Emergency room wait times have ballooned over the past few months, with two hospitals in Ontario announcing temporary closures due to COVID-19-related staffing shortages.
ER wait time data from April shows 86.5 per cent of patients admitted through the emergency department waited more than the provincial target of eight hours. Of the 104 hospitals that reported data to Health Quality Ontario, 13 reported that patients had waited over 24 hours on average. In the worst cases, for patients at West Lincoln Memorial Hospital in Grimsby and Greater Niagara General Hospital, the average waits were more than 48 hours.
<img class="wp-image-408394 alignleft" src="https://www.qpbriefing.com/wp-content/uploads/2022/07/Ontario-Wait-Times-405x303.png" alt="" width="495" height="370" srcset="https://old.qpbriefing.com/wp-content/uploads/2022/07/Ontario-Wait-Times-405x303.png 405w, https://old.qpbriefing.com/wp-content/uploads/2022/07/Ontario-Wait-Times-843x632.png 843w, https://old.qpbriefing.com/wp-content/uploads/2022/07/Ontario-Wait-Times-768x575.png 768w, https://old.qpbriefing.com/wp-content/uploads/2022/07/Ontario-Wait-Times-1536x1151.png 1536w, https://old.qpbriefing.com/wp-content/uploads/2022/07/Ontario-Wait-Times-2048x1535.png 2048w" sizes="(max-width: 495px) 100vw, 495px" />
All three of Niagara Health’s emergency departments — located in St. Catharines, Niagara Falls and Welland — all had average wait times of over 33 hours in April. Both of William Osler Health System’s emergency departments in Etobicoke and Brampton had average wait times of over 24 hours. Lakeridge Health’s Oshawa and Ajax emergency departments had average wait times of 32.5 and 45.8 hours long, respectively.
MRI and CT wait times are also both heavily backlogged, particularly for MRI scans, data from February shows. For priority two patients, whose conditions are serious enough that “failure to diagnose and initiate treatment would result in serious morbidity/mortality,” according to Health Quality Ontario, the average wait was seven times the provincial target of two days in Kingston. Hospitals in Milton, Oakville, London and Toronto had wait times of six days for priority two patients.
For those with less urgent conditions, the backlog stretches back even further. In London, the wait for priority four patients was 228 days on average, nearly eight times the provincial recommendation of 28 days.
Michael Hurley, president of the Ontario Council of Hospital Unions, blames a perfect storm of aging, staffing shortages and lack of capacity for the immense slowdown of wait times. He also adds that moving patients out too quickly can also lead to readmission, adding an additional burden to the health-care system. In 2020-21, according to the Canadian Institute of Health Information, Ontario’s readmission rate has been above the national average since at least 2016.
The “only solution that will work” is first, acknowledging the system doesn’t have enough capacity and building it up to “the average capacity of the rest of the country,” Hurley said. He added, “that means an investment in opening beds in existing hospitals, not waiting for new ones, and adding staff.”
“It’s a disaster, just a frickin’ disaster,” according to Professor Michael Carter, the founding director of U of T’s Centre for Healthcare Engineering.
Nurse and doctor shortages, caused by staff sick with COVID-19, amplifies the problem of capacity, Carter said. A nurse can take care of about five patients at a time, Carter said, so one nurse out sick has an amplifying effect on a given ward’s capacity. The added pressure falls on the remaining nurses to care for an overstretched ward, especially felt by nurses who have been burnt out having faced wave after wave of the pandemic. That builds on top of a hospital system already backlogged with patients that are technically discharged but waiting for continuing care outside of the hospital, like long-term care patients, adding layer upon layer of strain on the health-care system.
“My point is, it's not fair to focus on (emergency departments) itself. It's the flow through the entire system,” Carter said.
A centralized system that could handle planning and coordination of the health care, presumably Ontario Health, would be needed to ensure adequate access to health care across the province.
Right now, “governments don’t run health care, governments fund it … so nobody’s in charge.”
“Ontario Health needs to have responsibility and accountability for all levels of health care … (it) needs a lot more teeth,” Carter added.
The funding and management changes are in play but moving at “a snail’s pace towards,” Carter said, especially because it’s “politically very difficult” to consolidate the authority needed to manage the entire health-care system provincially.
“I am optimistic that in ten years,” Carter laughed before finishing his sentence, “that we are moving in that direction.”
Carter points out that these wait times and backlogs aren’t unprecedented, even for a worldwide pandemic and, like Hurley, pointed to the Harris government’s health-care cuts in the ‘'90s as an example of when wait times, especially in the early aughts, soared due to strains on the system.
On why areas around the GTA and the Niagara region are most heavily affected, Hurley says the lack of capacity in cities like Brampton and areas like Niagara stem from cascading effects of cuts made in the ‘'90s under former Premier Mike Harris’ government. “The dynamic of income, lack of access to family physicians, closure of some walk-in clinics” in these areas all add immense pressure on a tenuous system, Hurley said.
<img class="wp-image-408393 size-large aligncenter" src="https://www.qpbriefing.com/wp-content/uploads/2022/07/population_wait-843x397.png" alt="" width="843" height="397" srcset="https://old.qpbriefing.com/wp-content/uploads/2022/07/population_wait-843x397.png 843w, https://old.qpbriefing.com/wp-content/uploads/2022/07/population_wait-405x191.png 405w, https://old.qpbriefing.com/wp-content/uploads/2022/07/population_wait-768x362.png 768w, https://old.qpbriefing.com/wp-content/uploads/2022/07/population_wait-1536x723.png 1536w, https://old.qpbriefing.com/wp-content/uploads/2022/07/population_wait-2048x965.png 2048w" sizes="(max-width: 843px) 100vw, 843px" />For Carter, the regional differences come down to capacity and population growth, “It’s population versus capacity rates … the nation’s been growing but capacity hasn’t changed,” which is especially true for GTA “bedroom communities,” or commuter cities like Brampton and Etobicoke, he said.
“Niagara Health’s Emergency Department program is the fourth-busiest in Ontario. Niagara also has an aging population with 23.3 per cent age 65 and over compared to Ontario at 18.5 per cent, which impacts the levels of those who seek care at the hospital. Niagara residents have higher rates of chronic conditions than the provincial average that require care,” Dr. Johan Viljoen — chief of staff and executive vice president, medical affairs at Niagara Health — told QP Briefing.
Niagara Health’s three emergency departments all fell within the top ten longest wait times in the province in April.
Viljoen said the staff shortages caused by the pandemic and the high volume of patients “with complex needs” have added to the gummed-up emergency departments.
“In addition to growing demand for health services, there are a number of factors outside of Niagara Health that contribute to ED wait times. We care for patients for non-emergency matters in our ED because they do not have access to a family doctor or other primary care provider as the region is short at least 95 family physicians," he said.
"On any given day, we have up to 100 patients waiting in hospital beds for services to become available in the community, including home care and long-term care settings. The long-term care in our region has lost more than 400 beds as a result of new pandemic protocols. All of these factors contribute to wait times in our ED.”
According to Viljoen, Niagara Health is working with the province to set up virtual urgent care services and setting up an additional MRI, funded through the province and donations, to speed up wait times on both the ER and MRI fronts.
Bill Campbell, a spokesperson for the Ministry of Health, touted the government’s “historic investments” meant to “increase hospital capacity and end hallway health care.”
Campbell listed the province’s allocation of billions towards hospitals and maintenance of beds put in place during the pandemic, and the government’s efforts to recruit health-care workers from abroad through “emergency programs” that have added staff to hospitals.
Lakeridge Health and William Osler Health Systems did not respond to requests for comment before publishing time.
Want to know what the wait times were like in April for the ER closest to you? Check out this map:
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Some ER wait times hit nearly seven times the provincial target in April

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