Wait times for hospital admission from the ER are at a record high in Ontario. It’s a symptom of a system-wide crisis

In the emergency department of Toronto's Michael Garron Hospital more than 300 people a day seek medical help, an increase of 40 to 50 per cent from pre-pandemic times.

At St. Michael's Hospital, the emergency department is seeing patients who are much sicker than those who sought care before COVID-19.

Experts say the pressure is affecting hospitals throughout the province as emergency departments continue to navigate record-breaking volumes of patients with very high acuity and complex health-care needs.

The result is that the average wait time to get admitted to a hospital in the province through the emergency department is at a record high - 20 hours in April, up from 16 hours in 2017-18, the last year the data was available.

But as bad as the wait times are, they are a symptom of a deeper problem that is system-wide.

The emergency department is always sort of like the canary in the coal mine," said Dr. Katharine Smart, president of the Canadian Medical Association. When things aren't working well there, it's usually because there are other stressors throughout the system ... that then makes things in the emergency department back up, because it's the one place that's never closed and can never refuse patients."

Higher rates of admission combined with staffing shortages are making it very difficult because we don't have an adequate complement of staff to care for patients," said Smart. And, of course, that also makes it difficult to get (patient) turnover."

Fixing the problem will require a major overhaul of the systems which bookend hospitals, she said - primary and home care, as well as long-term care.

There's a lot of elderly people who are not able to live independently, who end up staying in hospital for long periods because those community supports aren't available," said Smart.

That's a huge issue," said Smart. Because when you have already a low hospital capacity, which we do in Canada, and Ontario, which has the lowest number of hospital beds in Canada, they need to be used appropriately."

And she said primary care needs to change to improve access to family physicians, who can't always manage complex illnesses and need to work as part of a team. Many are also leaving the profession.

It's challenging as it stands right now for doctors to take on complex patients. Often because of the way they're paid, (which) doesn't allow them to have the time for that," said Smart. Why are we thinking one person as an individual can look after someone with all the complexities of modern life right now in a 15-minute appointment for $30 and run an office?"

The pandemic has brought the system to a crisis point, with delays in diagnoses and surgeries.

At St. Michael's Hospital, part of the Unity Health network, the emergency department is seeing patients who have conditions that have deteriorated more so than patients before the pandemic.

The hospital is also seeing huge increases in its trauma volumes and that's theorized due to increased violence due to lack of prevention resources," said Dr. Carolyn Snider, the hospital's chief of emergency medicine.

The result is that 3,000 more patients were admitted to the hospital in the last year compared to the year before COVID-19 hit.

The demand for beds is occurring at the same time as a critical shortage of registered nurses and a patient can't be moved to a bed unless there's a nurse that can take care of that patient. It's a problem Snider said isn't unique to any one institution.

It's also happening as hospitals attempt to decrease surgical backlogs.

Meanwhile, RNs are leaving the profession because of burnout as well as the government's Bill 124, which limits pay raises to 1 per cent, at a time when workloads are increasing and patients are sicker. Snider said the higher patient loads mean nurses are missing breaks and vacations - the very things they need to recover.

I think they're the most undervalued for the kind of work they do," said Snider of RNs, financially in terms of what they're getting for the kind of care they're providing, which is life saving, incredibly difficult - requires high skill."

Over at Michael Garron Hospital, the emergency department is also dealing with patients requiring more acute care, which has resulted in higher hospital admissions, said Dr. Kyle Vojdani, chief and medical director of the hospital's emergency department.

Patient volumes have also increased due to a number of other factors, said Vojdani, including significant increases in mental health addictions, injuries as people became more active during the pandemic and a number of respiratory illnesses, not typical at this time of the year, but a result of exposure as COVID-19 restrictions subsided.

He said it's a strain on an emergency department that was already working at full tilt.

The system did not have the reserve capacity," said Vojdani. It was certainly always operating at a very high level. And now what's being asked of emergency departments across the province and across the country is to not operate at 100 or 110 per cent - they're being asked to operate at 160 per cent."

He said federal and provincial funding will be needed to help emergency departments, the only place where people can access care 24 hours a day.

I think we have to reinforce the safety net that's intended to support the community when we are in situations like this," said Vojdani. Because right now there are definitely cracks emerging. And I'm very concerned for our system and certainly patients requiring our services."

Vojdani added, We continue to do our best, but it gets harder to do so every day as this issue continues."

Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email: pwinsa@thestar.ca