Large variations in how long admitted patients wait in emergency rooms for hospital beds: CIHI

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Waits tend to be longer for older patients, during the day, and on weekdays

October 18, 2007 – Most patients admitted to an acute care hospital for reasons other than childbirth come through Canada’s emergency departments (60% outside Quebec), and the length of time these patients wait for hospital beds varies greatly, according to a new report by the Canadian Institute for Health Information (CIHI). The report found that in 2005, half of all patients admitted to hospital through Canada’s emergency departments (EDs) waited 1.7 hours or less for hospital beds once the decision to admit had been made, while the rest had longer waits. For example, the 10% of patients with the shortest waits were transferred immediately to acute care beds; the 10% with the longest waits waited 15.1 hours or more.

Understanding Emergency Department Wait Times: Access to Inpatient Beds and Patient Flow is the third in a three-report series examining factors associated with the length of time patients spend in EDs. Every year, Canadians make 14 million visits to EDs—with more than one million patients being admitted to hospital as a result. Based on data from 277 hospitals outside of Quebec—which collect wait time data in a similar fashion—this latest report provides new insight on the length of time patients spend in the ED from the moment a physician decides to admit a patient to hospital from the ED to the moment that the patient is transferred into an acute care bed.

“Experts suggest that the smooth transfer of patients to hospital beds helps to avoid emergency room crowding and ensure appropriate care for incoming patients with urgent medical needs,” says Greg Webster, CIHI’s Director of Research and Indicator Development. “By measuring how long emergency department patients are waiting for acute care beds, this report offers fresh insight on the factors associated with shorter and longer waits.”

Condition and age of patient, timing of ED visit, among factors associated with longer waits

In 2005, 4% of patients admitted to hospital through Canada’s EDs waited more than 24 hours for acute care beds. CIHI’s study found these patients tended to be older and have multiple health problems. They also had longer average lengths of stay in hospital after leaving the ED.

Other factors associated with longer waits for access to hospital beds include the time of day, the day of the week and the month of a patient’s visit to an ED. For example, in large community and teaching hospitals, ED bed wait times were typically longer during the day, on weekdays and from November to March.

“Waiting in the emergency department for inpatient beds can be hard for patients and their families,” says Dr. Michael Schull, Emergency Department Physician at Sunnybrook Health Sciences Centre in Toronto. “Research shows that many factors outside of the emergency department, such as how inpatient services are organized and access to care beyond the hospital’s walls, can affect how long patients wait for beds.”

Waits generally longer in larger hospitals

CIHI’s report found that in 2005 the waits in the ED for access to acute care beds, once the decisions to admit had been made, varied considerably by hospital type, ranging from median waits of 18 minutes in small community hospitals with up to 49 beds, to 2.1 hours in larger community hospitals with 200 or more beds, to 2.3 hours in teaching hospitals. (The median is the point at which half of all patients had shorter waits and half had longer waits.) For some patients in larger community and teaching hospitals, the waits were much longer. For example, 5% of these patients waited more than 24 hours for acute care beds, compared to about 1% of patients in small hospitals.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca