A family sits in an emergency department waiting room, their four-year-old crying with ear pain, watching the clock as hours pass. When they finally see a doctor, the diagnosis is a simple ear infection - but the wait has been exhausting for child and parents alike. An elderly man with abdominal pain is triaged as urgent, moved quickly to a bed, and within an hour has scans and a diagnosis. The triage nurse's assessment determined his path. A woman with a possible stroke is taken immediately to treatment, the triage recognizing signs that demand no delay. A young man with a sprained ankle waits seven hours before being seen, his frustration mounting, his injury one of many that is painful but not dangerous. He understands the logic but still feels forgotten. A mental health patient waits not hours but days, not for treatment but for a bed that doesn't exist, the emergency department becoming temporary home. Emergency department wait times measure the gap between healthcare's promise of immediate response and the reality of demand exceeding capacity. How these wait times are understood, measured, and addressed shapes both experience and outcomes.
The Case for Wait Time Reduction
Advocates argue that emergency department wait times must be reduced. From this view, waiting is harmful and unacceptable.
Wait times affect outcomes. For time-sensitive conditions, delay causes harm. Even for less urgent conditions, pain and anxiety during waiting affect wellbeing. Wait time reduction is not just about comfort but about health.
Wait times reflect system failure. Emergency departments that cannot see patients in reasonable time are failing their mission. Long waits indicate inadequate resources or inefficient processes. The system should be fixed.
Public expectations matter. Canadians expect timely emergency care. When waits are hours or days, trust in the healthcare system erodes. Meeting public expectations matters.
From this perspective, wait time reduction requires: increased emergency department capacity; improved hospital flow to free ED beds; alternatives for non-emergency needs; and process improvement within EDs.
The Case for Realistic Expectations
Others argue that wait time expectations must be calibrated to reality. From this view, not all waiting is problematic.
Triage prioritizes appropriately. The most urgent patients are seen first. Waiting for non-urgent conditions is appropriate when urgent cases need attention. Triage is working as designed.
Resources are finite. Eliminating all waits would require enormous resources. Some waiting is inevitable when demand exceeds capacity. Zero wait is not achievable.
Alternatives exist. Patients with non-urgent conditions could often be seen elsewhere. Virtual care, urgent care centres, and extended primary care hours can serve appropriate patients. Using EDs for non-emergencies creates waits for everyone.
From this perspective, wait time expectations should be realistic, with urgent conditions prioritized and alternatives developed for non-emergencies.
The Measurement Challenge
Wait times can be measured different ways.
From one view, time to see a physician is the key measure. Patients experience the wait as time sitting without care. The initial assessment matters most.
From another view, time to treatment completion matters. Seeing a physician quickly but then waiting hours for tests or results extends total ED time. Length of stay may be better measure.
How wait times are measured shapes what gets improved.
The Triage System
Triage determines who waits and who is seen immediately.
From one perspective, triage systems work well. Trained triage nurses accurately identify urgency. The sickest patients are seen first. Triage protects appropriate prioritization.
From another perspective, triage has limitations. Undertriage can miss serious conditions. Overtriage can delay truly urgent cases. Triage should be continuously improved.
How triage functions shapes wait time distribution.
The Flow Problem
ED waits often reflect hospital flow.
From one view, when patients cannot move from ED to inpatient beds, ED backs up. Flow problems are hospital problems, not ED problems. Solving flow solves ED waits.
From another view, EDs can improve internal flow. Process improvements, fast-track for simple cases, and other ED interventions can reduce waits regardless of hospital flow.
How flow is addressed shapes wait time solutions.
The Target Question
Wait time targets exist but are often unmet.
From one perspective, targets should be met. Setting targets then missing them repeatedly is meaningless. Targets should drive resource allocation and accountability.
From another perspective, arbitrary targets may not reflect clinical reality. Some variation in wait times is inevitable. Targets should guide improvement without becoming ends in themselves.
How targets are used shapes wait time governance.
The Canadian Context
Canadian emergency department wait times are measured and reported. Provincial targets exist. Performance varies by hospital and region. Time to see a physician often exceeds targets. Length of stay can be many hours. Mental health patients often wait longest. Improvement efforts are ongoing. Some successes have been achieved. Rural EDs may have shorter waits but longer travel times. Urban EDs often have longer waits but more resources. Wait times are a persistent political and public concern.
From one perspective, Canada must reduce emergency department wait times through investment and process improvement.
From another perspective, realistic expectations and appropriate alternatives should guide approach.
How Canada addresses ED wait times shapes emergency care experience.
The Question
If wait times affect outcomes, if triage prioritizes appropriately, if flow determines waits, if targets go unmet - what is the path forward? When a patient waits hours for a condition that turns out to be minor, was the wait wasted time or appropriate prioritization? When targets are set but not achieved year after year, what accountability exists? When hospital flow backs up EDs, whose problem is that? When patients use EDs because alternatives don't exist, whose responsibility is creating alternatives? When we measure wait times, are we measuring the right things? And when someone waits in pain and uncertainty, what experience are we actually providing?