Propagating the myth that ER crowding is a result of overutilization of the department by patients with non-urgent illness, a common governmental refrain is “we will build a bigger ER and patients will have less time to wait”. This is of course complete nonsense. ER crowding is a reflection of hospital crowding, not an onslaught of the worried well. The Ottawa Citizen reported on the Ontario governments commitment to increasing the space of the Carleton Place Hospital, a lovely community south west of Ottawa. The Minister of Health, the somewhat beleaguered Dr Eric Hoskins is reported to have said that the 9,000 square foot addition for the ER will reduce waiting times. What follows is a response in the form of a Letter to the Editor of the Ottawa Citizen:
“There can be no argument that the Carleton Place Hospital required an urgent upgrade to their emergency department. To be sure this was very welcome news.
To suggest, however, that a bigger ER will have any impact on ER wait times is entirely fallacious.
ER crowding has nothing to do with the number of patient visits or their urgency. It has everything to do with the boarding of the frail elderly in the emergency department who wait for interminable hours to be transferred to a ward bed. Every time an admitted patient occupies an ER stretcher for prolonged periods of time, four patients per hour in the waiting room are denied access to treatment.
ER crowding is a reflection of hospital crowding. When hospital bed occupancy rates are at the safe level of 85% crowding rarely occurs. When hospital bed occupancy rates hit 95%, ER crowding is a given. Ottawa hospitals routinely try to function, and often fail, at greater than 100% bed occupancy rates.
In this circumstance, a bigger ER simply means a bigger “warehouse” for admitted patients.
So by all means let’s celebrate a much needed improvement to the Carleton Place Hospital but let’s not for a moment believe that it will have any meaningful impact on wait times”.
Alan Drummond MD