TORONTO – Long waits in Canadian hospital emergency departments reflect a series of widespread weaknesses across the entire health care system: a shortage of hospital beds, insufficient long-term care facilities, staffing shortages, increasing clinical complexity of patients, and difficulties accessing community-based services. This is the conclusion of a new report by the Canadian Institute for Health Information (CIHI), titled Emergency department wait times in Canada: Insights from a health system perspective, which analyzes the causes of wait times in the country’s emergency departments.
According to the study (available in full here), emergency departments now act as a kind of “thermometer” of the overall health of the health system: when one part of the network becomes blocked, the effects inevitably spill over into emergency services. “There’s a national crisis around emergency services because we’ve optimized everything. We’ve taken all the elasticity out of the system, but the tap is still flowing. There’s a crisis: insufficient connected community resources, and little continuing care and long-term care,” writes Emergency Medicine Physician Paul Parks, former president of the Alberta Medical Association, in the report.
One of the most common misconceptions is that wait times are caused by patients presenting to emergency departments with non-urgent conditions. CIHI revisits this interpretation, showing that the main drivers of overcrowding are multiple: difficulty transferring patients to hospital wards, a shortage of available beds, and structural gaps in community and long-term care services.
The first issue in particular is a major contributor to delays: many patients who require hospital admission remain for hours—and in some cases days—in emergency departments because no inpatient beds are available. According to CIHI data, half of admitted patients spend more than 16 hours in the emergency department before receiving a hospital bed, while about one in ten remains for more than 48 hours. The effects are cascading: stretchers remain occupied, the capacity to receive new patients decreases, and overcrowding worsens.
Another factor is the increasing “acuity,” or clinical complexity and severity of patients arriving at emergency departments. Patients are generally older, have multiple chronic conditions, and require more complex diagnostic and treatment pathways than in the past, increasing length of stay and workload for healthcare staff. And another key issue highlighted in the report involves so-called ALC (Alternate Level of Care) patients—individuals who no longer require acute hospital care but cannot be discharged because appropriate placements in long-term care facilities, nursing homes, or home care services are unavailable. These patients occupy hospital beds that could otherwise be used for emergency admissions, creating a domino effect that slows the entire system. CIHI notes that about one in ten hospital patients remains in hospital while waiting for appropriate community or support services.
The situation is further aggravated by chronic staffing shortages, with healthcare workers facing rising workloads and an increasing risk of burnout.
CIHI’s conclusion is clear: there is no single solution to reduce emergency department wait times. Focusing only on improving access to family doctors or increasing outpatient visits is not enough. A multi-pronged approach is required: increasing hospital capacity, strengthening home and community care, expanding long-term care infrastructure, improving data collection, and making patient flow through the system more efficient.
In three words: a system overhaul.
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