How gaps in the system show up in emergency department wait times

Emergency department (ED) wait times are rising across Canada. It’s a shared reality felt by both patients seeking care and health care workers trying to deliver it. And yet, it would be a misdiagnosis to frame this issue as an ED problem.

According to a new report from the Canadian Institute for Health Information, Emergency department wait times in Canada: Insights from a health system perspective, the reality is that the ED is often where symptoms of a strained system become visible, not where they begin. Wait times are driven by both increasing patient complexity and a system that is struggling to manage the demand. When Canadians can’t access timely community care, can’t be admitted to hospital beds, and can’t be discharged to home care or long-term care (LTC), those unmet needs show up in ED wait times. 

Patient flow through the ED

Unlike a linear queue, patient flow through the ED is dynamic. When a patient presents to the ED, the wait is not one queue, but rather several that overlap and are spread across triage, admission and discharge. Each phase is measured as a separate wait time and can involve its own potential delay. Patients may see a crowded waiting room and assume it’s a busy day, but the data reveals that in most cases, the waits are systemic, not simply the result of a busy day.

When patients present to the ED, care is prioritized by urgency rather than arrival time, meaning the sickest patients are seen first. In 2024–2025, half of ED patients in Canada waited just under 2 hours to be assessed by an ED physician, while 1 in 10 patients waited more than 6 hours.

While the delays in the ED waiting room may feel the most immediately visible to a patient, the most significant bottlenecks affecting flow through the ED occur after the decision to admit the patient is made. For the 1 in 10 ED patients who are admitted to acute care, waiting for an inpatient bed accounts for nearly two-thirds of a patient’s total ED stay. And if a patient can’t be moved elsewhere, the ED becomes the buffer and is forced to absorb the overflow.

From a patient’s perspective, this can feel like being stuck. They know they are sick enough to be admitted, but without a clear sense of where they will go or when they will move, there is little sense of clarity about how their care plan may progress.

From a staffing perspective, this bottleneck creates a domino effect throughout the hospital. Patients who are admitted and waiting for a bed still require monitoring, treatment and nursing care. This means that ED staff are caring for admitted patients while simultaneously trying to attend to new emergencies. 

A system under strain

Dr. Paul Parks — an emergency medicine physician in Medicine Hat, Alberta — describes what is happening in EDs across Canada as a national crisis of the health system. “We’ve optimized everything. We’ve taken all the elasticity out of the system, but the tap is still flowing,” he said. “There’s a crisis: insufficient connected community resources, and little continuing care and long-term care.”

Dr. Parks’ metaphor points to an overextended health system that was designed for different pressures than the ones it faces today. The bottlenecks in the ED are not isolated; they are a result of co-existing and compounding pressures driven both upstream and downstream of hospitals themselves.

Within the hospital, on the downstream side, beds are not available because of patients waiting to access other services such as LTC or home care. These patients, designated as alternate level of care, are medically ready to be discharged but can remain in the hospital a median of 44 days while waiting for community supports. This limits the hospital’s ability to admit new patients from the ED.

Outside of the hospital, on the upstream side, patients presenting to the ED are increasingly older and have more medically complex conditions. In Canada, adults age 55 and older are among the most frequent ED patients. In 2024–2025, nearly one-third of ED visits involved patients with multiple comorbidities, meaning they required more complex assessment, testing and care coordination.

While some of this stems from an aging population, it also reflects gaps in access to primary and community care. Without access to these supports, people may turn to the ED as their entry point into the health system.

In some instances, patients present with conditions that could have been managed in the community if timely care had been available; in others, lack of access to primary care means those conditions become more complex and difficult to treat by the time patients arrive in the ED. This is particularly true for people living in the lowest-income neighbourhoods, who account for nearly half of all ED visits and often face greater barriers to accessing community care — often relying on the ED to fill the gap.

Together, these upstream and downstream factors cause unmet needs throughout the system to show up in ED wait times.

The ED as a warning signal

The ED serves as a sign of how the wider health system is performing. It becomes the face where the effects of insufficient community care and delayed discharge pathways are most immediately seen, not because the ED is the source of these pressures, but because it’s where these pressures converge in real time.

