Top five reasons you could be waiting in the Emergency Department
HAMILTON, ON – Hamilton Health Sciences’ (HHS) hospitals are under extreme pressure for a number of reasons, creating longer waits for care – including in the emergency department (ED) – and this is the case for many hospitals across Ontario and the country.
“Those who have visited one of HHS’ EDs for emergency care, or brought in a loved one, have very possibly experienced these pressures first-hand,” says Dr. Kuldeep Sidhu, Chief of Emergency Medicine at HHS. “We’re asking for patience as our teams do their best to care for all patients and their families.”
Below are five reasons causing longer wait times, and how teams at HHS are working hard to ensure every patient receives the care they need.
1. We need more staff and doctors.
There are record-high staffing pressures across Ontario and Canada, including at HHS, which affects all areas of hospital operations including our EDs. These staffing pressures existed before COVID-19, but were made worse by the pandemic and persist across our health care system.
One reason for these staffing pressures is the number of healthcare worker retirements, which have increased in recent years and are a reflection of our aging population. Since April 2022, retirements at HHS have increased by almost 30 per cent compared to the same period in 2021. We’re continuing to aggressively recruit for many positions hospital-wide including MRI technologists, perfusionists, medical laboratory technologists, respiratory therapists and many others. Some of these roles are highly specialized and the pool of skilled individuals is relatively small, resulting in competition across the health sector.
2. We have an extremely high number of patients
At the same time as we’re experiencing staffing pressures, our hospital sites are over capacity. There are more patients who need beds and care than we have resources for.
“The accepted standard for hospital capacity is 85 per cent, yet there are many days where our hospitals are at 110 per cent or more,” notes Dr. Sidhu. “We simply have no more slack in the system.”
The downstream effect of this on emergency patients who need to be admitted is that they may have to wait in the ED for a while until a bed opens up elsewhere in the hospital.
Currently, 100 per cent of our provincially-funded beds are full on a daily basis, and we’ve made another 60 to 80 unfunded beds available. These extra beds amount to the equivalent of a small hospital.
“Our EDs are often full beyond capacity, which is why some patients are cared for in unconventional spaces like hallways while they wait for a bed to open up,” says Dr. Sidhu. “But even in these less-than-ideal situations, our emergency teams are doing the best they can to meet the needs of their patients.”
3. We can’t admit patients because we can’t discharge patients
Our healthcare system has been chronically congested. Gridlock is a term used by hospitals when inpatient beds are full, leaving no room for patients in the ED to be moved into a bed on a hospital unit.
For example, we have a record number of patients who no longer need hospital-level care but are waiting to move to a community setting, such as a long-term care home. Since long-term care beds are also scarce, these patients remain in a holding pattern in hospital. Currently, the number of patients waiting in hospital for alternate care in the community is at an historic high.
4. We are a regional centre for trauma, children’s care, stroke and more
“Our EDs remain extremely busy, and we also care for some of the sickest patients across the region. For example, HHS is a regional centre for cardiac, stroke and trauma care,” adds Dr. Sidhu. “These heart attack, stroke and seriously injured trauma patients receive care first, meaning that people with less serious conditions may face longer wait times.”
All patients are triaged when they arrive at an ED, meaning the most seriously ill patients are treated first. This is done using the Canadian Triage and Acuity Scale – a tool used nationally and internationally by EDs to prioritize which patients are most in need of care.
Whether you arrive by ambulance or on your own, you care is measured on the same scale. Your wait time depends on how serious your illness or injury is compared to others who are also waiting.
5. Fall means more sickness
While the summer is known as trauma season, the fall and winter are usually our busiest time for viral illnesses. This includes the flu, RSV, and now, also, COVID.
“While we often see fall surges in flu activity, this year’s viral season is adding further strain to a healthcare system already burdened by staffing and capacity pressures,” adds Dr. Sidhu. “It’s important to get a flu shot and to stay up to date with COVID vaccines and boosters. If you have symptoms of flu or COVID you should also stay home, regardless of rapid test results, to reduce spread of viruses.”
Most patients don’t need to come the ED because of these viruses, but for people who have another illness that weakens their immune system, these viruses can be very dangerous and they may need urgent or emergency care.
There are also people who come to the ED because their surgery was delayed or they didn’t get other health care they needed because of the pandemic, so now their original condition is worse. We are seeing more people who are sicker when they arrive at the hospital for care.
Know your options
“Despite these very real pressures, it’s still vitally important for anyone needing emergency care to go to the ED. Depending on your health care issue, you may have to wait, but this is because our most critically ill or injured patients are more in need,” adds Dr. Sidhu. “We ask for your patience and understanding as we work to resolve these wait-time issues with our government and community partners.”
Please also note that other options are available for people not experiencing a medical emergency. You can visit your family doctor for health concerns that can wait a day or more; contact Health Connect Ontario to speak with a registered nurse 24/7 via phone or web chat; or visit an urgent care centre for health concerns that aren’t life-threatening but can’t wait for a doctor’s appointment. Go to needadoc.ca to learn more.