have encountered long wait-times. Solutions exist across all age groups, and at all hospital levels, to combat this recurring issue.
In 2012, Newfoundland and Labrador devised a detailed action plan to reduce emergency wait times across the province. Its strategy included adjusting staff scheduling to meet high patient volumes, appropriate discharge policies in line with high patient flow and minimal healthcare resources and improving the physical layout of the ED to reduce inefficiencies.
A way to mitigate long wait times is to increase access to family doctors since the lack of access to primary care providers drives more people to visit the ED. Canada has one of the highest rates of ED visits in the world. Between 2014 and 2018, nearly 5 million Canadians reported not having access to a family doctor. When asked, a majority of patients reported that they would have chosen a primary care service over a visit to the ED if one had been available.
Another solution is to develop and implement a strategy to provide community-based alternatives to care for our aging population such as referrals to community or long-term care (LTC) centres. Not only does this free up EDs, it also takes into account non-biological aspects that may not necessarily be resolved through nosocomial care such as senior isolation and day-to-day tasks.
An additional strategy is to hire more nurse practitioners (NPs). NPs differ from registered nurses (RNs) in that they are given more autonomy; can diagnose and treat acute illnesses; can prescribe medications; and can see patients independently. Undoubtedly, nurses serve as an invaluable asset to the healthcare team. Studies show that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident.
When evaluating barriers to healthcare service in Canada, it is critical to adopt a multidimensional view. Rather than placing the blame on physicians for slow processing of individuals, patients must understand that they are trading time for high-quality service. It is this give-and-take relationship that generates an effective healthcare system.
Solutions to this issue exist across all levels and for patients of all ages. It is time to implement them to combat long wait times across Canada.
Neel Mistry is a medical student at the University of Ottawa. He is passionate about medical education, public policy and health management.
Paul Rooprai is a medical student at the University of Ottawa. He is passionate about public health, clinical research and patient safety.
Shubham Mistry is a PharmD candidate at the University of Toronto’s Leslie Dan Faculty of Pharmacy. He is passionate about rational prescribing and high-quality patient care.