Addressing hospital capacity problems is “critical” to reducing emergency room wait times, according to the authors of a new Alberta study.
The research, published in the Canadian Journal of Emergency Medicine, analyzed more than half a million ER visits at 14 Alberta hospitals between May 2022 and March 2023.
“Emergency crowding and emergency wait times are a significant public health problem,” said Dr. Eddy Lang, lead author and professor in the department of emergency medicine at the University of Calgary’s Cumming School of Medicine.
According to Lang, there is a tendency to simplify the causes — such as pointing to the number of people visiting ERs who don’t need emergency care — resulting in ineffective solutions.
“We felt that there’s probably a lot more complexity,” he said.
Researchers looked at a wide variety of factors, ranging from a patient’s age, socio-economic status and connection to a primary care provider, to system-level data, including hospital occupancy and how many admitted patients were stuck in emergency rooms and unable to move onto the wards.
“The ability to get the admitted patients upstairs and move them through the hospital was of paramount importance,” said Lang, noting the findings underscore what many frontline providers see every day.
According to Lang, the hospitals that kept occupancy close to 100 per cent had shorter ER waits.
“Hospitals that were struggling and had occupancy rates of 110 [or] 120 per cent had more difficulties in this regard and hence their emergency department’s wait times were longer,” he said.
“And although that’s not earth shattering news, there were quite a bit of differences between hospitals.”
These differences, he said, can be seen in facility-specific data reported publicly by the Health Quality Council of Alberta.
Researchers also found factors like “older age, greater material or social deprivation, and any mode of emergency medical services transport were associated with longer [emergency department] length of stay.”
Connection to a primary care physician was associated with shorter stays, the study said.
An association was also found between higher hours worked per nurse and shorter stays, which reserachers said could reflect patient handovers or other internal processes.
The research comes at a time when there is growing concern about emergency department overcrowding in Alberta.
A fatality inquiry has been ordered into the death of a 44-year-old man who died while waiting to be seen by a doctor at an Edmonton emergency department in December.
Doctors have been raising the alarm about other deaths they claim could have been prevented, and patients have been speaking out about their own near-misses.
“Addressing hospital capacity constraints — particularly high inpatient occupancy — remains critical. Strategies such as expedited discharge procedures and demand-driven overcapacity protocols have been shown to improve bed availability without increasing ICU transfers or mortality,” the authors wrote.
In addition, optimizing staffing and improving co-ordination across the patient trajectory (including the ER, inpatient units and post-discharge services) could improve efficiency and reduce long stays, the study said.
Lang hopes the findings will spur change.
“If hospital A has a lower level of occupancy and lower numbers of admitted patients, we should go and find out what the secret sauce is,” he said.
According to Lang, some facilities appear to concentrate risk in the emergency room, by trapping the bottleneck in the ER, which he describes as unfair.
Others, he said, are able to spread that risk evenly through departments.
For example, according to Lang some hospitals allow for surging onto inpatient units during critical times. That means patients are sent to the wards even if it means they’re treated in hallways until a bed opens up.
“There are hospitals that … don’t allow things to get out of control in the emergency department. It takes all hands on deck,” he said. “But it’s absolutely achievable.”
Canada-wide problem
“Crowded emergency departments have been a systemic issue across all of the provinces for at least 15 years and potentially even longer,” said Jason Sutherland, professor of health services and policy in the School of Population and Public Health at the University of British Columbia.
He said the Alberta study confirms what’s long been known about the problems in the system and provides an up-to-date snapshot of the pressures.
What’s needed next, according to Sutherland, is a roadmap for solutions.
“In my opinion, [there has been] a bit of a systemic failure to look after people in the community and identify the high risk — or high needs people — before they show up in the emergency departments, either through health prevention, health promotion, housing needs, food security needs.”
He pointed to the number of seniors who are stuck in hospitals waiting for alternative levels of care, such as a space in a long-term care facility, as another area of concern.
“Someone needs to be in charge and accountable for wrestling this issue down to the ground,” said Sutherland.
The Alberta government has committed, through its Acute Care Action plan, to take a number of steps to address overcrowding in hospitals and improve patient flow, including increasing the number of continuing care spaces in the province and plans for 1,000 additional beds in Calgary and Edmonton.
It is also piloting triage physician positions in five Edmonton and Calgary hospital emergency rooms in response to overcrowding concerns.
