Hospital emergency rooms (ERs) are the health system’s equivalent of the proverbial canary in a coal mine. If something is amiss in the health system, it manifests first in the ER, typically with patients waiting forever for treatment or, if they require admission to the hospital, staying far too long in the ER waiting for a hospital bed.

I know this first-hand because during my 40-plus years in Ontario health care, I’ve worked in several different hospital ERs, written government reports on ER wait times and participated in studies evaluating methods for reducing ER waits. I also know the extremely high quality of the people who work in Ontario ERs.

ERs are the first casualty of hospital overcrowding (also known as Hallway Medicine). When hospitals have too many patients in their wards, admitted patients in the ER can wait for long hours or even days while a bed is being freed up. This limits spots for assessing and treating new patients arriving at the ER with potentially critical illnesses.

Since leaving the ministry of health, I’ve kept in contact with nurses, doctors and administrators who closely observe ERs across the province. These experts understand that there is a seasonable variability to ER activity. It is always busiest in the first three months of the calendar year when flu season affects elderly patients who are also at risk of wintertime falls and fractures. By contrast summer provides a reprieve with quieter ERs. But this past summer worries Ontario’s ER experts.

Summer 2019 was an exception to the usual summertime slowdown. June 2019 was the worst June ever reported for ER wait times

To make matters worse, we recently learned that the wait times for people listed for long-term care beds have also hit historic highs and that no new long-term care beds are expected for two years. Given that hospitals are mainly crowded with patients who no longer need hospital services but are waiting for long-term care beds, ER experts are worried that we could reach gridlock this winter.

ER gridlock occurs when sick patients cannot leave the ER to be admitted to hospital units. The presence of these patients prevents newly arrived patients from being transferred quickly to the ER for assessment and treatment. Needless to say, some new patients require immediate care and if people are frozen out by gridlock, tragedy can occur.

What can we do at this late date to prevent ER gridlock in January 2020? In winter 2018, 1,200 extra hospital beds were funded and opened along with 200 new supportive housing spaces and 600 new “transitional care” spaces in formerly closed hospitals.

In the short term, these contingency measures prevented ER gridlock but did not solve longer term overcrowding.

The current government has continued many of these measures. However, the historic overcrowding in June suggests another urgent contingency plan is needed.

This contingency plan needs to be introduced immediately, even before the fall economic statement expected in November. The plan needs to assure all Ontario hospitals that they can expect funding to open all available beds and temporary spaces for six months starting in November. Hospitals should be directed to engage staff to open every bed (many have most beds open already) and to develop plans for contingency spaces (clinic spaces, meeting areas and other space that can be readily converted to temporary in-patient activity) this winter.

There may be some capital costs (purchase of new beds for example) associated with this contingency plan. But most of the costs are in staffing.

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To increase Ontario hospital capacity by 5 per cent for the winter months will require staffing costs of more than $100 million. The necessary staff will likely be available if hospitals make an immediate concerted effort to convince part time and casual workers to increase hours over the winter months. However, unless the hospitals start staffing up immediately, they will not be able to open contingency spaces in January to prevent ER gridlock.

The cost of preventing gridlock is not cheap. However, without a concerted effort now to keep our ERs open, we may pay a far greater price in a gridlocked ER somewhere in Ontario this winter.