Every part of the health care system is important and plays a vital role in the care and healing of millions of Ontarians. The emergency departments across this province are among the most visible parts. Ranging in size from a handful of beds in a remote Ontario community to huge multi-site technology-laden centers in urban settings, they serve as critical points of care at some of the most life-threatening moments in our lives and those of our loved ones. For this reason our expectations are great for emergency departments, and they serve as a touchstone and a promise of ‘care when you need it.’

Emergency departments are also a critical barometer of the functioning of the health care system. Some have called them the ‘canary in the coalmine.’ They often serve as the intersection point of numerous health sectors and play a key role in helping patients navigate the system. When emergency departments are not working well the ripples can be felt throughout the system. Similarly, as a physician who has worked in more than a dozen emergency departments across the province, I can attest that when other parts of the system are functioning poorly or there are major health crises (such as flu outbreaks and large traumas) the impact on the emergency department is quickly felt. 

That is why this report is so important.

It’s of some comfort to learn, as this report shows, that patients are spending less time in Ontario’s emergency departments and seeing emergency doctors more quickly than in previous years. Strategies and innovations locally and at the system level have stimulated substantial improvements in hospital emergency departments.

But it’s not all good news. Too many seriously ill patients have to wait more than three hours to see an emergency doctor. And too many admitted patients have to wait more than a day lying on a stretcher in an emergency department cubicle, or in a hallway, waiting for an inpatient bed to become available. Many would say even one patient is too many to be waiting in a hallway for so long.

Patients who live in urban areas, where emergency departments are more crowded, are the ones most affected by lengthy waits for care. These patients spend almost 50% longer in emergency and wait more time to see a doctor than people in rural areas.

In an effort to keep people healthy and to divert less-seriously ill people away from emergency departments, numerous efforts have been made to strengthen primary care and home care over the last decade, thus providing alternatives to emergency department care.

Yet the flow of patients into hospital emergency departments continues unabated at a time when many are stretched to capacity. Over the period covered by our report there has been a 13% increase in patient visits.

Patients are already lying in hallways and being seen by doctors in waiting rooms. Under current conditions, the ability of Ontario’s emergency departments to care properly for patients could be seriously compromised by an occurrence as predictable as a bad flu season or as unpredictable as a SARS outbreak or a major weather event.

The pressure on emergency departments is not going to ease anytime soon. The province’s population is projected to grow by 30% over the next 25 years. The number of people aged 65 and older – who tend to require more complex emergency care – is expected to more than double over the next 25 years.

Inside emergency departments, the search for new and better ways of doing things continues, but some of the solutions need to be found elsewhere in the health system, starting with better capacity planning within and across hospitals. Beyond this, in the community, sustained focus on issues such as coordination of care, access and equity will be necessary to help maintain people’s health and minimize their need for emergency care.

Let’s celebrate the good news about how emergency departments have ably managed with the challenges they have faced, and commend the hard work done by so many people to achieve the improvements made so far. But considering the challenges that remain, the hard work is only beginning.



Dr. Joshua Tepper
President and CEO

Health Quality Ontario