Emergency Department Overcrowding in Canada

Abstract

What Is the Issue? Emergency departments (EDs) across Canada are under strain and experiencing overcrowding, a situation that arises when the demand for health services in the ED exceeds the capacity of the health system — which includes the ED, hospital, and community — to provide quality care in a reasonable amount of time. ED overcrowding is contributing to a deteriorating standard of care as health care providers and staff become overworked and burned out, is putting health and lives at risk, and is placing additional strain on an already overwhelmed health care system. What Did We Do? The CADTH Health Technology Expert Review Panel (HTERP) convened to develop objective, impartial, trusted pan-Canadian guidance to inform decisions about which evidence-informed solutions should be considered to help alleviate ED overcrowding in Canada. What Is HTERP’s Position on ED Overcrowding? ED overcrowding is a complex health system issue. EDs operate within hospitals and broader health and social systems, which means that accountability for causes, impacts, and solutions do not lie solely within the ED and its operations. Output factors (e.g., misalignment between acute care bed capacity within the hospital and population needs) and input factors (e.g., misalignment between care available in the community and population needs, including care outside of regular business hours) respectively, are the main contributors to ED overcrowding in Canada. Health system capacity is not aligned with, nor has kept pace with, the growing and changing health care needs of the population, which results in overcrowded EDs. Health systems will observe better results by implementing strategies that improve patient flow and focus on output and input factors relative to throughput factors. What Is HTERP’s Guidance to Help Alleviate ED Overcrowding? Interventions to alleviate overcrowding need to align with the main contributing factors to ED overcrowding in the particular context in which they will be implemented. Understanding the context in which ED overcrowding is occurring, with attention to bottlenecks to patient flow, should be the first step to identify evidence-informed solutions. Transparency and accountability should be key principles in ED, hospital, and health system operations. HTERP recommends identifying and ensuring clear roles, responsibilities, and reporting relationships embedded within an accountability framework for ED overcrowding across health system partners, including a commitment to act on data. Each province and territory should mandate consistent and comprehensive reporting by all hospitals to the Canadian Institute of Health Information’s National Ambulatory Care Reporting System (NACRS) database. HTERP’s guidance includes an Evidence Navigation Guide to support identification of evidence-informed interventions to help alleviate ED overcrowding.