The Current - ER waits reach new lengths this summer

Episode Date: September 3, 2026

With fewer colds and flus, ER doctors used to care for fewer patients in the summer.  Not anymore.  Patients are waiting longer than ever.  We hear from Dr. Noam Katz in Winnipeg and Dr. Brittany Ellis in Saskatoon about what their patients have been dealing with all summer and what needs to change.

Hi, I'm Jamie Poisson and I host CBC's Daily News podcast, Frontburner. Every weekday, we sit out to have a conversation about the biggest Canadian and global issues that you want to know more about, from politics to culture to online stuff. We spend a lot of time on the show thinking about the best ways to have those conversations and searching for the smartest people to have them with. That's it. That's the cell. I hope you'll tune in. This is a CBC podcast. I'm Paul Hunter. and this is the current podcast. If you've had to spend any time in an emergency room this summer,

I'm going to guess you had a long wait. Summer used to be a time when ER staff got a little bit of a break with fewer patients with colds and flus to care for, but not this summer. ER staff across the country are reporting flu season levels of illness and warning about system collapse. It's a reality that has ER doctors calling once again for significant changes.

I've got two of those physicians with me now. Dr. Noam Kates is a staff emergency physician at St. Boniface Hospital in Winnipeg. Dr. Brittany Ellis is an emergency room physician in Saskatoon and a representative of the Canadian Association of Emergency Physicians. Good morning to both of you. Good morning. Dr. Kates, I'll begin with you, if you don't mind.

I mean, describe it for me. What's the summer being like in your ER? I think to sum it up, I would say relentless. And I wouldn't say that this is a new feeling that we've been experiencing. I think that this has been the standard that we see, at least within the emergency departments in Manitoba, for months, if not years at this point. So it's been a struggle. So what kind of weights are we talking about, the weights that patients have been dealing with? Routinely, we see 15-hour waits in Winnipeg at the center that I work.

work. So that's a standard day for us when you come. And I would say that that's been ongoing for about months at this point. Routinely. That's... Routinely. I can hear the frustration in your voice. I mean, you know, in this country, we often try to, you know, sometimes it seems like things are being overstated, but is it fair to say the system is close to collapse? Is that an overstatement? Well, I think first and foremost, it's important to say that when Canadians across the board access care, when they're able to get access to that care, I believe that that care is exceptional. I think if the system was functioning, we wouldn't be having this conversation now. So when we talk about close to collapse, I think that the fact that across the country we're seeing the general feeling of struggle that we are all experiencing, that the current system as it stands is not functioning in the way that represents the health

equity that we all expect in Canada. You've also said, I think you told the Globe and Mail that this is the end, this is a quote I think from you, this is the end state of what people have been warning everybody about for years. You stand by that? Absolutely, right? And I believe that this is not a surprise since I entered into medicine. I started middle school in 2008.

We've been talking about this silver tsunami or however you would like to term it, but we know we've had an aging population that's been coming for some time. And not only are we seeing people who are living longer, but we're seeing people with multiple illnesses who are sicker when they present. And often people who live longer require living facilities when they're no longer able to live independently. And I don't believe that the planning met the need based on that aging population and complexity of illness.

Dr. Ellis, from your perspective in Saskatoon, what's the summer being like in the ER where you work? I think I can just reflect back what Dr. Kates is saying, both in Saskatchewan but also just nationally. What we're hearing is that, you know, hallways remain to be full. We're not getting that normal reprieve that we sometimes get over the summers,

that patients are waiting extremely long times. There's no privacy. You know, we're having to patrol our waiting room boards trying to find the sickest patients all the time, which adds up. It adds up to frustrated patients. It adds up to difficulties with maintaining staffing, both as physicians, nursing, health care aids, all the important people that work in emergency departments. And, you know, I kind of atone it to the statement that it feels like death by a thousand paper cuts sometimes. You know, there's so many small things going on that are leading to really, really big and important. outcomes for our patients, for our healthcare system and for our providers.

And I do think it's important. I think Dr. Kate's made the point that the care is good once you get it, but it's that weight, right? So Dr. Ellis, I mean, can you put a number on it? What kind of wait times are you seeing for patients? You know, I think it's important to highlight that patients wait a variety of times. You know, we do occasionally see patients waiting eight, 10, 12 hours, potentially not quite to the extreme that Dr. Cates is describing, but these are patients who haven't been properly assessed, who we don't know what is going on. We don't know if they are going to be the next one to experience a really bad outcome, like collapsing or even death.

And so it's not just about the individual wait times. It's about, you know, the risk that's going on in those waiting rooms and how we're trying to manage that. So what's behind it? I mean, what's the cause of this? And I'd like to hear from both of you on this, but Dr. Ellis, why don't you pick it up first? What's at the root of this? I think it's truly, you know, a multifactor cause.

Dr. Cates did allude to the fact that, you know, we know there's shortages in other areas of care, which is having downstream effects and coming back to the emergency department. So just like when we talk about overcrowding in the emergency departments and patients, not being able to move from our departments into inpatient beds, The same kind of reasons are contributing to patients coming to our departments in the first place.

And that has to do with the entire system of care, with access to primary care in an time-efficient manner, with access to home care, with access for older adults who require long-term care to have access to long-term care. So without all of these systems and more coming together, the one point in the one place that is always open is the emergency department. And so patients will find their way there. Dr. Kates? Yeah, I think Dr. Ellis has sort of hit the nail on the head here. But the important point is the emergency department's dysfunction across the board is a representation of a systems problem. So rather than focusing on the emergency department as the fix, I believe that focusing more on the downstream issues that are leading to the dysfunction that we experience is the most important thing.

And one of the best ways that I think it was ever put to me is when your sink is clogged, the answer isn't building a bigger sink. And I think a lot of the solutions that have been focused on to this point are focusing on how are we going to make the emergency department hold more patients or function more optimally. But the reality is it's just getting patients out of the emergency department so we can actually see these what we call undifferentiated patients, meaning if somebody comes in with chest pain, we don't know if they come in with a pulled muscle or if they're coming in with a life-threatening problem, like a heart attack or tearing of the big arteries like an aortic dissection, which is time-sensitive and life-threatening.

So like Dr. Ellis has said, you know, we are constantly just looking for the needle in the haystack. The problem is, even if we discover them, it's hard to find a place where we can actually provide that care to them. I mean, I got to say, you both sound, I don't know, I mean, not defeated but beaten down by all this. There's a kind of a forlornness, if that's a word in your voices, it seems to me, as a result of what you're encountering all the time. Dr. Cates, I wonder, is there a moment or an incident particular that stays with you from this summer? I don't think that there is one moment because they all blend together and the challenges that we face seem to be constant. And I think the term that's more important than defeated is demoralized. And we see that amongst majority of our colleagues at this point, which was reflected in a recent study that showed, you know, one out of 10 emergency physicians in this country has left emergency medicine.

And that's not a choice I think anybody has made easily at all. I think we all love this job and we believe in our system and we enjoy providing care to our patients. And that's meaningful to all of us. And when you're not able to provide that care, that's when you experience things like moral, injury. And when that happens on a daily basis, it becomes harder and harder to actually function as a physician that's providing the care optimally that we all believe we should provide to our patients. So that's what becomes harder and harder as a sustainability element to keep doing the profession that we all love. Dr. Ellis, how do you feel, I mean, on that, have you been able, in your view, have you been able to provide the care you want to provide for your patients? You know, I would have to say no. And I think that that's a really important point.

I think the thing that Dr. Kates is trying to highlight that really, you know, comes out to me is that we're all here to do the best that we can. We all want to care for our patients. We all want patients to have good outcomes. And that these wait times that you're discussing, they're not just a mere inconvenience. You know, when we talk about four, six, eight, 12, 15 hours, we know that with those increased stays, people die as a result of those. There's good evidence to show that an older adult

staying in an emergency department overnight has an increased risk of dying while in hospital, that very same admission. We know that patients are undergoing harm as a result of the conditions in the emergency department. And so I think that every person you see, knowing that that is the case, it really does take a toll on your wellness

and your ability to feel like you're doing the job that you were trained to do. And a little bit of time we got left, let's move to prescriptions. Dr. Cates, what needs to change? Well, I think this has been highlighted by many people who are smarter than me. So the Canadian Association of Emergency Physicians had a report penned called the Empower Report that described a lot of these solutions.

I think we need to be able to move people out of the emergency department. So we need better staffed and open beds on the admission wards within the hospital. We need the ability to move patients who no longer require acute care out of the hospital. So that includes things like respite care, assisted living, personal care homes or nursing homes for people who are no longer able to live independently. And we need to provide patients outpatient care to prevent them from worsening and requiring the emergency department. So a one-stop shop solution, which is what the emergency department has become, has proven to be ineffective in the current state that we operate in in Canada. And Dr. Ellis, last word to you. I also think in addition to what Dr. Kate's is saying is that we need a better understanding and more reported outcomes regarding what is happening in our emergency departments and in our hospitals.

We need the public to be more aware and we need people to be more accountable to what we're seeing. If there's a saying in emergency medicine, if you don't take a temperature, you're not sure if there's a fever. And if we're not actually looking at what is happening through data, we can. can't effectively manage the problem and begin to come up with solutions. Well, to both of you, thanks. It's a tough time. But I think everyone that you encounter is surely grateful for the work that you do. And thank you for taking the time with us today.

Thank you for the conversation. It is an honor to be an emergency physician in Canada. Agreed. Thanks for having us. Dr. Noam Kates is a staff emergency physician at St. Boniface Hospital, in Winnipeg, Dr. Brittany Ellis is an emergency room physician in Saskatoon and a representative of the Canadian Association of Emergency Physicians. Hi, everybody. I'm Jamie Poisson and I host Front Burner. How many podcasts have you heard where people are searching out facts on the fly? Or where they just talk in circles and two

hours later, you're not really sure what you just learned. Well, Front Burner is not that. Five days a week, you get one story a day. It's deeply researched. about 20 minutes long, and hopefully we answer all the questions that you want asked. We do lots of Canadian news, but a wide range of topics too. Find and follow Front Burner wherever you get your podcasts. As hospitals across the country are dealing with higher patient volumes, many emergency rooms are looking for solutions, including the Scarborough Health Network, which runs three hospitals in the Toronto area. Dr. Myrandra Ravi Chandran is the deputy chief of emergency medicine

at the Scarborough Health Network. Good morning. Good morning. Thank you for having me. My pleasure. Briefly, tell us, what have you done to reduce wait times in your ERs? When a patient walks into your ER, I mean, what does it look like in terms of the process for them? No, firstly, I wanted to address some of the comments by my colleagues as well. And I think the frustration that they are experiencing is something that we all feel and we all do experience, I think, throughout the country. That being said, we started this process in our department a few years ago just coming out of the pandemic. And some of the work was done during the pandemic as well. And what we tried to look at with our model is to flip some of the things around so that the wait times that many patients experience at the front before, you know,

some of the, what was described by Dr. Alice and Dr. Cates, all that time that spent up front is the time is the most dangerous time for the patient where we don't know what's going on with them. They don't know what's going on with them. And those are the risky periods during that wait where if something goes wrong, we don't have any answers. So what we tried to do was move everything to the front. So we have our clinical team, including the physicians and nurses, closer to the triage assessment period, physically. process-wise. So what this allows us to do is start things like blood work imaging treatment earlier in the

process, along with the assessment happening much earlier in the process. So when the patients do wait after, it's with a purpose of either having been treated or having had their blood work drawn, waiting for results or imaging ordered and waiting for that to happen. So that's from a patient experience perspective, from a patient risk perspective, has significantly improved things for us. And from a experience perspective for physicians and nurses as well, again, walking into a department with 40 patients in the waiting room is frustrating. And it kind of tells us what that shift is going to look like. but being able to look at it as kind of a more segmented process

where things have started to happen and we can see how to move patients through the department has allowed us to objectively reduce wait times but also subjectively improve patient experience and that's been reflected in the patient experience surveys as well for our patients in Scarborough. So have you been able to measure the difference like in terms of wait times?

Well, yes, of course. So we've had significant changes in terms of Ontario health measures, wait times for all of our, all hospitals. And they put out rankings. So two of our hospitals jumped into the top five in terms of rankings. We've managed to, so the metrics that we, Ontario Health often measures looks at the 90th percentile. But when we look at even break it down further at our Burschmount site, 70% of our patients will see a physician within less than two hours. And that's important for us because, again, that's what reduces the risk for the patient and reduces the risk for physicians and nurses to know that, you know, something is in the work, something is happening so that we have answers much earlier in the process.

the idea of having these patients sit and without they have they have no idea what's going on they're obviously scared they're concerned that's why they're waiting um eight hours nine hours in the in the waiting room because they want they want some reassurance or answers when they leave so you're seeing some obviously positivity there and i think you're listening to dr kates and dr ellis and we were toward the end of that talking about not just the challenges but what needs to be What is your answer? I mean, you've made some progress, but what else has to change? I think this is an ongoing issue.

It is easy to make changes up front, but it's also much more difficult to sustain unless that system is supported long term. I think what we managed to do in our department has been a whole organizational initiative. From top down, we've had support from our state. senior leadership team, but all the frontline workers. Everyone has an understanding of what we're trying to do. And that involves also other departments as well. We've had to get buy-in from our diagnostic imaging teams, our internal medicine surgery teams. Because as my colleagues discussed earlier, the difficulty is the downstream issues often reflect on us. So if we don't have buy-in and a process improvement that involves the whole organization, it's very difficult to make a change just in the emergency department.

Building a bigger one or changing the department on its own in isolation is not possible to make a change in any of these metrics or any of these patient experience, things that are important to patients as well. I hate to say it. We kind of run out of time, but I do want to just, so I'm going to have to go yes or no on this one last one, which is whether the things that you've done in your view can be implemented in other ERs across the country. Just super, super yes or no briefly. Doable?

Yes, I think so. But yes, I think it is doable. And we've done it based off our observations of other sites across the world. We've looked at what other people have done. And we've tried to emulate it specifically for our system. And I think other hospitals can do the same looking at what's, what's unique about their own system, about their own communities. And again, we've had support from the organization to get it done. Thank you. We've got to run. I hate running out of time,

but we just did. Thank you, doctor. Appreciate your time. No problem. Thanks for having me. Dr. Mayerendra Ravi Chandran is the deputy chief of emergency medicine at the Scarborough Health Network. You've been listening to the current podcast. I'm Paul Hunter. For more CBC podcasts, go to cBC.ca.ca slash podcasts.