Last Updated : November 28, 2023
CADTH has published new evidence and guidance on the issue of emergency department (ED) overcrowding. The guidance comes as EDs in Canada continue coping with persistently higher patient volumes, staffing shortages and burnout, and as they brace for a potential influx of visits during respiratory virus season.
CADTH’s new evidence reports and guidance from its Health Technology Expert Review Panel (HTERP) aim to support government and health system decision-making on alleviating the systems-wide issue of ED overcrowding in Canada. This work offers decision-makers a road map to identifying the factors contributing to ED overcrowding in their particular context and selecting appropriate interventions and strategies to help alleviate it.
ED overcrowding in Canada contributes to a deteriorating standard of care as health care providers and staff become overworked and burned out. When treatment needs in the ED exceed the available resources and expand the scope of practice required to address them, the health and lives of patients are put at risk.
Given the strain ED overcrowding puts on health systems in Canada and the need for objective advice, CADTH set out to obtain expert input and take an objective look at the scientific literature on the issue. To inform the guidance, CADTH engaged researchers, ED staff and practitioners, health care providers, patients, caregivers, and senior administrators who could bring diverse perspectives and deliver practical and actionable advice.
CADTH adapted an existing and widely accepted conceptual model to categorize the contributing factors and interventions that can alleviate ED overcrowding. The 4 categories are:
Noting that health system capacity is not aligned with and has not kept pace with the growing and changing needs of the country’s population, HTERP identifies a priority order of the most relevant factors contributing to ED overcrowding in Canada:
Based on the evidence and expert opinion, HTERP asserts that output factors, followed by input factors, are the main contributors to ED overcrowding in Canada. While all contributing factors play a role in ED overcrowding, to have the most significant impact on the issue, the panel advises health systems to prioritize implementing strategies that improve patient flow in and out of the ED over interventions that enhance efficiencies within the ED.
In its guidance, HTERP also emphasizes that ED overcrowding occurs because of interconnected and interdependent factors in the ED, in the broader hospital, within health authorities, and in the community. Because of this, solutions will need to involve all health system partners and not rest solely within the ED and its operations. With no one solution that will fix overcrowding, the guidance provides information and advice for decision-makers on how to:
The guidance includes an accompanying Evidence Navigation Guide to help decision-makers identify and implement appropriate interventions. Within this guide, users have direct access to categorized and relevant studies and interventions identified by our experts and included in CADTH’s assessment of the effectiveness of different interventions (with a rating to indicate the quality of evidence).
The panel also makes strong recommendations around the consistent and comprehensive collection, analysis, use, and reporting of health system data to help align population needs with health system capacity. It calls for each province and territory to mandate consistent and comprehensive reporting by all hospitals to the National Ambulatory Care Reporting System (NACRS) database that the Canadian Institute for Health Information manages. At the time of publication, only 4 jurisdictions (Alberta, Ontario, Quebec, and Yukon) were mandated to submit data to NACRS.
While acknowledging the challenge of comprehensive data collection and analysis, HTERP notes that automation and integrated technology systems may help reduce the burden. Further, reporting most data elements to NACRS may be automated with minimal technology and included in the implementation of ED information systems.
Although ED overcrowding is not a new phenomenon, data shows it is worsening nationwide. Trends show that health care needs in Canada are changing and more complex, which in part can be attributed to a growing, aging, and more culturally diverse population. At the same time, administrative data shows that resources critical to support health services demand have not increased proportionally with population growth, resulting in overcrowded EDs:
CADTH’s series of reports and expert guidance on ED overcrowding includes: