Charlene Snow, aged 67, found herself in the emergency department of a Nova Scotia hospital last December, yet after waiting for seven hours and seeing no doctor, she decided to return home.
Tragically, less than an hour after her departure, she died.
Although an isolated tragedy, the horrifying reality of Snow’s case is that the circumstances surrounding her death are becoming increasingly prevalent across Canada. Rising reports indicate that Canadians frequently visit emergency departments, only to eventually leave without receiving any medical care due to lengthy waits and overcrowded facilities. This is an issue formally recognized by hospitals as “LWBS” or “Leave without being seen.”
Alberta based emergency specialist, Dr. Eddy Lang, pointed out that many conditions are time-sensitive, where a significant delay in treatment can severely affect the patients’ wellbeing. He opines that waiting for long hours and then leaving without any medical help due to unacceptable wait times is a direct compromise on the quality of care provided to patients.
Statistics from the Canadian Institute for Health Information indicate a disturbing rise in this trend. In 2003-2004, 184,753 individuals visited the ER and left without any medical assistance, except for an initial nurse interview. Two decades later, this number has skyrocketed to 963,637 in 2022, totaling over 14 million hospital visits. This implies a fivefold rise in patients leaving without receiving any medical care since 2003.
Emergency room doctor Lisa Salamon from Scarborough, Ontario, expressed disbelief and concern over these staggering numbers, highlighting that there likely are patients who critically need emergency care and are leaving without it. Amid the daily pressures of hospital work, doctors struggle to grasp the significance of these figures.
The ER procedure includes an immediate assessment upon patient arrival, prioritizing dire emergencies, while patients with less severe symptoms are often left waiting for hours. The increasingly unmanageable wait times are discouraging patients, prompting them to leave.
Dawn Peta, an ER nurse in Lethbridge, Alberta, and co-chair of the National Emergency Nurses Association, warns that the fallout from a missed ER visit could be substantial. She stresses the importance of understanding how severe a condition can be and how leaving without adequate attention may affect them.
Snow’s death serves as a tragic example. She presented flu-like symptoms and jaw pain to the ER but passed away at home due to fluid buildup around her heart, a condition she was likely unaware of and could have been treated had she seen an ER doctor in time. Yet she was one among the one in 14 patients who leave the ER without care.
Despite increasing ER visits to pre-pandemic levels in 2023, data reveals that hospitals are operating in a significantly different environment than they were in 2019. Dr. Trevor Jain, an emergency physician debunked the misconception that patient overload with minor concerns is causing the overcrowding in ERs. The real issue, he explains, is the lack of available hospital beds and complete capacity more frequently than not, leading to a backed-up waiting room.
According to Dr. Lang, hospitals need to maintain a level of occupancy that prevents ERs from becoming a hazardous place. Hospitals should employ sufficient staff and allocate adequate space to accommodate patients timely to other departments avoiding lingering in the ER. Despite the increasing pressure on Canada’s healthcare system, a solution is frustratingly absent from many political discussions.
Taxpayers expecting a high-quality healthcare system should question their representatives on the existing state of affairs, where the emergency departments – considered as safety nets – are functioning suboptimally.
Although the majority of patients leaving the ER without care are generally low-risk, the rising instances of “left without being seen” patients are a marker for overcrowding and low staffing issues within a health-care institution. In a typical hospital, this figure should be less than one per cent. However, some emergency departments have reported rates as high as 40 per cent during peak times.
Despite investing nearly $200 billion in Canadian healthcare over the next ten years, the federal Health Minister’s office fell short of addressing the rising number of Canadians who depart the ER without receiving care. Concerns remain from institutions such as the Canadian Association of Emergency Physicians (CAEP), who believe that patients leaving the ER without any care pose significant risks.
Recognizing the urgent need for a multi-faceted solution, CAEP has been advocating for a national forum on emergency care to address core issues that result in patients leaving hospitals without receiving the care they require.