Don’t blame orphan patients for ER overcrowding, research shows

by admin admin | Oct 07, 2009

OTTAWA (October 7, 2009) - When an emergency department becomes dangerously backlogged, don't point the finger at people without family doctors - so-called orphan patients - or those requiring non-urgent care. The problem is far more complex and results from a wide range of factors, says a paper released today by the Canadian Health Services Research Foundation (CHSRF).

The article titled "Myth: Emergency room overcrowding is caused by non-urgent cases," is the latest in the Mythbusters series from CHSRF, an independent, not-for-profit organization with a mandate to promote the use of evidence to strengthen the delivery of health services in Canada.

"The problem of emergency room overcrowding is not as simple as long wait times caused by the sheer volume of non-urgent and orphan patients coming into the ER," says Malcolm Doupe, a Winnipeg-based researcher who contributed to the Mythbusters article. "The situation is far more complex."

In its review of existing evidence about how the country's ERs function, the CHSRF Mythbusters article reports that:

  • ER backlogs are not caused by people without a family doctor (so-called orphan patients). For example, a 2008 B.C. study found that 94% of ER patients do have a family physician.
  • Diverting non-urgent patients from the ER undercuts safety. One study of urban ERs found that 7.6% of non-urgent patients (one of every 13) ended up being admitted to hospital.
  • Urgent patients don't have longer waits because of people with minor health problems. One reason for this is because Canada's ERs use a proven and standardized method of triage called the Canadian Emergency Department Triage and Acuity Scale.

The CHSRF article makes the case that overcrowded emergency rooms are the symptom of a complicated interplay of issues.

"Overcrowding is really about patient flow and the need to keep people moving through the ER," says Doupe, a senior research scientist at the Manitoba Centre for Health Policy, a research unit in the Department of Community Health Sciences in the Faculty of Medicine at the University of Manitoba. "ERs can improve flow by changing how they do things - there are a number of successful examples across the country. But ERs are also at the mercy of other parts of the healthcare system and can become clogged when they are unable to move their patients to the next point of care."

For example, sometimes a needed bed is being used by a patient who could leave the hospital but can't obtain appropriate care in the community. In other cases the ER may be unaware that there is an available bed at another hospital, or that a department within the hospital could provide a bed for the patient until one is available in the desired ward.

"While it's encouraging that some ERs and hospitals have started addressing a number of the issues related to overcrowding, this Mythbusters article makes one thing very clear," says Maureen O'Neil, CEO and President of CHSRF. "Hospitals alone cannot fully address the problem of emergency department overcrowding. It's a system-wide issue that needs a system-wide solution."

CHSRF is hosting a Researcher on Call session about ER overcrowding on Wednesday, October 14 at noon ET.

The Canadian Health Services Research Foundation is an independent, not-for-profit corporation with a mandate to promote the use of evidence to strengthen the delivery of health services that improve the health of Canadians. CHSRF is funded by the Government of Canada.

For further information:

Elizabeth Everson
Director, Communications and Public Affairs
Tel: 613-728-2238, ext. 242