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ED wait times in Canada: Is CIHI right?

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On Thursday, the Canadian Institute of Health Information released their seventh annual report on wait times.

The Press were quick to point out the “bad” news that Canada has the longest ER wait times among the top eleven developed nations.

They pointed out that “about one in 10 patients seeking emergency care here will wait eight hours or more, while the average length of an ER visit in this country is more than four hours.”

“Canada overall ranked last out of 11 (developed) countries on waits for emergency department care,” says Kathleen Morris, director of Systems Analysis and Emerging Issues at the CIHI.

“When we look at an international survey that looked at the per cent who wait more than four hours, it’s below 20 per cent (of patients) in all countries except Canada.”

“Indeed, where half of Canadian patients will be cooling their heels for more than four hours during ER visits, less than 5 per cent of emergency room patients in the U.K., Germany and the Netherlands face similar delays.”

“Ontario and Alberta are the only Canadian provinces that provide comprehensive wait-time data for emergency departments.”

What was missing was the “good” news.  Health care in Canada is a provincial concern and the Canadian Association of Emergency Physicians has committed its advocacy efforts at the provinical level.  Their view (my view, as well) is that our advocacy efforts should be focused on the provincial level with the hope of the development of best practices that can be adopted across the country.  It is our hope and our belief that if we can get one or two provinces to commit to a solution to the problem that in our federation, other provinces will adopt similiar and promising initiatives.

Internationally, we are probably the only nation that has figured out that the problem is political and have focused our efforts on the political aspect of the equation. On the crowding file, Canada’s emergency physicians, through CAEP, have advocated with the provinces of Ontario, Nova Scotia, Newfoundland, Manitoba, Alberta and British Columbia.  By far, Ontario has adopted a leadership role in addressing the crowding problem. 

Hundreds of millions of dollars and a multi-factorial approach has shown some very positive results with reductions in ED wait times across Canada’s most populated province.

While recognizing that ED crowding is a system problem and associated with unacceptable patient outcomes, Ontario has been successful in developing an approach to the problem.

Definitions for wait times vs care times, performance targets, coaching and pay for performanbce have all led to tangible improvements in emergency care delivery.

The problem has existed in excess of two decades, it has become the “new norm” and its solution will require considerable time and effort.  Nevertheless, the Canadian experience would suggest that we are making substantial improvements and will see, in our clinical life times, relegation of ED crowding to a historic and regrettable anomaly.

 

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