August was a tough month for Ontario's emergency departments.

Despite fewer people going to EDs compared to August 2021, various indicators suggest they're waiting longer and having a tougher time getting seen by medical professionals.

Metrics like wait times, length of stay in an ED and the amount of time it takes to get an inpatient bed, plus ambulance offload times all spiked as summer came to a close.

It was the worst August for Ontario's EDs in 15 years, the data show.

That's according to internal Ontario Health data leaked to Liberal MPP Dr. Adil Shamji, a longtime ED doctor, and provided to reporters on Wednesday morning.

Shamji said he's "not at liberty" to say where he got the info, but the fact that he ended up with it suggests "that there may be individuals out there that want this information to be known publicly," Shamji said.

"People are unhappy with what they're seeing in the emergency departments (and) are feeling hamstrung in what they're able to do in order to improve the health-care system and improve the experience for patients."

Hospital executives and ED heads regularly get the kinds of data found in this report.

The data in the report is presented as "90th percentile" as opposed to a traditional metric like average. Where an average captures all numbers within a given dataset, the 90th percentile approach captures all numbers up to the 90th percentile.

"For example, if the 90th percentile for length of stay of admitted patients in an ED is 44.1 hours, it means that 90 per cent of patients waited up to 44.1 hours to go to a hospital bed. Conversely, 10 per cent of patients waited longer than 44.1 hours," Shamji wrote in a briefing note given to reporters. "It is helpful to look at wait times in this way because the 90th percentile reveals the longest waits and the most dangerous scenarios."

Essentially, if you lined up 100 ED patients left to right based on how long they waited — with the furthest left being no wait at all— the 90th person in that line will have waited 44.1 hours. The folks to the right of that person would've waited longer than 44.1 hours.

Ontario Health's system performance dashboard shows wildly different numbers, but uses different indicators — such as average length of stay and average time spent waiting. The OH numbers are much lower.

In August, the average wait time was 1.9 hours for first assessment in an ED, and patients stayed an average of three hours, OH data shows.

Over 450,000 people visited an Ontario ED in August, down nearly 10 per cent from August 2021, according to the report.

Despite the lower patient load, hospitals weren't able to cut down on wait times. Instead, many wait time indicators went up — some rather dramatically.

In August, it took about 16 per cent longer — up to about 12 hours from about 10 hours — for someone to finish their stay in an ED compared to the same time last year.

For patients who've been admitted to the ED and who are waiting for an emergency bed, wait times went up by nearly 50 per cent during the same timeframe. It between zero to 44.1 hours for 90 per cent of those patients to finish their hospital trip.

"Nearly two days," Shamji said.

If you're in an ED bed but waiting for an inpatient bed, you might be facing waits of up to 33 hours or more. That's a 54 per cent increase from August 2021.

Despite overall hospital loads being lower this year, there are a lot more people in EDs every morning waiting for an inpatient bed.

On average, 883.8 people found themselves in this situation in August 2022 — up over 50 per cent from last year — creating ethical problems for hospitals and physicians, Shamji said.

If you have so many people in the ED waiting for inpatient beds every morning, "I need to find a way to clear beds and to keep seeing patients," he said.

"That might mean that I'm seeing patients in the hallway, I might be seeing them in triage in front of everybody else. And when I'm thinking about discharging patients, I may not necessarily do all the usual steps that I might if I had more time and more space," he said.

What about those who've been taken to the ED in an ambulance? Offload time data shows it can take up to 83 minutes, a 40 per cent jump from August 2021. That's with fewer people calling ambulances compared to last year, the report notes.

The internal data comes as Ontario's health-care system faces immense strain from the pandemic and staffing shortages. Dozens of EDs across the province have closed for hours or days at a time.

The government released a plan in August that sought to free up 2,500 beds in Ontario hospitals through a range of measures including moving alternate level of care patients to long-term care homes, quickly credentialing foreign-trained nurses, making more space for private service delivery, and more.

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Shamji called on Premier Doug Ford and Health Minister Sylvia Jones to provide weekly updates, explain what improvements the government's made since August and why ministers' public rhetoric departs from internal data.

He said a four-point strategy — based around bolstering primary and home care, boosting health-care wages, investing more in the public system, and getting more foreign-trained professionals into Ontario hospitals — would go a long way.

Leaked Ontario Health data paints grim picture of hospitals

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