On Monday morning, Maureen Armstrong’s elderly mother suffered a fall and was taken by ambulance to a Windsor, Ont., emergency room. There, she waited more than 48 hours to be admitted.
By the time Armstrong spoke with CBC News on Wednesday afternoon, her 81-year-old mother was still waiting in the hallway for a hospital bed.
“It’s very noisy and volatile and there’s a lot of patients that might be unruly and things that security guards are taking care of,” Armstrong said. “It’s not really a healthy environment to be in long term.”
Armstrong’s mother isn’t alone.
One in 10 Canadians admitted to hospital during the 2024-2025 fiscal year spent more than 48 hours waiting in the emergency department — that’s a 12-hour increase from 36 hours during the 2018-2019 fiscal year, according to a Thursday report by the Canadian Institute for Health Information (CIHI).
The report found that limited emergency room capacity, difficulties in accessing standard care and the country’s aging population are to blame for the worsening backlog.
“We’re keeping admitted patients in hallways, doubling up rooms, trying to find any nook or cranny to see patients,” said Dr. Michael Herman, an Ottawa-area emergency physician. “It’s more cramped, it’s more chaotic, and there’s more pressure than ever on these emergency departments.”
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Patients wait longer to seek care
CIHI’s report found that with almost one in five Canadian adults lacking a regular health-care provider, patients are waiting longer to seek care, leading to more serious conditions that tie up hospital beds.
“A length of stay that would have been much shorter before is now increasing because of this complex patient population, and because of a patient population that can’t otherwise access these resources except through emergency care,” Herman said.
Because of this, emergency rooms are seeing more complex cases, with 32 per cent of patients now seeking care for multiple medical conditions at the same time, requiring doctors to spend more time with each patient.
“These patients often require more involved testing and investigation,” Herman said, meaning an increase in labs and diagnostics. “All of those add to the length of stay.”
While medical advances over the last several decades have increased overall life expectancy, Herman says they’ve also increased the number of Canadians requiring complex treatment.
Almost 50,000 people are currently waitlisted for long-term care in Ontario, according to the Ontario Long Term Care Association, nearly double the number waiting a decade ago.
This dearth of long-term care homes to support Canada’s rapidly aging population puts additional strain on emergency departments, which serve as a last resort for every gap in the country’s medical system.
“Every other service, when they reach their capacity … they can sort of close the shutters,” Herman said. “The only reasonable approach for people is to come to the emergency department.”
Older patients also tend to wait longer for hospital admission, despite lengthy emergency room waits being particularly detrimental for seniors. One 2023 study out of France published in JAMA Internal Medicine found that patients older than 75 who waited overnight in an ER were more likely to die in the hospital compared to patients admitted to a ward before midnight.
Herman says these problems lead to direct patient harm and require everybody, from top to bottom, to help solve them.
“Where we are right now is a result of policy, and the solution to bad policy is good policy.”
The number of acute care beds per capita also declined slightly in Canada, straining capacity further, the report found, but an increase in primary care physicians, specialist services, long-term care facilities and inpatient beds could ease the backlog.
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Most patients need urgent medical care
Waiting longer to see a doctor can worsen a patient’s clinical condition and increase adverse results, CIHI’s report found.
About 16,000 patients died while waiting for care in the 2024-2025 fiscal year, making up 0.1 per cent of all patients who sought emergency care, according to Cheryl Chui, CIHI’s director of health system analytics.
“We have really robust evidence that delays in getting to an inpatient bed and remaining in the emergency department is not just judged as inconvenient, it’s lethal,” Herman said.
Herman says there’s a common misconception that patients with less severe conditions are flooding hospitals and increasing the backlog. The CIHI report suggests the opposite is true, with about two-thirds of emergency room patients requiring immediate or urgent medical care, 1.7 million more than in the 2018-2019 fiscal year.
Herman agrees with the report’s conclusion that solutions to the systemic backlog must start outside of the emergency room.
The report suggests that limited inpatient and long-term care capacity are delaying both hospital admissions and discharges, causing patients who require specialized care to spend longer in emergency departments. Herman agrees.
“It’s an environment that’s really a square peg in a round hole — emergency departments are designed for brief episodic care,” Herman said. “But now you’re putting a patient population in there that [requires] more longitudinal care.”