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Emergency: Why Patients Are Not Seen in Order of Arrival

An emergency room sign.
Written by Lisa Priest

The Question: I have been waiting in your emergency department for over 90 minutes. Other patients who arrived later than me are being seen first. Am I being discriminated against for some reason? I want to know why I am still in the waiting room when other people who don’t look as sick are going ahead. What is going on?

The Answer: In the emergency department, those who are most acutely ill are seen first and wait times for patients who do not require immediate medical attention can be several hours. This is the case in many hospitals, especially Sunnybrook, where patients may drive hours to emergency for a consultation with a specialist or have a complex medical condition they think this teaching hospital is best equipped to handle.

“Patients are not seen in their order of arrival,” said Dr. Jeffrey Tyberg, Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre. “It is not first come, first served – it is who is sickest or who needs to be seen first. Our responsibility is to triage patients in order of how acute they are.”

Sunnybrook has a bustling emergency department, with 54,950 visits taking place in fiscal 2011-12. Of those, 12,428 patients – or 23 per cent – were admitted to hospital, according to hospital figures. That is more than double the 9.6 per cent admission rate of the province.

In this emergency, patients are seen, then sent to different colored zones based on the urgency of their illness.

The most acutely ill are sent to the green zone and include conditions such as chest pain and gastrointestinal bleeds that require more workup.

The blue zone is for intermediate cases and includes a resuscitation room for non-trauma cases, and an accelerated care and treatment zone, which is used to rapidly cycle patients who can be seen in a stretcher by a physician, then wait in a chair for treatment or investigations.

The purple zone is for more minor medical problems, including sprained ankles and red eyes. The orange zone has a mixed use and includes intermediary patients plus those patients who have been seen, admitted and are waiting for a bed.

So you may be correct; that someone less ill than you was treated first because their zone was less busy. Or, it turned out that they actually were sicker than you, even though it did not appear that way.

There is no question that emergency department’s all over the province are having a difficult time treating less urgent patients in a timely manner.

Tracking wait times in emergency has become a priority for Ontario, which has set wait time targets for hospitals to meet and publicly reports them on its government web site.

Some hospitals have struggled to meet even those long waits, according to September figures, the latest available from Ontario’s ministry of health.

The maximum time nine out of 10 patients with complex conditions spend in emergency is 10.9 hours – 2.9 hours longer than the provincial target. For minor or uncomplicated conditions it is 4.1 hours, just above the provincial target of 4 hours.

Sunnybrook’s numbers are higher, with the maximum time nine out of 10 patients spend in emergency taking 17.2 hours; for minor or uncomplicated conditions, it is 5.9 hours.

Total time spent in the emergency is defined as that period tracked the moment a patient arrives and registers to the time that patient is discharged or admitted to hospital.

About the author

Lisa Priest

Lisa Priest is the Director and Patient Engagement Lead of the North East Toronto Health Link.

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1 Comment

  • It is helpful to understand why one has to wait longer to receive care but would not this information be helpful right at the point of triage assessment. Rarely is this information given voluntarily. Normally a patient is assessed and then asked to have a seat in the waiting area without any further comments. I would find it very beneficial if there was better communication to me about how long it would take for my next assessment (without having to ask every time).

    I appreciate the openness in the information that Sunnybrook’s emergency wait times are higher than the provincial target but why is this so? Is something being done to address this situation?