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REPORT: Ontario’s health care system under increased strain

By Health Quality Ontario   



Many parts of Ontario’s health care system are under increased strain, according to Measuring Up 2018, Health Quality Ontario’s 12th yearly report on the performance of the province’s health system.

“One of the things we’re seeing is hospital overcrowding and how it’s both a symptom and a source of cascading pressures throughout the system,” says Anna Greenberg, interim president and CEO of Health Quality Ontario.

The report’s key findings emphasize the backlog in different parts of the health system, underscoring the hospital overcrowding issue. Some examples include:

  • Emergency department visits are on the rise, especially among patients with serious conditions. Plus, patients are spending more time in the emergency department before being admitted to hospital.
  • Hospital emergency departments are also facing an increased challenge dealing with the opioid crisis.
  • The number of hospital beds occupied by patients waiting to receive care elsewhere continues to increase and is equivalent to more than 10 large, 400-bed hospitals filled to capacity every day.
  • Patients are waiting longer to access long-term care, assisted living and home care, from hospital and from the community too.

Despite these challenges, the report also shows bright spots scattered throughout the health system:

  • People in Ontario are living longer and less likely to die before the age of 75.
  • More people are having cancer-related or general surgeries within the recommended wait times.
  • Rates of hospital-acquired C. difficile, a potentially life-threatening infection, continue to improve.
  • Fewer children and youths are having their first care for a mental health condition occur in the emergency department.
  • More Ontarians are receiving palliative care in their homes in their last days of life.

“The improvements we have seen in areas like wait times for cancer-related or general surgeries are a testament to focused and sustained efforts based on meaningful data by those on the frontlines,” says Greenberg. “With the same system-wide focus that is informed by data, and ingenuity on the frontlines and at regional levels, tackling a complex problem like hospital overcrowding is also possible.”

“In order to better meet patient needs, it is essential to understand the conditions and pressures in emergency rooms today, and the profound difficulty our health care system has always faced in creating better ways to care for people, especially in their home and in long-term care,” says Anthony Dale, president and CEO of the Ontario Hospital Association. “Accurately measuring and understanding these challenges and their root causes creates the foundation for creating the long-term solutions needed to end hallway health care in Ontario.”

Findings in areas that need further improvement

  • Visits to Ontario’s emergency departments increased by 11.3% over the last six years to 5.9 million in 2017/18, from 5.3 million in 2011/12. Visits by high-acuity patients – those who have more serious conditions – also rose by 26% to 4.1 million from 3.3 million.
  • The average time spent in emergency by patients admitted to the hospital from emergency increased to 16 hours in 2017/18, from 15.3 hours in 2016/17.
  • Visits to the emergency department for opioid poisoning more than tripled to 54.6 per 100,000 population in 2017, from 15.2 per 100,000 in 2003.
  • In 2016/17, an average of 4,233 Ontario hospital beds were occupied every day by patients waiting to receive care somewhere else – such as in a long-term care home or rehabilitation facility. That was the equivalent of more than 10 large, 400-bed hospitals filled to capacity each day.
  • The median amount of time people waited from hospital to move into a long-term care home was 31.4% longer in 2016/17 (92 days) than in 2015/16 (70 days). The median wait time for people waiting to move into a long-term care home from the community also increased by 12.9%, to 149 days in 2016/17, compared to 132 days in 2015/16.
  • In 2017, fewer patients (32.3%) reported being able to see a specialist less than 30 days after being referred to one, compared to 37.8% in 2016.
  • Fewer patients had their surgery within target times in 2017/18 for common surgeries like knee (73.7%) and hip replacements (78.0%).
  • More than a quarter (26.1%) of home care clients who received care for more than two months had a primary family or friend caregiver who experienced continued distress, anger or depression in the first half of 2017/18, up from 23.6% the previous year.

Findings in areas that are doing well or improving

  • Ontarians are less likely to die before the age of 75. They are losing fewer years of life to premature death, decreasing to 4,188 years per 100,000 people in 2015, compared to 4,897 in 2005. Ontario has one of the lowest rates of potential years of life lost among Canadian provinces.
  • The percentage of patients who had cancer surgery within target times for their assigned priority level increased to 87.3% in 2017/18, up from 70.9% in 2008/09. Among patients who had general surgery in 2017/18, wait time targets were also met for 95% of patients, an increase from 90.6% in 2008/09.
  • The rate of hospital-acquired C. difficile infections has decreased steadily in Ontario in recent years to 0.22 cases per 1,000 inpatient days in 2017/18, compared to 0.35 in 2011/12.
  • Fewer children and youths up to 24 years of age received their first care for a mental health condition in the emergency department. The rate decreased to about 4 in 10 in 2016, which was an improvement from 10 years earlier when the rate was about 5 in 10.
  • More than a quarter (25.5%) of people who lived in the community during their last 30 days of life received a palliative-specific home care service in 2016/17, compared to 22.6% in 2011/12.

To read the full Measuring Up 2018 report, visit:

About Measuring Up
Measuring Up 2018 is Health Quality Ontario’s 12th yearly report to Ontarians on health system performance. The data are grounded in a focused set of indicators selected by Health Quality Ontario, in partnership with health experts and system partners. This year’s report highlights findings from 47 indicators.

About Health Quality Ontario
Health Quality Ontario is the provincial lead on the quality of health care. We help nurses, doctors and other health care professionals working hard on the frontlines be more effective in what they do – by providing objective advice and data, and by supporting them and government in improving health care for the people of Ontario. Visit for more information.

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