Canada’s Emergency Rooms Are Stretching Patients to Dangerous Limits
Across Canada, patients are spending longer and longer in emergency departments, with some waiting days on hard gurneys or in crowded hallways before getting a hospital bed. New data from the Canadian Institute for Health Information (CIHI) shows that in 2024–2025, one in 10 emergency patients—about 1.5 million people—spent more than 14 hours in an emergency department.
Of the 16.1 million emergency visits recorded, 1.8 million people ultimately needed to be hospitalized. While half of admitted patients waited less than five hours for a bed after the decision to admit them, one in ten—around 180,000 people—spent 48 hours or more in the emergency department before being transferred to a ward bed or operating room.
Longer Waits, Higher Risk of Death
Emergency physicians say these delays are not just uncomfortable—they can be deadly. “Not only is this unpleasant for patients, it is also fatal,” said Dr. Michael Herman, an emergency physician in Ottawa and board member of the Canadian Association of Emergency Physicians.
Studies cited in the report indicate that for every 82 patients who wait more than six to eight hours to be transferred to an inpatient bed, one additional death occurs. Using that estimate, Herman said that among the 180,000 patients who waited more than two days for an inpatient bed, “we can expect 2,195 deaths.”
Emergency departments are designed for “short, episodic care and high turnover,” Herman explained, and do not have the resources of an inpatient unit. The longer people stay in emergency—especially older adults—the worse their outcomes, with increased risks of deterioration and delirium.
More Patients, Sicker Than Ever
The CIHI report confirms what emergency physicians have been warning for years: patients are arriving sicker and more complex, and they are staying longer in hospital.
Two-thirds of emergency patients are now classified as “high-acuity,” meaning they have life-threatening conditions such as cardiac arrest, severe chest pain, signs of sepsis, or serious abnormal vital signs. Severe, unstable cases rose from 59% to 66% of all emergency visits compared with the pre-COVID period of 2018–2019, representing an additional 1.7 million visits.
Herman pushed back against what he called the “zombie myth” that emergency rooms are crowded mainly with people who have minor ailments. “The data clearly shows that this is not true,” he said. “We are seeing a decline in our low-acuity patients, and yet wait times are increasing.”
How Long Are Canadians Spending in Emergency?
Overall, half of emergency patients spent four hours or less in the department from registration or triage to departure. Forty percent spent five to 14 hours, and one in 10 spent more than 14 hours—an increase of 28% compared with 2018–19.
Despite the growing strain, the sickest patients are still being prioritized. Half of the most urgent patients waited less than 12 minutes to be assessed by a doctor. However, even among these high-acuity cases, 10% waited nearly 47 hours for an inpatient bed or the operating room.
In 88% of all visits, patients were treated and sent home within 10 hours. But Herman argued that 10 hours is still “an unacceptably long time” and exceeds guidelines recommended by emergency medical groups.
Patients Waiting in Hallways, Closets and Bathrooms
Emergency departments across the country are experiencing historic levels of “hallway medicine,” with admitted patients held on stretchers in noisy, crowded hallways or makeshift spaces. This practice increases the risk of complications and can be humiliating and dangerous, especially for older patients.
People aged 55 and over now wait the longest for a hospital bed. Unlike younger patients, they often cannot be placed in any available bed. Due to infections such as pneumonia, they may need specific wards or isolation rooms, which can further delay transfer out of emergency.
Children under 10 (often with fever and infections), adults over 55 (with injuries, infections, pneumonia, urinary tract infections and chronic illnesses), and Canadians in lower-income areas—who are less likely to have a primary care doctor—were among the most likely to visit emergency departments last year.
More Patients Leaving Without Being Seen
As emergency departments become more crowded and waits grow, more people are leaving without a medical evaluation. In 2024–25, 7.7% of emergency visits—about 1.2 million—involved someone leaving before being seen by a doctor.
Before the pandemic, that figure was 5.4%, or about 800,000 visits. The sharp rise in patients leaving without being seen is another sign of mounting pressure on emergency departments and the frustration families are experiencing.
A System-Wide Crisis, Not Just an Emergency Problem
The report emphasizes that the emergency crisis is largely beyond the control of emergency departments themselves. “It’s really the strains on the health care system that are manifesting themselves in the emergency room,” said Cheryl Chui, CIHI’s director of health system analysis.
Upstream pressures include:
- An aging population living with diabetes, hypertension, heart failure and other chronic illnesses
- Limited timely access to primary care physicians and specialists
- Diagnostic wait times of 200 days or longer for MRIs and other tests, pushing desperate patients into emergency rooms
Downstream bottlenecks are also clogging the system:
- Limited home care and long-term care options
- Patients who no longer need hospital care staying in inpatient beds because they have nowhere safe to go
- Half of people waiting for long-term care spending up to 44 days in hospital in 2024–25
These blockages mean fewer beds are available for new patients coming through the emergency department, creating a cycle of overcrowding, longer waits and more people leaving before being seen.
Canada’s Hospital Capacity Problem
According to the report, in 2023 Canada had one of the lowest hospital beds per capita and the highest acute bed utilization among 32 OECD countries. That leaves hospitals with little capacity to handle surges in demand, whether from seasonal illness, accidents or chronic disease complications.
“It really has to come down to responsibility,” Herman said. At the provincial level, he asked whether governments are providing enough primary care, community support and long-term care to help move patients out of hospitals and into appropriate settings.
At the hospital level, he argued, patient flow must be treated as a 24/7 priority. “We know how dangerous it is to keep patients in the emergency room,” he said.
Inside the Emergency Department: A 24/7 Bottleneck
Even when emergency staff identify that a patient needs to be admitted quickly, they often have no control over how long that takes. “You may have a patient on your doorstep at 1 a.m. who you know needs to be admitted, but you can’t get the (appropriate) specialist in until 7 a.m.,” Herman said. “That’s six hours through no fault of the emergency department.”
He stressed that what is often labeled an emergency problem is actually a hospital-wide issue. Delays in specialist consultations, inpatient bed availability and post-acute care options all converge in emergency departments, turning them into pressure points for the entire health system.
Patients Share Their Experiences
The human toll of these delays is visible in the stories patients tell. Saskatoon resident Barbara Martin described waiting in pain for eight hours in an emergency room “with her leg dangling” after breaking her tibia and fibula. As a trauma case, she was initially taken to one hospital, then transferred to another for trauma surgery.
“After eight hours, the resident saw me and said, ‘I have to admit you,’” Martin recalled. She was then placed in a hallway bed “for maybe 12 hours” before finally getting a ward bed.
Emergency Care Still Essential, but System Needs Change
Despite the pressures, CIHI and emergency physicians stress that people should not avoid emergency departments when they need urgent care. “If you have any worrisome symptoms, please go to the emergency room,” Chui said. “Everyone is working very hard and doing the best they can.”
The report is intended not to discourage people from seeking emergency care, but to highlight that the problem is systemic and requires coordinated solutions across primary care, hospitals, home care and long-term care.
“This report tries to show that this is indeed a systemic problem,” Chui said, “and solutions also need to be coordinated, which makes it challenging. It’s a complex systemic problem.”
For patients like Martin, and for the millions who pass through Canada’s emergency departments each year, the stakes are clear: without changes to how care is delivered before and after emergency visits, overcrowding, long waits and their most serious consequences will persist.
