Rising ER Wait Times in Ontario
Ontario’s emergency departments are experiencing significantly longer waits than in the past. In the 2022/23 fiscal year, patients waited on average about 118 minutes from triage to see an ER physician, which is roughly 30 minutes longer than a decade prior¹. Even more troubling, the sickest 10% of patients (90th percentile) waited over 4 hours (257 minutes) for initial assessment, up from about 3 hours (183 minutes) in 2013/14¹. These delays extend further when a patient needs hospital admission: recent data show Ontario patients admitted via ER spent over 22 hours on average waiting for a hospital bed, with only 23% of patients getting admitted within the target time of 8 hours². Such waits far exceed recommended benchmarks – some hospitals have reported average waits as high as 22 hours, nearly three times the recommended targets for ER-to-bed transfer².
Wait times vary widely across the province. Regional data reveal stark disparities: for example, patients in Eastern Ontario’s Champlain region waited 169 minutes on average, more than twice as long as those in the Central region (79 minutes)¹. Individual hospital performance also ranges dramatically. During a recent audit, Windsor Regional Hospital’s Metropolitan Campus had an average physician wait of about 247 minutes (over 4 hours), five times longer than the 45-minute average at Etobicoke General Hospital in Toronto³. Hospital administrators in Windsor cited a lack of primary care availability (especially on evenings and weekends) as a major reason for their long ER waits – many patients were coming to ER for issues a family doctor could treat, or for access to diagnostics, because no other care was accessible³. By contrast, larger urban centres with greater resources (and perhaps more alternatives for care) tended to manage shorter waits. The net effect is a system where when and where you seek emergency care in Ontario can drastically change your wait time.
Patients Leaving Without Being Seen
Long waits have led to a surge in patients who leave the ER without receiving care. Ontario’s “left without being seen” (LWBS) rate averaged 5.3% of ER visits in 2022/23, according to the Auditor General¹. Some hospitals saw extraordinarily high walkout rates – at one hospital, about 14% of ER visitors gave up and left before a doctor saw them¹. (Notably, that same hospital had one of the longest wait times, ~175 minutes to see a physician¹.) This is a worrying trend: by comparison, about 3% of patients left untreated in the early 2000s, and the rate rarely exceeded 4% pre-pandemic⁴. Since 2020, LWBS rates have spiked, frequently surpassing that 4% threshold as overcrowding and delays worsen⁴.
Walking out of the ER is not a risk-free choice. A recent ICES study found that patients who leave without being seen have a 14% higher risk of death or hospitalization within 7 days compared to those who stayed for treatment⁵. The lead author noted that “there are many reasons why people choose to leave the emergency department, but it’s usually about wait times,” underscoring how excessive delays drive frustrated patients away⁵. Crucially, many who left were relatively young (median age 41) and had no recent hospitalization history⁵ – in other words, they might have appeared low-risk, yet outcomes prove leaving was often unsafe. Researchers cautioned that these events “should not be considered benign,” especially now, given the overall strains on the system: rising ER volumes, ongoing rural ER closures, inadequate long-term care beds, staffing shortages, and poor primary care access all intersect to make today’s emergency care environment more perilous⁵. In short, ER walkouts are increasing in Ontario, a symptom of system overload that not only represents unmet medical needs, but also can carry severe health consequences.
Urban vs. Rural: A Gap in Emergency Access
Regional and rural/urban divides have become apparent in Ontario’s emergency care. Smaller rural hospitals have been hit hardest by ER service disruptions. In 2024, Ontario saw a record number of ER closures – a CBC analysis found 1 in every 5 hospitals with an ER or urgent care had to temporarily shut down at least once that year, the vast majority of them in rural communities⁶. Between July 2022 and June 2023 alone, emergency departments across Ontario were forced to close 203 times at 23 different hospitals, mostly in rural and northern areas, due to lack of staff⁷. Each closure can leave an entire town without local emergency services. This is more than an inconvenience: as Ontario’s Auditor General noted, when a rural ER shuts its doors, residents face longer travel to the next hospital – and the health risks increase with every extra minute of travel time¹. In emergency care, distance can be deadly.
Even when rural ERs remain open, many operate with limited hours or tenuous staffing. For example, the small community hospital in Chesley, ON has faced chronic ER closures since 2022 and can now only stay open from 7 a.m. to 5 p.m. on weekdays⁸. Residents there describe never knowing if their only emergency room will be open when a crisis strikes⁸. Other rural hospitals have avoided outright closure by leaning heavily on temporary staff. Ontario’s Emergency Department Locum Program, meant as a last-resort stopgap, saw usage skyrocket – providing over 60,000 hours of physician coverage in 2022/23 (more than double the hours from 2018/19) to prop up understaffed ERs¹. A dozen small hospitals have relied on at least 500 locum hours every year, with a couple needing over 1,000 hours annually, just to keep ER doors open⁹. This heavy reliance on visiting doctors reflects how severe the local physician shortages have become in some communities. Hospital leaders admit many rural ERs would be frequently closed without stopgap locums filling shifts⁹. It’s a stark illustration of the urban-rural gap: while big-city hospitals struggle with crowding, small-town hospitals struggle just to stay open.
Prince Edward County is one community emblematic of these challenges. Its local hospital (PECMH in Picton) handles roughly 20,000 ER visits a year, serving a mix of rural residents and seasonal tourists. Staff and patients there report that “volumes of patients…are higher than pre-COVID and expected to continue,” often running well over 100% capacity on inpatient units¹⁰. Like many areas, Prince Edward County has an older population and a shortage of primary care providers, leading more people to seek care at the ER. “The reasons are many – more elderly patients with complex health issues, an increased number of patients without a family doctor, and delayed care during the pandemic,” explained a Quinte Health official, noting that discharging patients is also hard when home care and long-term care are strained¹⁰. In short, rural communities such as Prince Edward County are facing a multifaceted crunch: they must care for more (and older) patients with fewer local doctors and an overstretched workforce, all in facilities that haven’t expanded with demand. The result can be long wait times even in a small-town ER, and the ever-present worry of diversion or closure if a single nurse or physician shift can’t be covered. Residents of these areas are increasingly vocal, organizing town halls and even protests to demand better support. They’ve called for solutions like extending small ER hours and bolstering local clinics, because they see clearly that rural Ontarians are at risk of falling through the cracks of an unstable emergency care network.
Sources
- Office of the Auditor General of Ontario – Emergency Departments Audit 2023
- CityNews Toronto – ER wait times and hospital admissions
- CBC Windsor – Local ER delay causes and hospital comparisons
- ICES – ER walkouts and historical comparison data (2024)
- ICES – Patient outcomes following LWBS
- CBC News – Emergency department closures analysis
- Ontario Ministry of Health – Hospital staffing data
- CBC News – Chesley ER closures
- Health Quality Ontario – Emergency Department Locum Program usage
- Prince Edward County Memorial Hospital Foundation – Local ER pressures