Alberta study shows hospital overcrowding is leading factor in long emergency room waits

Addressing hospital capacity issues is “critical” to reducing emergency room wait times, according to the authors of a new Alberta study.

Research, published in Canadian Journal of Emergency Medicineanalyzed more than half a million ER visits between 14 hospitals in Alberta May 2022 and March 2023.

“Emergency crowding and emergency wait times are a significant public health problem,” said Dr. Eddie 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 reasons — Like pointing to the number of people coming to the ER who don’t need emergency care — Resulting in ineffective solutions.

“We thought maybe there was too much complexity,” he said.

The researchers looked at a variety of factors, ranging from patient age, socioeconomic status and connection to a primary care provider, to system-level data on the number of hospital stays and how many admitted patients were stuck in emergency rooms and unable to get to the wards.

“The ability to get admitted patients up and move them through the hospital was of the utmost importance,” Lang said, adding that the findings underscore what many frontline providers see every day.

According to Lang, hospitals where occupancy was close to 100 percent had shorter ER waits.

“Hospitals that were struggling and had occupancy rates of 110 (or) 120 percent had more difficulties in this regard and so their emergency department wait times were longer,” he said.

“And although this is not surprising news, there were considerable differences between hospitals.”

These differences can be seen in publicly reported facility-specific data, he said Health Quality Council of Alberta.

The researchers also found that “older age, greater material or social deprivation, and no mode of transportation to emergency medical services were associated with longer (emergency department) stays.”

Contact with a primary care physician was associated with shorter length of stay, the study said.

An association was also found between working more hours per nurse and shorter lengths of stay, which researchers say may reflect patient assignment or other internal processes.

The research comes as concerns are growing about emergency department overcrowding in Alberta.

An investigation into the death has been ordered A 44-year-old man died while waiting to see a doctor in an Edmonton emergency department in December.

have been doctors Sounding the alarm about other deaths They claim it could have been prevented, and that patients have been prevented Speaking about your near-misses.

“Addressing hospital capacity constraints – particularly high patient occupancy – remains important. Strategies such as accelerated discharge processes and demand-driven overcapacity protocols have been shown to improve bed availability without increasing ICU transfers or mortality,” the authors wrote.

Additionally, optimizing staffing and improving coordination across patient trajectories (including the ER, inpatient units, and post-discharge services) could improve efficiency and reduce longer lengths of stay, the study said.

Lang hopes the findings will spur change.

“If hospital A has low occupancy levels and the number of admitted patients is low, we should go and find out what the secret sauce is,” he said.

According to Lang, some facilities appear to concentrate the risk in the emergency room by creating bottlenecks in the ER, which he calls unfair.

Others are able to spread that risk more evenly through departments, he said.

For example, according to Lang, some hospitals allow increased inpatient units during critical times. This means patients are sent to wards, even if it means they are treated in the hallway until a bed opens up.

“There are hospitals that … don’t let things get out of control in the emergency department. Everyone has to be careful,” he said. “But it’s absolutely achievable.”

Canada-wide problem

“Overcrowded emergency departments have been a systemic issue in all provinces for at least 15 years and possibly 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 has long been known about problems in the system and provides the latest snapshot of pressures.

According to Sutherland, the solution requires a roadmap forward.

“In my opinion, there has been (some) systemic failure to care for people in the community and identify high risk — or people with high needs — “Before they even show up to emergency departments through health prevention, health promotion, housing needs, food safety needs.”

He pointed to the number of seniors who are stuck in hospitals waiting for alternative levels of care, such as a place in a long-term care facility, as another area of ​​concern.

“Someone needs to be in charge and accountable to solve this issue at the grassroots level,” Sutherland said.

The Alberta government has committed through Acute Care Action PlanTo take several steps to address overcrowding in hospitals and improve patient flow, including increasing the number of continuing care locations in the province and planning for 1,000 additional beds in Calgary and Edmonton.

this is also piloting triage doctor post in five Edmonton and Calgary hospital emergency rooms in response to overcrowding concerns.