Last December, 67-year-old Charlene Snow waited in the emergency department in a Nova Scotia hospital for seven hours before she gave up and went home — without seeing a doctor.
Less than an hour later, she was dead.
While a tragedy on its own, Snow’s case is all the more horrifying because the circumstances which led to her death are playing out across the nation with increasing frequency.
The number of Canadians who visit emergency departments across the country only to give up and leave before they receive any care has increased more than fivefold, according to new data collected by CTV News.
The problem is coded by hospital emergency departments as “LWBS” — patients who “leave without being seen” due to long waits caused by overcrowded ERs and staff shortages.
“A lot of the conditions we’re worried about are what we call time sensitive,” Dr. Eddy Lang, an emergency specialist in Alberta, told CTV National News. “If there’s a significant delay in time, the treatment of the patient does a lot worse.
“But more importantly, it’s not good quality care when people are waiting so long and then have to go home because the wait is just unacceptable.”
Data from the Canadian Institute for Health information (CIHI) shows that 184,753 people went to the ER for help in 2003-2004 and then left without medical attention aside from the initial nurse interview. In the two decades since, rates have risen every year, aside from a small dip in 2020-2021 when Canadians were generally avoiding ER visits during the first part of the pandemic.
In the most recent data available, CIHI reports that there were more than 14 million hospital visits in 2022 and that a whopping 963,637 patients simply left before receiving care. This means the number of patients leaving without getting any care is five times the number recorded in 2003.
Lisa Salamon, an emergency room doctor in Scarborough, Ont., found the numbers “unbelievable” when she heard them for the first time.
“That is an astronomical number and really is very concerning, because there are definitely patients who need emergency care that have left,” she told CTV National News.
Although doctors have been raising alarm bells for years about the huge stress the health-care system is under, the sheer amount of patients leaving the hospital without receiving help isn’t something most doctors are able to grasp in the day-to-day.
“We do our job and we’re not made aware of how many people have left without being seen,” Salamon said.
When a patient presents to the emergency department, they are given an initial assessment to see if they are in need of immediate care — for instance, a person experiencing a heart attack will be seen within minutes, regardless of the number of people already waiting.
But those exhibiting what seem to be less serious symptoms can be stuck waiting for hours. And the wait time is increasingly becoming too much for patients.
Dawn Peta, an ER nurse in Lethbridge, Alta., said the consequences from a missed emergency department visit could be huge.
“It worries me because some of the people who may leave may not have insight to how sick they may be and leaving could be the wrong choice,” Peta, who is co-chair of the National Emergency Nurses association, wrote in an email.
“Leaving can or may lead to a worsening condition of what may have brought you in.”
When Snow presented to the ER in Cape Breton Regional Hospital last winter, she had jaw pain and flu-like symptoms. She died at home because of fluid buildup around her heart, something which could have been treated if she was able to see an ER doctor.
The 2021-2022 CIHI data means that one in 14 patients left without care. More ticking time bombs like Snow were undoubtedly among them.
“There’s a lot of things that people may find, for them, ‘Well, I want to get this checked out,’ and then after waiting numerous hours, are like, ‘I can’t be bothered anymore, I’m just gonna go home,’ without the important test to either reassure them that it’s OK, without arranging, perhaps, follow-up that might be necessary, or without catching some things that could be life-threatening,” Salamon said.
DOCTORS: POLITICAL WILL NEEDED TO STOP A SINKING SHIP
Data from the National Ambulatory Care Reporting System (NACRS) shows that from April 2022 to March 2023, which is the most recent complete year of data, there were more than 15.1 million unscheduled ER visits reported in Canada — up from the 14 million reported in 2021–2022.
This means visits are returning to pre-pandemic volumes, as almost 15.1 million visits to the ER were logged in 2019-2020. But the health-care system is far different in 2023 than it was in 2019.
Dr. Trevor Jain, an emergency physician, told CTV National News that there’s a misconception that an influx of patients coming to the emergency department with small concerns is what is causing overcrowded ERs.
“That’s false,” he said. “It’s full hospitals — we’ve nowhere to put our admitted patients from the emergency department to the rest of the facility. Therefore, it backs up the waiting room and we can’t get at those patients in a timely fashion.”
Doctors report that there aren’t enough hospital beds and that many hospitals at operating at 100 per cent capacity.
“We need to keep our hospitals at a level of occupancy that prevents the emergency department from turning into a dangerous place,” Lang said. “That means that when we identify a patient who has to come into the hospital, be it with a broken hip, or pneumonia, or a heart attack or appendicitis, they cannot linger in the emergency department for hours and hours and even days.”
Lang, who is a professor and department head for emergency medicine at the Cumming School of Medicine at the University of Calgary, said that without the staffing capacity and space to move patients to other departments, there’s nothing doctors can do.
“Until our health-care system can bring those admitted patients upstairs, we will continue to have unacceptably high numbers of ‘left without being seen.’”
It should be something politicians are actively trying to fix, Lang said, but the crisis has been frustratingly absent from many political discussions.
“It is, or it should be, a political issue. The proportion of the provincial budgets that go to health care are astronomical. They’re upwards of 40 or 50 per cent,” he said.
“Taxpayers have a right, given how much they’re spending on their on taxes, to demand a high quality health-care system.”
Lang said that Canadians should be pressuring their representatives for answers.
“We should put our politicians to answer for what they will do to address the current state of affairs, (in which) the safety net which is the emergency departments are functioning at levels that are suboptimal because of what’s going on.”
The majority of patients who leave the ED without being seen are “overall a low-risk population,” Lang said, in terms of experiencing a life-threatening outcome because they didn’t receive emergency care.
“These bad outcomes are relatively rare, even though they do occur and maybe that’s not why they’re getting attention,” he said.
“(But) people don’t come to the emergency department for non-important reasons.”
The percentage of patients who leave without receiving care is a marker for overcrowding and low staffing issues within a health-care institution. In the average hospital, it should be less than one per cent.
“We’d like them to be zero. But there’s some emergency departments on the east coast in the summertime that were reporting ‘left without being seen’ rates as high as 40 per cent,” Dr. Trevor Jain, an emergency physician, told CTV National News. “That means that 40 per cent of patients that registered to see an emergency department physician left due to the wait times, lack of resources or (a) full hospital.”
When presented with the new data showing a fivefold increase, the office of the federal Health Minister did not address the rising number of Canadians who are leaving the emergency department without having received care, but said in a statement that they know Canadians worry about wait times.
“Canadians have told us that they are worried about increasingly long wait times in the ER — we heard them loud and clear,” the statement reads. “This is why we are investing nearly $200 billion in Canadian health care over the next 10 years. Over $46 billion of this new funding is reserved for tailored bilateral agreements with every province and territory so they can invest in their specific jurisdictional health-care system needs.”
The Canadian Association of Emergency Physicians (CAEP) is deeply concerned.
“We recognize that patients leaving the ED without care poses significant risks to their health,” the organization wrote in a statement. “Addressing the root causes is crucial for patient safety.”
They’ve been calling for a national forum on emergency care to finally address the core issues — and stop patients from leaving hospitals without the care they require.
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