Joey Salmingo took his two-and-a-half-week-old son to a Markham hospital with a fever. He wasn’t seen by a doctor for five hours. Experts in the industry say this is indicative of a worsening crisis in emergency room wait times, and more needs to be done.
Markham, Ont., man says 2-week-old son wasn’t seen by triage nurse for an hour
Patrick Swadden · CBC News
· Posted: Jan 06, 2024 5:00 AM EST | Last Updated: January 6
Joey Salmingo says it took an hour for his son to be assessed by a triage nurse at Markham Stouffville Hospital and another seven before he was seen by a doctor. (Craig Chivers/CBC)When Joey Salmingo took his newborn to an Ontario emergency room in late December, he didn’t expect him to wait five hours to be seen by a doctor and eight hours to be admitted to the hospital.
Salmingo says it took an hour for his son, who had a fever and was only two and a half weeks old at the time, just to be assessed by a triage nurse at a hospital north of Toronto on Dec. 30
“The biggest thing and most upsetting thing is the fact that this is just commonplace,” said Salmingo.
Salmingo says his son was discharged on Jan. 2 and is now healthy and at home.
But according Dr. Raghu Venugopal, an emergency physician who works in three Toronto hospitals, an eight-hour wait time “shatters any notion of what is acceptable medical care” in Canada.
He says a child with a fever could have sepsis — a serious condition in which the immune system has an extreme response to an infection — and should have been seen by a physician within 15 to 30 minutes.
Venugopal doesn’t blame emergency room staff, but says the worsening trend of chronically strained Ontario hospitals is making it nearly impossible to meet national Canadian health-care standards.
“We as a nation are failing children, women, seniors, regular patients with this kind of situation,” said Venugopal.
He says a lack of available emergency and non-emergency hospital beds, systemic staffing shortages, worsening vaccine uptake and respiratory hygiene in Ontario’s population and a shortage of primary care physicians are putting pressure on an already strained system.
Dr. Raghu Venugopal, an emergency physician in Toronto, says a febrile baby should have been seen by a physician within 15 to 30 minutes of arrival in an emergency room. (Susan Goodspeed/CBC News)Health Quality Ontario, a provincial agency that monitors health-care standards, shows a 2.1-hour average wait time across Ontario from the time a person checks in to an emergency room to when they are first assessed by a doctor or nurse.
‘Flow in is far bigger than the flow out’According to the agency, figures from October 2023 show patients admitted to hospitals in Ontario spent nearly 22 hours hours on average waiting in a emergency room for an inpatient bed, and only 23 per cent of patients were admitted to hospital from the emergency department within the provincial target time of eight hours.
“The simple issue is that the flow in is far bigger than the flow out,” said Dr. Carolyn Snider, who represents the Canadian Association of Emergency Physicians.
Snider says emergency room patients often can’t get an inpatient hospital bed because they are filled with people waiting for space in other areas of the health-care industry, such as long-term care homes or rehabilitation clinics.
“It’s not uncommon for emergency physicians to be providing care for their entire shift in waiting rooms and hallways,” said Snider, who adds wait times are the worst she’s seen in 20 years.
Dr. Carolyn Snider says in her 20 years as an emergency physician, wait times have never been longer than now. (Michael Wilson/CBC)The high stress of emergency room environments and lack of incentive to stay in the field is driving practitioners out, says Dr. Kyle Vojdani, chief and medical director of the emergency department at Michael Garron Hospital.
“We’ve we’re seeing growing amounts of violence directed towards health-care workers and the reality is there are a lot of other options for health-care providers to practice and work,” said Vojdani.
He says the pay emergency room practitioners receive often does not recognize the additional risk and stress the job entails.
Province incentivizing ERs that reduce wait timesIn an email statement to CBC News, a spokesperson for the minister of health said it added $44 million dollars to an annual $90 million investment that rewards emergency departments for innovating solution to reduce emergency wait times.
The Ministry of Health says it is also working “to make it easier for internationally and interprovincially educated health-care workers to register and practice in Ontario,” and removing financial barriers for nurses wanting to learn the skills necessary to work in critical care areas of hospitals.
The ministry did not respond to specific questions about emergency room wait times in Ontario.
Many in the health-care industry say hospital workers are facing historic burnout.
A nurse walks toward a patient in the emergency department of Humber River Hospital, in Toronto, on Jan. 25, 2022. (Evan Mitsui/CBC)In a recent Nanos poll of 774 hospital workers conducted by the Ontario Council of Hospital Unions (OCHU) — including registered practical nurses, technologists and clerical workers — the vast majority said they don’t believe government will make improvements to health care over the coming year.
“Nearly 70 percent of workers polled across Ontario say there are not enough staff to deliver high quality patient care,” said Sharon Richer, OCHU’s secretary-treasurer.
Hospital workers face burnout: unionOver six in 10 responded they are exhausted, while two in five say they dread going into work and are contemplating leaving their position.
The union is calling for an injection of funding into the province’s health-care system to help curtail the staffing crisis, saying it wants the province to invest $1.25 billion annually over the next four years on top of inflation.
In response to those calls, a spokesperson for Ontario’s minister of health said the province’s nurses are among the highest paid in Canada and that 15,000 nurses were added in 2023.
Vojdani says one of the things that could take pressure off emergency departments is investing in primary care, whose doctor shortage currently leaves over two million Ontarians needing a family physician.
“The truth is that most health-care services are reduced after hours,” adds Vojdani, saying that emergency departments wait times are complicated by the fact that it is often the only solution outside normal work hours.
WATCH | Burnout commonplace among health workers:
Health-care staff shortages causing burnout and stressA union representing Ontario health-care workers has released survey data highlighting the stress, exhaustion and burnout experienced by hospital workers — with many considering a new career path. The union is calling for more provincial funding to ease the worsening staffing crisis.
Venugopal says the province needs to robustly increase hospital capacity and better incentivize work, adding that it could also experiment with expanding virtual care and not-for-profit beds in the community.
“We have to make the work environment and health care more enticing and palatable for people who go to battle everyday,” said Venugopal.
Venugopal adds that while Ontarians could also help take strain off emergency rooms by keeping vaccinations up to date and staying home while sick, nurses and physicians will always tend to injured and critically ill patients.
“If people exercise judgment and they can stay healthy, that reduces overall volumes.”
CorrectionsA previous version of this story incorrectly stated Salmingo’s baby waited eight hours to be seen by a doctor. In fact, the child was seen by a doctor after five hours and was not admitted to the hospital for eight hours.
Jan 06, 2024 3:09 PM ET
ABOUT THE AUTHOR
Patrick is a reporter and producer for CBC News in Toronto. He is from Vancouver, BC, where he previously worked for CityNews and reported on the overdose crisis.