Overcrowding

Overcrowding - Primary Issue

The Canadian Association of Emergency Physicians (CAEP) is a national advocacy and professional development organization representing over 1,800 of Canada's emergency physicians. In its mission CAEP is committed to excellence in emergency health care in Canada with a vision to improve emergency health care for Canadians.

CAEP has grown quite substantially in the past ten years and is now able to concentrate efforts on patient advocacy and addressing the emergency health care needs of Canadians.

The single most important issue currently facing Emergency Departments is overcrowding resulting in prolonged Emergency Department wait times. This is CAEP's primary advocacy issue.

Overcrowding - The Cause

• Overcrowding is a "systems" problem. It varies by province and region but is an issue across Canada.
• Despite being a systems problem the root cause of overcrowding in most regions is the lack of availability of acute care beds on hospital wards and in Intensive Care Units.
• Increasingly hospitals have more patients that need acute care beds than there are beds to accommodate them. To cope with this situation, acutely ill overflow patients occupy acute care stretchers in the Emergency Department and are kept in emergency departments as "corridor" patients. The direct result is a block to access of care in the Emergency Department and increased Emergency Department wait times.
• One of the most common myths about overcrowding is the notion that it is caused by an overflow of patients with minor problems. The scientific literature does not support this. The reality is that emergency departments can usually handle these cases efficiently. "Non-urgent" patients do not occupy acute care stretchers, they require little or no nursing care, and they typically have brief treatment times.
• The lack of acute care stretchers has serious consequences for newly arriving patients who may be critically ill or injured. If the department's stretchers and nurses are diverted to the care of admitted patients, emergency patients cannot be placed in (already full) treatment areas; paramedics cannot unload their patients and patients who have not yet been evaluated or stabilized are denied access to an acute care stretcher.

Overcrowding - The Solution

CAEP has the following recommendations for addressing the issue of overcrowding in emergency departments:

1. Federal and Provincial governments must acknowledge that there is a problem with overcrowding in Canada's Emergency Departments and Emergency Department wait times.
2. Strategies for addressing the systems issues related to overcrowding are well documented and researched. These straggles need to be enacted upon aggressively.
3. Governments must restore bed capacity. Depending upon the local needs increasing the number of acute care hospital beds and creating more long-term and chronic care beds within the hospital and/or in the community is of critical importance.
4. In order to ensure a high standard of care for emergency patients, federal and provincial governments will need to renew their commitment as stated in the Health Care Accord to achieve meaningful reductions in wait times, and to include, as a priority, reducing wait times in emergency room departments.
5. Resources for restoring bed capacity should be made available, where necessary, through the Wait Times Reduction Fund of the First Ministers' Health Care Accord.
6. Future needs must also be assessed in order to anticipate the impact of the "Baby Boomers" as they become acute care patients in the decade to come.

Overcrowding - Fast Facts

• A recent Ipsos-Reid poll suggests that 74 per cent of Canadians were concerned about prolonged ER waits and deteriorating service.
• On average, one patient "warehoused" in the ER denies access to four patients per hour to the emergency department.
• Between 1991 and 1997 the occupancy rate of acute care beds in Toronto hospitals exceeded 90 per cent and peaked at 96 per cent in 2000. Overcrowding in emergency departments exists only when bed occupancy rates exceed 90%.
• Estimates are that 10 to 25 per cent of available, funded hospital beds are taken by so-called "bed blockers" -- people who should be receiving care outside a hospital (e.g. in a long-term care facility). This blockage in hospital wards contributes to the backlog of patients waiting for admission in the emergency department.
• During 1999 there was a 2 per cent increase in the number of patients who left the emergency department of an Ontario hospital without having been assessed by a physician.
• Statistics that track the incidence of ambulance re-directs (also known as critical care bypass) in Toronto show a dramatic increase when total hours are combined: 49 hours (January 1996); 180 hours (January 1998); and 290 hours (January, 2000).
• The emergency department is a major access point to the health care system. In Ontario, in 1990 there were an estimated 3.4 million annual visits to the province's emergency departments. In 1993 that statistic rose to over 4 million visits, and in 1999 it had increased to 5.1 million.