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Ottawa Citizen, February 12, 2003

By Siri Agrell

A study of emergency room waiting times has confirmed what Ottawa hospital administrators have long suspected - that patients are kept waiting after being admitted simply because there are no beds for them to go to.

Dr. Alan Forster and colleagues at the Ottawa Hospital Research Institute and the University of Ottawa published a paper in this month's issue of the journal Academic Emergency Medicine that shows hospital bed closings in Ottawa have greatly contributed to emergency room overcrowding.

While people have assumed that emergency departments are the first to feel the effect of hospital bed cuts, this is one of the first studies to actually show the effect. And although Ottawa-area hospitals are doing what they can to shave minutes off their ERs' long waiting times, there may not be much they can do to improve the situation in the long term.

"The problems in the emergency room aren't necessarily of the emergency room," said Wendy Fortier, clinical director of emergency and critical care at The Ottawa Hospital. "The decrease in beds and in funding, the lack of family physicians - all of these impact the ER. It's difficult times."

Adding to the stress is news from City of Ottawa officials that clogged hospital emergency rooms are causing paramedics to spend precious time waiting for patients to be admitted - which in turn limits attempts to reduce emergency response times, in a field where delays can be deadly.

Last week, the Ottawa Hospital started an audit of paramedics' wait times and the managers of all of Ottawa's emergency departments are meeting with Emergency Services representatives tomorrow to discuss the problem.

"We're not going to get more beds," said Ms. Fortier. "But I'm an optimist. There's always a will to try to fix something."

As for the study, Ms. Fortier said the findings came as no surprise to hospital administrators, who have been struggling for years to address increasing ER waiting times.

The study was the first to show a definitive connection between bed shortages and ER crowding. It looked at all emergency patients admitted to the old Ottawa Civic Hospital between April 1993 and June 1999. The total number of beds in the hospital decreased during that period to an average of 432 in 1999 from 610 in 1993.

Dr. Forster and his team found that, while the emergency department didn't get busier during the study period - with about 155 visits per day on average - the amount of time admitted patients waited in emergency increased steadily.

By the end of the study period, admitted patients were waiting on average over one hour longer to get to their hospital bed then they did at the beginning of the study.

"It may not seem significant," said Dr. Forster. "But with an average of 30 patients admitted through the (emergency department) daily, it adds an extra nine hours of emergency patient care time for emergency staff each day, not to mention the space patients take up in emergency while waiting for a bed."

Ottawa's four major hospitals are working together to try and improve waiting times by initiating new programs and enforcing stricter admittance, treatment and discharge regulations.

The Ottawa Hospital now has an emergency liaison whose job it is to make sure patients are discharged on time and their beds are efficiently reassigned.

Ms. Fortier has also initiated a "Code ER", which sends out an announcement and automatically pages department heads when there are more than 10 people in the emergency room waiting for a bed.

The hospital is also ensuring that geriatric patients are examined for every possible medical problem, to avoid them returning on multiple occasions.

Dr. Forster knew his research would not come as a surprise to hospitals, but does hope it will help fuel the demand for change.

"It needs to be shown that ER crowding causes problems. There have definitely been high-profile cases of long waits causing death, and clearly now there's a lot of public outcry for something to be done."

(Reprinted with permission by The Ottawa Citizen)