Wrong patients crowding ER: Study

Only 1% required life-saving treatments Many patients could have been treated elsewhere

More than half of Canadians crowding into hospital emergency rooms don’t need to be there, says a new study.

In fact, the Canadian Institute for Health Information found that less than one per cent of patients visiting emergency departments are so severely ill they need life- saving treatment.

“ We found that over half of patients visiting emergency departments were there for lessurgent or non-urgent conditions, things like chronic back pain or a sore throat,” said Jennifer Zelmer, the institute’s vice- president of research and analysis. And those patients could likely be treated elsewhere, the report suggests. Using data collected from 2003-04, the study examines why and when Canadians go to hospital ERs. Most of the data came from Ontario hospitals, but they were also collected from centres in Nova Scotia, British Columbia and P. E. I. While the report found that one in 10 Canadians waited three hours or more, half of all patients were seen by a doctor within a maximum of 51 minutes. Another 10 per cent waited 10 minutes or less.

Wait times varied with the severity of the patient’s condition, with half of the most urgent seeing a doctor within five minutes.

However, 10 per cent of the most severely ill patients — with such conditions as major trauma or respiratory distress — waited 45 minutes or more. The idea that many patients can best be treated elsewhere

infuriates the head of one of Toronto’s busiest ERs.

“ It’s an attractive notion that maybe if we could offload these people we’d make the system better,” said Dr. Dan Cass, chief of emergency medicine at St. Michael’s Hospital. “ But there’s too much evidence it doesn’t work that way and it’s not going to help.”

Cass believes that many non- urgent patients are often quite sick and can end up being admitted to the hospital.

“ Even if they’re not so acute that they need to be seen immediately, they often have serious problems. And we know from other studies four or five per cent of these so- called non urgent patients get admitted to the hospital.”

Cass said the study is flawed because it sorts patients based on the hospital “ triage method” — from the most severe cases to the least.

“ The triage system is not meant to say who doesn’t need to be seen here. It’s ( for) who needs to be seen first and that’s the whole crux of the triage tool.” The report’s findings differ somewhat from those of a 2004 international survey, in which nearly half of Canadians polled said they waited two or more hours to see a doctor on their last visit to an emergency department compared to only 36 per cent in the United Kingdom, 34 per cent in the United States, 29 per cent in Australia and 27 per cent in New Zealand.

That may be because Canadians are relatively big users of emergency departments. The international survey showed that almost four in 10 Canadians reported having been to an emergency room in the previous two years.

Overall, Canadians make more than 14 million visits each year to emergency departments, a number that has remained stable in the last four years.

Toronto emergency rooms seem to be the exception to the picture painted by the study, where only five per cent of the visits are considered to be nonurgent. “ In Toronto patients treated in emergency rooms are much more likely to be very ill,” said Zelmer. The report did not suggest any reason for this. But Toronto wait times are longer than in rural areas. “ In Toronto half the patients are in and out within just over three hours,” said Zelmer. “ Whereas the provincial average is just under two hours. The discrepancy is likely because Toronto emergency rooms are treating a higher proportion of sick people. They may need more diagnostic tests or need to see a specialist.”