Doctors are warning that ERs are on the verge of collapse.
In July, 14 hospitals across Ontario temporarily closed their ERs and ICU units. Earlier this month, the Ontario Nurses Association reported that it had scaled back operations at 25 hospitals across the province, sending patients looking for care elsewhere. Six emergency rooms temporarily shut down in Quebec in July while multiple hospitals in B.C.—many in rural areas—faced temporary closures. Wait times to see an ER physician can range from eight hours in Winnipeg to 20 hours in Ontario, as hospitals struggle to make do with staff shortages, burnout among those left behind and sicker patients who’ve delayed getting care during COVID-19 waves.
“When we see patients who have been waiting eight hours or who fall asleep on the chair or the stretcher before we even see them, they are often frustrated,” says Dr. Sameer Masood, an emergency physician at the University Health Network in Toronto. But that frustration is shared by healthcare professionals in ICUs too, who he says sometimes face abuse from patients who are sick and waiting for help. “Things can easily spiral out of control when wait times are longer and we don’t have the resources that we need to do our job.”
Chatelaine spoke to Massood and Dr. Abdo Shabah, an ER physician in Quebec, about when you should go to the ER, and the other care options that exist.
When should you absolutely go to the ER?
There is no simple checklist: Whether or not you should go to the ER depends on your medical history, the severity of your symptoms and whether you have access to other healthcare options. You should absolutely go to the ER if you have heart attack or stroke symptoms, a severe allergic reaction, difficulty breathing, and burns or open wounds that won’t stop bleeding. Other symptoms that affect a patient’s stability—very low blood pressure, a rapid heartbeat or feelings of confusion—are classified as a top priority by triage nurses in the ER, says Shabah. Triaging allows the sickest patients to get medical help first.
Seemingly mild symptoms can also warrant a trip to the ER depending on your medical history. Blood in your stool, for instance, is cause for concern if you have a history of colon cancer.
ERs also see a lot of patients with chronic conditions such as diabetes or arthritis, adds Masood, but it isn’t the best place to help you manage regular symptoms. (ER doctors also aren’t able to refer you to a specialist.) If you do have a complication related to your chronic condition, however, ER physicians can help. High blood sugar in diabetic patients causing dehydration and vomiting is one example of an emergency complication that warrants a trip to the ER.
If you’re unsure whether to head to the ER, consider the severity of your symptoms. If you have stomach pain or a headache, for example, are you in excruciating pain? If you’re feeling really unwell, start to pass out or have a high fever that hasn’t broken in days, then it’s best to visit the ER.
If your symptoms are mild and you think you can wait to see a doctor in the next few days, then scheduling an appointment with your family doctor or visiting a walk-in clinic would be a better option. But if you don’t have access to a family doctor and are concerned about your symptoms, Masood stresses that you shouldn’t hesitate to come to the ER. “We’re the safety net,” he says. “We don’t replace your specialists or your primary care physicians, but we’re there if you need us.”
What about urgent care centres?
Urgent care centres treat patients who might not be able to wait to see their family doctor in a few days but also don’t feel sick enough to go to the ER. These symptoms could include sprained ankles or wrists, headaches and sore throats that aren’t getting better, and high fevers or infections.
These centres aren’t designed to replace ERs—if you have a life-threatening illness or injury, going to the ER is your best option. Urgent care centres also aren’t open 24/7; they usually run on weekends and close at a certain time in the evenings on other days. Masood also adds that urgent care centres also might not have the same tools a large ER would—they may be able to do X-rays but not CAT scans, for example. If patients need to be admitted to the hospital from an urgent care centre, they would have to first be transferred to the ER.
While there aren’t a lot of urgent care centres across Canada, the ones that do exist are often affiliated with hospitals, says Masood. That means that if you need to be admitted to hospital following an urgent care visit, you’d bypass the long ER wait and be seen directly by an ER physician.
What about a walk-in clinic?
If you’re looking for a prescription refill or feel well enough to wait out your symptoms, then visiting your family doctor is a better option than visiting urgent care. But if you’re one of the 4.6 million Canadians without a family doctor or are unable to book a timely appointment with yours, try a walk-in clinic. Doctors at walk-in clinics can help with non-urgent medical concerns, like coughs and colds, sinus infections, or illnesses like pink eye.
Some family doctors work in group practices called family health teams, notes Masood. When your family doctor is away, they can direct you to a specific clinic where another doctor in their team will have access to your records. If you go to an unaffiliated clinic, doctors won’t have access to your medical history.
When should I call Telehealth?
If you’re unsure whether your symptoms are cause for concern, calling a Telehealth nurse can help. The 24/7 phone line available across most provinces and territories connects you with registered nurses who provide medical advice based on your symptoms and medical history.
Although the service has different names across provinces (HealthLink in B.C. or Health Connect Ontario), those living outside of Manitoba, Nunavut or the Northwest Territories can speak with a nurse by dialling 811. Manitoba has the same service but uses a different number for its phone line, while those in Nunavut and the Northwest Territories can arrange for virtual appointments with a healthcare provider instead.
Telehealth nurses triage you in the same way ER nurses do, and can offer advice on whether you should go to the ER, monitor your symptoms at home or wait to see your family doctor. They can also refer you to specific hospitals in your area for help, including ERs with specialists that can better treat your condition. “This decreases the burden on emergency rooms because you will go directly where you can get help for your condition,” says Shabah.
What virtual options are there?
Masood says many non-life-threatening conditions that are still urgent can be assessed by your doctor virtually. These might include anything from skin rashes to sore throats and coughs to chest pain that isn’t associated with a stroke or heart attack to headaches. Other symptoms might be difficult for doctors to diagnose over Zoom. “If you’ve fallen off a ladder and broken your ankle, I have to examine your joint or if you’re having a lot of belly pain, I need to examine your abdomen—those are difficult to assess virtually,” he says.
But what if you’re without a family doctor? In that case, virtual services like Rocket Doctor (available in Ontario, British Columbia and Alberta) and Tia Health (available in Ontario, British Columbia, Alberta, and Quebec) are free with a valid health card and connect patients with doctors and specialists virtually. They can’t find you a family doctor, but they can help with prescription renewals or referrals to a specialist, and are also a good option if you’re too sick or immobile to visit a walk-in clinic.
Finally, virtual ERs—a pandemic fix to address the crisis in ERs and expand access to care—are another option. An Ontario-wide virtual ER spearheaded by doctors at three Toronto hospitals offers same-day appointments to meet virtually with a physician. During your virtual appointment, doctors can refer you to a specialist, ask you to visit an ER in person, give you care instructions or ask you to follow up with your family doctor. Other virtual ERs have also popped up to provide care during ER closures, such as in Newfoundland and Labrador.