Canadian Emergency Departments in crisis?

Not because of patient numbers, according to CIHI/NACRS

For all age categories, it can be seen that the volume of ER visits in 2021/22 is still lower than the volume of visits prior to covid lockdowns.

This data gives us some indication that ER traffic has not been all that exceptional in terms of volume. However, we need to look at severity of patient presentations, as well as ER length of stay, which is a marker of overcrowding on hospital wards.

PATIENTS PRESENTING TO ER FOR RESUSCITATION:

As with other ER data, we see a drop across all ages caused by lockdown. One can of course question whether this means Canadians were having fewer episodes of life-threatening illness/injury, or whether they died without going to hospital.

One unusual finding is that ER visits for resuscitation were markedly higher in the 20-44 year-old age group. This will be explored in a further post.

However, overall, it does not appear that ER visits for resuscitations were significantly different in 2021/22 than they were pre-pandemic.

NUMBER OF PATIENTS GETTING ADMITTED TO HOSPITAL IS UNCHANGED

Here we can see that, as with the resuscitated patients, there is actually an overall decrease in the number of patients getting admitted to hospital.

ER LENGTH OF STAY

This is the only variable that shows a problem. Patients who were admitted to hospital were stuck in the emergency department for roughly two hours longer than they had been in 2020/21. The likely reason that patients were admitted into beds more rapidly in 2020/21 is that more hospital beds were empty, as lockdowns in hospitals were used as a way to transfer chronic patients to nursing home, freeing up bed space. When we look at year-by-year trends in length of stay in emergency departments, we see a gradual upward trend over the past 4 years, interrupted by covid.

SUMMARY

The crisis in Canadian hospitals in 2021/22 does not appear to be driven by more severe illness (except in 20-44 year olds), or by the the number of ER visits, or by the number of admitted patients.

So what is the problem?

It seems highly likely that something knocked Canada’s hospitals’ efficiency off kilter in 2021/22.