Are Canadian emergency rooms worth waiting for?

People are waiting in emergency rooms across the country, but not always for the right reasons.

Through the National Ambulatory Care Reporting System, the Canadian Institute for Health Information recorded approximately 10.4 million visits to Canadian emergency rooms between 2013 and 2014 which they say accounts for about 60 % of total emergency room visits in Canada in that year. Tracy Johnson from CIHI says that there are different agreements across Canada on the collection of health data and due to this, not all emergency rooms are represented in their data.

During these emergency room visits, people experience something called a length of stay. In Canada, CIHI defines length of stay as a measure that describes the span of time that a patient arrives in the emergency room to the time that they leave.

The median length of stay in Canadian emergency rooms was measured at 2.5 hours. Steve Erwin, manager of Corporate Communications, Government and Community Relations at Windsor Regional Hospital, says this is pretty normal.

“In general, a time period of greater than 2.5 hours from start to discharge home from the emergency department should be expected. If a patient is attending an emergency department and from start to disposition of discharge is 2.5 hours or less then either they are in the wrong setting or they have limited options to receive health care,” says Erwin.

In all of Canada, Manitoba has the highest median length of stay of 3.9 hours and Yukon Territories has the lowest median length of stay of 1.4 hours. Ontario falls in the middle and in line with Canada with a median length of stay of 2.5 hours. Erwin explains Ontario’s situation.

“As a province, Ontario has more work to do but again a time period of greater than 2.5 hours from start to discharge home in the ED should be expected. It’s important to note that critical cases are seen immediately; those who are not in life-threatening situations may have to wait a longer period of time while critical cases are being covered,” says Erwin.

 

This graph describes the lengths of stay for each province and Canada overall. Please remember that not every emergency room and not every province submitted data to this study so results may be skewed. The data also comes after age adjustments.

 

Having to wait can be very time-consuming. Canadian Cassie Lussier was not pleased with the length of stay of her last visit.

“The last time I went I had a stomach issue and it took me six hours to be seen and then three hours to wait for my results. That’s the longest time I’ve ever been and it was really annoying because my stomach was hurting the whole time,” she said.

While many Canadians are flocking to the emergency room when they have a problem, they aren’t always waiting in the right place. Some illnesses and injuries are better suited for other places like a family doctor and are referred to as “Family Practice Sensitive Conditions.” According to CIHI, about 1 in 5 visits to the emergency department that result in not being admitted are because of FPSCs.

The top two recorded FPSCs between 2013 and 2014, not including the category “other FPSCs,” were acute upper-respiratory infections like colds and other medical care that focused mainly on antibiotic therapy. Number six on the top ten FPSCs list was a migraine, something that Kevin Sanchez Tejada ended up at the emergency room with.

“When the migraine happened, it was late at night and the only place we could think of was to go to the ER since it’s open 24-7 with hopes they might have something to help with it,” says Tejada.

 

This chart looks at the top ten reasons that people visit the ER that would be qualified as an FPSC and details each type of FPSC visit as a percentage of total FPSC visits. Because numbers were rounded in the data and therefore numbers do not add up to 100, a section called “Unaccounted for” was added and the graph was renamed Top 11 FPSC visits.

 

There is a specific age group that visits the emergency room most often for an FPSC. 36 per cent of FPSC visits to the ER are for children under the age of one. They’re most commonly brought in for acute upper-respiratory infections like colds. Sarah Dean says she would never bring her children in for a condition like that.

“Waiting hours in a germ filled environment for only a cold is a waste of time. Even if the cough was a croupy sounding cough and​ it was the weekend, I would wait until Monday for the family doctor. Emergency is for emergencies,” says Dean.

About 15 per cent of all reported visits in Ontario are related to FPSCs. Erwin thinks that getting rid of types of visits would be better for the patient and system but understands that this isn’t always possible.

“Until as a province we have more options to receive primary care, such as through family physicians and nurse practitioners, we will continue to only have limited healthcare options at certain times of the day. We can’t blame patients for coming to the ED if they feel they have no other option,” says Erwin.

However, he did suggest that annual check ups would reduce ER visits. For now, the future is uncertain.

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