Ontario emergency physicians knew, right from the get-go, that Premier Doug Ford’s electoral promise to End Hallway Medicine was hooey.

Ontarians have been forced to suffer the indignities of receiving care, if one can call it that, in the ER hallway since the mid-1990s. Hospitals across the province reduced their acute care bed capacity by 30 per cent in an attempt to respond to Paul Martin’s reduction of the national deficit onto the backs of the provinces. It was a matter of balancing the books pure and simple with little to no regard on the effect of patients.

The provinces, in a vain attempt to explain the cuts, promised a healthcare dividend of improved home care and health promotion.

It never happened. Instead, the healthcare needs of an aging population, with their multiple chronic illnesses and co-morbidities, including dementia still needed the hospital ward bed as much as they ever had. As a result, most hospitals far exceed the recognized safe occupancy rate of 85 per cent and in Ontario routinely exceed 100 per cent bed occupancy rates.

Most urban Ontario hospitals routinely have 15-20 per cent of their available acute care beds occupied by the so-called Alternate Level of Care patient; those who no longer need the acute care services of a large hospital but are unable to be discharged because of a family’s inability to cope, insufficient home care and an overall lack of nursing home beds.

Do the math. A 30-per-cent reduction in acute care bed capacity and a further 20-per-cent reduction due to patients with nowhere else to go. The healthcare dividend never materialized and now hospitals and more specifically emergency departments are crowded and dangerous.

For seemingly generations, the Ontario government has tried to paint the problem as one of inappropriate overutilization by patients who would be better served by improved access to primary care. Money has been spent, nay wasted, on attempts at diversion of non-urgent patients away from the ER. All have failed because that never was the problem.

Bed capacity is the issue and under the current government’s plan is not satisfactorily addressed. Yes, we need more nursing home beds but can we afford to wait five or 10 years for these to materialize if ever.

A crowded ER is a dangerous ER. It is not safe. It is a killing ground for your sick and elderly granny and yet governments treat the problem as if it is a mere inconvenience that can wait for system reform that will never come in our lifetime.

These are the facts. A crowded ER, besides exposing your loved ones to incalculable suffering and indignity, leads to an increased risk of medical harm, including death.

An Ontario study of 22 million patient visits to Ontario emergency departments over a five-year period, found that the risk of death and hospital readmission increased incrementally with the degree of crowding at the time the patient arrived in the emergency department. The authors estimated that if the average length of stay in the emergency department was an hour less, about 150 fewer Ontarians would die each year.

Death aside, the crowded ER leads to delayed access to life-saving interventions, infectious outbreaks (remember SARS?) increases the risk of medical error, delirium, the risk of patients leaving without being assessed, hospitalization costs and system gridlock leading to ambulances waiting for interminable hours waiting to offload patients, inability of ambulances to respond to emergencies in the community and an inability to transfer the sick and injured to university hospitals from outlying rural hospitals.

Recently I had a discussion with a seasoned emergency physician at a university hospital in Eastern Ontario who told me the situation was as worse as it had ever been in a long and distinguished career spanning four decades. Eighty patients waiting to be seen in the waiting room, 20 ambulances waiting on the ramp to offload and all the monitored beds occupied, with fully eight patients with cardiac conditions unable to be monitored to a degree acceptable in a western hospital.

The response of the administration? Form several committees to study the problem.

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Patients do not know this, but their safety can no longer be guaranteed in an Ontario emergency department.

It is time for the Ford government to do what they promised what they would do in ending hallway medicine. Until such time as the transformation of health care in our province shows some meaningful promise, restore hospital bed capacity to a safe range. Free up some beds; keep Ontarians safe.

Alan Drummond is an emergency physician in Perth and co-chair of public affairs for the Canadian Association of Emergency Physicians.

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