by Regina Annirood

Graphic design by Raymond Zhang

Visiting the hospital when sick is an experience most people dread. After arriving, whether on your own or by ambulance, you register with a triage nurse who asks pointed questions, records your vitals, and assigns a level of urgency. You hope to be seen quickly, but instead wait for hours with little communication, anxious and hungry among others in varying states of illness. This is the reality for many patients in Canadian emergency departments, and it is time to ask what must change.

The Process

Arriving at an emergency department follows a predictable process. After registering with personal details, a triage nurse assesses the patient using the Canadian Triage and Acuity Scale (CTAS), recording vital signs, main complaints, and medical history.¹ Implemented in 1999, the CTAS was designed to identify patients’ needs for timely care and to standardize emergency department operations.¹ Yet, despite advances in technology and rising patient volumes, it has changed little over the past 25 years and now struggles to keep pace with the complexity, data demands, and technological possibilities of 2025.¹ After triage, patients wait to see a physician or healthcare provider, with urgent cases prioritized.¹ Many then undergo tests, imaging, or consultations, necessary parts of care that nonetheless add to overall delays.¹ These delays often stem not from the assessments themselves but from limited staffing and high clinician workloads, which slow both the completion of tests and the response to results.² The final step, known as disposition, determines whether the patient is discharged, admitted to the hospital, or referred elsewhere. Each stage in the process depends on staffing, bed availability, and system flow, so delays at any point extend wait times for everyone.²

How long are the emergency room waits in Ontario?

Across Canada, median wait times and total length of stay have risen in almost every province over the past five years, with the largest increases in Ontario and Alberta.³ Emergency room wait times in Ontario have worsened over the past decade. Health Quality Ontario (2024) reports an average two-hour wait from registration to initial assessment, about three hours for low-urgency non-admitted patients, five hours for high-urgency cases requiring more extensive testing or assessment and 19.2 hours for those eventually admitted.⁴ In 2017–18, the average emergency department stay for admitted patients was nearly 16 hours, which is two hours longer than in 2015–16.⁴ The prolonged effects of pandemic-related staffing shortages, delays in elective care, and elevated patient volumes have further strained emergency departments, pushing wait times to record highs. In Ontario, a projected shortfall of 33,000 nurses and personal support workers by 2027 to 2028 is expected to further strain the system, worsening wait times and causing more temporary closures.⁵ Together, these statistics reflect a system in which long waits are no longer the exception, but the expectation.

Lack of communication and transparency

One of the hardest parts of visiting the emergency room is not just the wait, but the lack of communication. Patients often do not know how many people are ahead of them, what stage of care they are in, or what they are waiting for. A 2021 study explored patients’information needs while waiting in emergency departments and found strong demand for real-time updates on wait times and care progress.⁶ The research revealed that most patients wanted transparent, continuously updated information about expected delays and the sequence of care but noted that few hospitals provide such systems.⁶ This finding wasn’t specific to a single study – in fact, a 2024 review of 29 studies examining patient experiences of emergency department triage identified communication as a key determinant of perceived quality of care, highlighting that clear, compassionate, and timely communication during triage and waiting periods significantly shapes patient satisfaction, trust, and overall experience.⁷ These growing concerns suggest that the system needs to shift towards treating patients as active participants in their care. 

Food, Fatigue, and the Strain of Crowded Waiting Rooms

While delays in receiving clinical care are concerning, the side effects of long wait times should also be recognized. Many hospitals have cafés or food courts, but few operate around the clock, leaving vending machines as the only accessible option during overnight hours. These machines rarely offer nutritious choices, as an INFORMAS Canada survey found that only 3% of hospitals provided exclusively healthier food options, with an average of 4.7 less healthy items out of every 10 available.⁸ This prolonged waiting and lack of nourishment contribute to growing fatigue and discomfort. Beyond physical needs, the environment itself adds to the strain. Crowded waiting rooms filled with patients of varying conditions heighten noise, stress, and discomfort for everyone. Research shows that noise levels in emergency departments frequently exceed World Health Organization recommendations, contributing to increased patient anxiety and dissatisfaction with care.⁹ Similarly, studies on emergency department environments have found that overcrowding and constant activity negatively affect patients’ sense of safety and overall experience.¹⁰

Possible solutions and ways forward

While structural reforms are essential to address the root causes of prolonged wait times, there are also opportunities to improve patient experience within the existing system. Patients could be grouped by severity of their condition, creating quieter and lower stress areas for those needing urgent attention.⁹ Hospital staff should clearly explain the process during triage by informing patients of their status, such as, “You have been assigned CTAS Level 3; expect to wait about X hours; here is what comes next.” Even approximate updates can ease anxiety.⁷

Digital tools can also improve transparency. Many clinics already use text notifications and queue tracking apps; similar systems could show patients their place in line or send alerts when they are next. Studies show strong patient support for access to real-time wait information.⁶ Further, small quality-of-life changes such as healthier vending options, extended cafeteria hours, comfortable seating, quieter areas, and charging outlets also make a difference by signaling respect and care.

Many of these solutions do not require reinventing care. Instead, they involve small, practical changes in how waiting is treated as part of the care process, how communication is handled, and how time and space are managed. Waiting in an emergency department should not feel like being left in limbo. While medical urgency differs, the need for clarity, dignity, and timely care remains universal. As we work to address structural issues underlying long emergency room wait times, we must also work to make waiting itself a transparent, humane, and intentional part of the care experience.

References

1. Kayuni J, Dordunoo D, Mallidou A, Mohan M, Marquard P. Exploring delay points at the emergency department.Can J Emerg Nurs. 2024;47(1):14–19.
2. Calder-Sprackman S, Kwok ES, Bradley R, Calder LA. Availability of emergency department wait times information: A patient-centered needs assessment. Emerg Med Int. 2021;2021:8883933. 
3. Health Quality Ontario. Time spent in emergency departments. 2024 [Internet]. Available from: https://www.hqontario.ca
4. Canadian Medical Association. Why are ER times so long in Canada? CMA Health Care for Real [Internet]. Ottawa (ON): Canadian Medical Association; [cited 2025 Oct 29]. Available from: https://www.cma.ca
5. Financial Accountability Office of Ontario. Expenditure Monitor 2023–24: Q3—Health sector. Toronto (ON): Financial Accountability Office of Ontario; 2024.
6. Afilalo M, Lapointe L, Lavoie J, Léger R, Pomey M-P. Availability of emergency department wait times and the patients’ information needs: A mixed-methods study. Int J Emerg Med. 2021;14(1):37.
7. Janerka C, Jordan Z, Tran DT, Crawford T, Carter B. Patient experience of emergency department triage: An integrative review. Int Emerg Nurs. 2024;78:102353. 
8. INFORMAS Canada. An in-depth look at Canadian food environments. Toronto (ON): INFORMAS Canada; 2025. 
9. Adams C, Short A, Johnstone M. Noise levels in the emergency department: Are we meeting World Health Organization standards? Int Emerg Nurs. 2024;73:102242. 
10. Rowe A, Zaremba L, Goldmann E, Doran K. The impact of the healthcare environment on patient experience in the emergency department. J Patient Exp. 2022;9:23743735221086545.