Emergency departments are at capacity and are understaffed. ED crowding has led to longer wait times, higher proportions of patients leaving without receiving care and increased demands on staff.Reference1 Reference2 Reference3

The causes of ED crowding are multi-faceted and go beyond primary care access. Increased access to primary care may be one factor that could reduce ED visits. But this access is not enough, on its own, to improve the situation in crowded emergency departments. Primary care access issues are not a major driver of overcrowding.Reference2 Reference4

A recent review by Canada’s Drug Agency summarized the complex issue of emergency department overcrowding as “a problem of hospital overcrowding and strained resources in the broader social and health care systems.�Reference2 The situation in emergency departments reflects larger system challenges: patient flow in acute care hospitals and long-term care, staffing shortages, increasing complexity of patient needs, and lack of community social supports.Reference3

• Patient flow, especially for patients who need to be admitted, is a major challenge: ºìÁì½í¹Ï±¨data shows that half of patients who were admitted to hospital spent more than 16 hours in the emergency department, and 1 in 10 spent more than 48 hours there.Reference5
• Other indicators of health care access point toward strained resources leading to broader systemic challenges. For example,
  • 1 in 10 patients in hospital have their stay extended until home care services or supports are ready for their discharge.Reference6 Reference7
  • Almost 1 in 10 patients who visit the emergency department for help with mental health or substance use have done so at least 4 times a year.Reference8
  • People who frequently visit the ED show signs suggesting that their needs for the care in the community are not being met.Reference9

Interventions aimed at relieving overcrowding need to address not just processes and resource capacities in emergency departments. They also need to address broader issues influencing the types of patients who visit the ED; the flow of patients out of the ED; and the social contexts influencing population needs for services.Reference2

The Canadian Association of Emergency Physicians recommends a comprehensive approach to addressing ED overcrowding. This approach includes policies that give patients options outside the emergency department to address their primary health needs. It also includes frameworks for addressing issues in hospital capacity and the role of emergency departments in broader health care systems.Reference3

The indicators in this report measure unmet needs for access to primary care through the lens of emergency departments. 

Improving access to primary care may reduce ED visits for conditions that could be managed in primary care. This would also improve patient experiences and continuity of care, as well as reduce some demand on staff. 

However, tackling primary care access alone will not solve emergency department overcrowding. For this, we need an approach that addresses hospital capacity and capacity in other sectors of care (such as home care and long-term care); performance management and accountability; and broader population needs.Reference3

ºìÁì½í¹Ï±¨

Canadians should not go to EDs in desperation because they have no alternative; they should use EDs when they think they have a true emergent or urgent problem. Primary care access is not a major driver of ED crowding but is a reflection of important challenges across the wider health care system. — Dr. Howard Ovens, Staff Emergency Physician and Chief Medical Strategy Officer, Sinai ºìÁì½í¹Ï±¨

• Shared ºìÁì½í¹Ï±¨ Priorities
• NACRS emergency department visits and lengths of stay
• Access and wait times data at CIHI

If you have any questions or would like to learn more, please send us an email.

hsp@cihi.ca