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An increasing percentage of Ontario hospital beds are being used for people who are waiting for care elsewhere.
More than 1 in every 7 days (14.8%) that patients spent in Ontario hospitals in 2016/17 were spent waiting to go elsewhere, such as a long-term care home or rehabilitation facility. That’s the highest rate in the last five years and the equivalent of more than 10 large hospitals being occupied every day by patients waiting for care elsewhere. The proportion of hospital beds that were occupied by patients waiting for care elsewhere (called ‘alternate level of care’) varied across Ontario’s regions, from 6.4% to 29.8%.
Emergency department visits are on the rise, especially among those with serious conditions.
Crowded hospital emergency departments across Ontario are under pressure to care for an increasing number of patients. Visits to Ontario’s emergency departments increased by 11.3% over the last six years, to 5.9 million in 2017/18 from 5.3 million in 2011/12. Visits by high-acuity patients – those with more serious conditions – rose at an even higher rate, up by 26% to 4.1 million from 3.3 million.
Hospital emergency departments are facing an increasing challenge dealing with the opioid crisis. Visits to the emergency department due to opioids more than tripled to 54.6 per 100,000 people in 2017, from 15.2 per 100,000 in 2003.
For more information on emergency department wait times in hospitals make sure to check out our online reporting page
Karen, an emergency physician and co-program medical director in Kingston, talks about the impact of emergency department overcrowding on hospital front-line staff and patients, and how the hospital has made improvements.
Read Karen's story
Karen, an emergency physician and co-program medical director in Kingston, talks about the impact of emergency department overcrowding on hospital front-line staff and patients, and how the hospital has made improvements. This story features excerpts from Karen’s interview with the Faces of Health Care blog
“The patients are more complex and elderly. Overcrowding is the biggest change. When I first started 20 years ago, if one or two patients were in the department for over 24 hours, that would really have caught our attention. We’d be like, ‘What’s going on?’ Now there are 30, sometimes more.”
The toll on front-line staff
“We’re a department of 38 beds and we often have up to 30 admitted patients. We see a volume of about 170 a day, which means we are trying to see 170 people in eight beds. So, we are doing a lot of hallway and make-do medicine. Overcrowding causes real morbidity and mortality, and there’s an incredible toll on the staff trying to deal with it.” “I feel guilty that I am part of a system that does this to people. Patients are angry, and rightly so. I can think of umpteen dozens of patients where I just feel like I am constantly apologizing. Personally, it’s taken an emotional toll. I’ve even given up apologizing. I just agree with patients that this isn’t good care, and ask them to complain to others because I am not having any luck.” “We lost a lot of our good, experienced nurses a few years ago. It’s really hard on them. Sometimes I wonder why they stick around. One of our nurses came back after six months. She said she missed the camaraderie and the team work. Despite it all, we have good people and we work closely as a team. That’s the fun part. The saving grace is the people I work with. I love them. On bad days it gets me through.”
Unable to wait
“I saw an elderly man who had a severe infection and ended up in the ICU. I realized that he had been in the waiting room the day before and left after five hours without being seen by a physician. I read the nurse’s notes from the evening before, and he had symptoms of a urinary tract infection. I felt so bad because if he had just been given an antibiotic then, he might have been fine. The people who leave our waiting room are sometimes the sick older patients who need to be seen, but who feel too unwell to stay.”
Lack of community resources
“The lack of resources in the community is a real problem. People are parked in our department for literally days because no one wants to admit them and they can’t go home without help. Like someone with a stable pelvic fracture who with a bit of help could probably manage at home. That’s a daily occurrence.
One year later, Karen reflects on improvements
“The good news is that over the past year, our hospital has had a new senior leadership team facilitate multiple hospital-wide initiatives to address overcrowding. As a result, the amount of time nine out of 10 people spent in our emergency department before being admitted plummeted from 57 hours to 27 hours. This statistic is impressive, but the evidence alone fails to fully reflect the positive impact this has had on both the quality of patient care and staff morale. It goes to show what good leadership and teamwork can accomplish in this era of increasing health care demands.”
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