An Ontario doctor says ERs are more stressed than he’s ever seen — the data backs it up

Patients in emergency rooms around Ontario are waiting record times to be hospitalized, a situation that medical experts say is only looking to get worse.

This trend is particularly worrisome for hospitals because it is ongoing despite a dwindling COVID-19 load, and because it comes at a time of year when the burden on emergency departments typically eases.

More than two years into the pandemic, wait times are indicative of how chronically strained provincial hospitals have become.

Howard Ovens, who has worked in the emergency department at Toronto’s Mount Sinai Hospital for nearly 40 years and chairs the provincial emergency services advisory committee, said: I’m experiencing more stress than I’ve ever seen in my career.

Have you or someone close to you recently endured a prolonged stay in the emergency room in Ontario? Email CBC News Let us know about your experience.

“The workload with the patients we are seeing is at a record high,” Ovens said in an interview.

Nurses in the emergency department at Scarborough General Hospital. Staffing shortages due to illness, COVID-19 exposure and burnout are among the reasons behind the increasing wait times in emergency rooms in Ontario. (Evan Mitsui / CBC)

The main factors that lead to long wait times are largely side effects of the pandemic:

  • The percentage of employees who are sick or unable to work is high because they have been exposed to COVID-19.

  • Patients get worse, often because they delay treatment during pandemics.

  • Hospital wards were filled up trying to keep up with backlogs of surgeries and procedures, so it was a challenge to squeeze those ER patients who needed to be hospitalized.

This happens on top of long-term problems in the system that extend beyond the emergency room door, including discharge blockages due to a lack of long-term care space and home care support.

Underpinning the increasing emergency department wait times are problems that existed in Ontario’s health care system long before COVID-19 was born and have never really gone away: illnesses Hospitals often stretch beyond their capacity to the point where patient care in the hallways has become the norm.

Combine it all with what officials say is a record high number of patients arriving by ambulance and a record high number of ER patients requiring hospitalization, and that leads to wait times in emergency room never seen before at this time of year.

Paramedics are pictured outside the emergency department of West Toronto Hospital on June 15. Health system officials say Ontario hospitals are seeing an influx of patients being brought to their rooms. emergency by ambulance record. (Esteban Eduardo Cuevas Gonzalez / CBC)

The Latest statistics published by Ontario Health found that patients who visited the emergency room in April and were hospitalized spent an average of 20 hours in the ER before going to bed at the clinic.

That number is the longest wait time Ontario has ever posted in April. It is 42 percent higher than it was in April 2021 and a fraction of the record-high average wait time of 20.1 hours seen at the peak of the Omicron wave in January.

While recent wait time statistics are not widely available, administrators and medical professionals with direct knowledge of the system say the situation in emergency rooms is still uncertain. improved since April.

“Emergency departments are on fire,” said Amie Archibald-Varley, a registered nurse who works in the emergency room of a large hospital in the Greater Toronto Area.

“Everybody is functioning at very, very high levels and with high stress levels,” said Archibald-Varley, co-host of the Gritty Nurse Podcast. “The emergency department has always been a fast-paced area … but we’re beyond capacity now.”

Archibald-Varley is among those involved in the system, saying the shortage of specially trained nurses is today’s most pressing human resource challenge facing ERs.

“Really what we’re trying to do is keep our heads above the water,” she said. “But it was a very, very stressful and very, very difficult time right there in the emergency departments.”

Amie Archibald-Varley is a registered nurse in the emergency department of a large hospital in the Greater Toronto Area and co-host of the Gritty Nurse Podcast. (Danielle Blancher)

The heavy demands on staff mean that an ER experience is far from ideal for patients. In some particularly stressful hospitals, admitted patients had to wait more than two days in the emergency room on average before they received a bed.

Those patients often spend that time waiting on a stretcher in a hallway or a rearranged room, and their constant presence contributes to a kind of deadlock in the emergency department.

Medical staff have difficulty waiting next to the person they have brought in by ambulance because there are no nurses available to take care of new patients.

Cathryn Hoy, president of the Ontario Nurses Association, said some emergency departments are operating without filling large numbers of nursing positions, and the patient-to-staff ratio is growing significantly.

“I don’t think Ontarians really know what’s going on in emergency rooms,” said Hoy, whose union represents 68,000 nurses and other healthcare professionals across the province.

A paramedic checks on a patient waiting in the hallway of the Humber River Hospital emergency department in Toronto on January 13, 2022. (Evan Mitsui / CBC)

“Our current staff shortage is getting worse and worse. There’s burnout. They’re sick. They’re under a lot of stress,” Hoy said in an interview.

Doctors are describing what is happening in the ERs in profile form.

“It was quite a difficult and challenging time,” said Dr Andrew Arcand, chief of emergency medicine at Markham-Stouffville Hospital.

“We’re seeing more [patient] The number, the number is more than ever before, Arcand said in an interview. And perhaps the most impressive thing is that our hospital is running at 100% better capacity every day. “

As a result, Arcand said patients who need to be hospitalized remain in the emergency department while waiting for a bed, while staff try to keep up with new patients arriving in the emergency room.

“It’s a level we’ve never seen before in the history of our department,” he said.

Dr. Andrew Arcand is chief of the emergency department at Markham-Stouffville Hospital. (Michael Charles Cole / CBC)

Kashif Pirzada, an emergency room physician in Toronto, said a combination of short staffing and high patient demand is leading to unprecedented patient wait times and staff costs. fee.

“We’re basically stretching like never before in our careers, and that goes back 15 years,” Pirzada said in an interview.

“Every wave of COVID causes a wave of enrollments that stress the system,” he said. “It’s a chronic stress that the system wasn’t designed to deal with.”

However, doctors still recommend that people go to the emergency room if they are so sick that they need urgent care. They also say that staff drop everything to bring immediate attention to people who come in with life-or-death circumstances like trauma or a heart attack.

“I’m very proud of my colleagues … doing their best under difficult conditions,” said Ovens.

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