Improving ED wait times means looking beyond the ED itself, and instead to the broader health system within which it operates. 

Canadian Institute for Health Information. How gaps in the system show up in emergency department wait times.

Emergency department wait times reflect pressures across Canada’s entire healthcare system

Emergency department (ED) wait times have become one of the most visible indicators of the challenges facing Canada’s healthcare system. But according to a new report from the Canadian Institute for Health Information (CIHI), the causes of long waits extend far beyond the walls of the emergency department itself.

Rather than viewing emergency department overcrowding as an isolated issue, the report highlights how patient flow through the ED reflects the performance of the entire healthcare system—from access to primary care and diagnostic imaging to the availability of hospital beds, home care and long-term care.

In 2024–2025, Canadian emergency departments recorded approximately 16.1 million visits, representing about 89 per cent of all ED visits across the country. While most patients were treated and discharged home, nearly 12 per cent required admission to hospital, placing additional pressure on already strained inpatient units.

Perhaps most concerning, more than 1.2 million emergency department visits ended before patients were ever assessed by a physician. Although these cases were not included in the report’s analysis, they serve as an important indicator of overcrowding and prolonged wait times.

Understanding where delays occur

The report examines patient flow through three key stages of an emergency department visit: triage and registration, time under clinical care and disposition, when patients are discharged, transferred or admitted to hospital.

Each stage offers insight into different system pressures.

Patients are first assessed using the Canadian Triage and Acuity Scale (CTAS), which prioritizes care based on the severity and urgency of their condition. Once under care, they may require physician assessment, diagnostic imaging, laboratory testing or consultations with specialists before a treatment decision can be made.

For many patients, the longest delay occurs after the decision has already been made to admit them to hospital. When inpatient beds are unavailable, admitted patients remain in the emergency department, continuing to require nursing care, monitoring and treatment while occupying valuable clinical space. This creates a ripple effect throughout the department, slowing care for newly arriving patients.

The pressures begin long before patients arrive

The report emphasizes that many emergency department visits are driven by limited access to healthcare services elsewhere in the system.

Nearly one in five Canadian adults does not have a regular primary care provider. Even among those who do, timely access remains challenging. Only about one-quarter report being able to see their provider the same or next day, while evening and weekend appointments remain difficult to obtain.

Access to specialist consultations and diagnostic imaging also contributes to emergency department demand. Many patients face months-long waits for MRI or CT scans, while others experience lengthy delays accessing home care or community services. As health conditions worsen, the emergency department often becomes the only available option.

An aging population further compounds these challenges. Older adults are more likely to live with multiple chronic illnesses requiring urgent assessment, symptom management and diagnostic testing that may not be readily available outside hospital settings.

As emergency physician Dr. Simon Berthelot notes in the report, strong primary care can prevent many chronic conditions from deteriorating to the point where emergency care or hospitalization becomes necessary.

Solving emergency department overcrowding requires system-wide solutions

While emergency departments continue to introduce new models of care and improve internal processes, the report suggests meaningful improvements in wait times will depend on broader health system capacity.

Increasing access to family physicians, specialists, diagnostic imaging, home care and long-term care could reduce avoidable emergency visits while helping patients receive care earlier in their illness.

At the same time, improving hospital capacity and patient flow beyond the emergency department would allow admitted patients to move to inpatient units more quickly, freeing emergency resources for incoming patients.

Patient partner Cristyana Aloysious, whose perspective is included in the report, says the current system can be particularly challenging for people living with chronic illnesses who repeatedly return to the emergency department because they lack coordinated, ongoing care.

The report concludes that emergency department wait times should not simply be viewed as an emergency medicine issue. Instead, they provide a window into how effectively the healthcare system functions as a whole. Addressing delays will require coordinated investments across the entire continuum of care—from community-based services and primary care to hospital capacity and post-acute supports.

As Canada’s healthcare system continues to evolve, improving patient flow throughout the system—not just within emergency departments—may prove to be one of the most important steps toward reducing wait times and improving access to care for all Canadians.

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