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Complaints about care in hospital emergency departments

Delays, poor communication and a lack of sensitivity were among the 17% increase of emergency department complains compared to last year.

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The issue in 2021/22

In our 2021/22 annual report,¹ Patient Ombudsman spotlighted the pressures on Ontario emergency departments and the impact on patient experiences. Our recommendations focused on the importance of communication with patients and caregivers, including:

providing as much information as possible about expected wait times;
letting patients know what to do if they have urgent questions or their condition changes while they are waiting;
having information available for patients about alternatives to emergency department care for non-urgent needs;
explaining the hospital’s policy about the ability for a family member or caregiver to enter and remain in the emergency department with vulnerable patients and ensuring family members know who to contact if they are not permitted to stay; and
listening to patients and family members with a caring and courteous manner.

The issue in 2022/23

In 2022/23, Patient Ombudsman received more than 350 new complaints about experiences in hospital emergency departments, a 17% increase over 2021/22.

The nature of complaints most often reflected concerns with delays, the quality of assessments, diagnostics and treatment, poor communication and a lack of sensitivity and caring, highlighting that the past recommendations remain relevant. Patients and caregivers frequently cited concerns about emergency department triage processes, and a sense that their symptoms and health concerns weren’t being considered seriously, including reports that they were mocked or yelled at. Of greatest concern is a growing number of complaints that serious health conditions were not recognized or treated, resulting in patients leaving to seek treatment elsewhere or serious consequences including patient deaths.

At the same time, the pressure on staff in emergency departments has been unrelenting since the COVID-19 pandemic was declared in 2020 and compounded over the past three years by staffing shortages and increasing levels of workplace violence.² Recent research has highlighted high levels of depression, burnout and compassion fatigue among health care providers in emergency departments.³ The research highlights the critical importance of programs to regularly assess and enhance the resilience of emergency department staff as an ethical imperative as well as an operational necessity.

Health Care Experience

Patent Ombudsman received a whistleblower complaint from a health care professional who worked in a hospital emergency department expressing concerns about patient care. The whistleblower described staffing shortages, delays in care and unsafe conditions for patients and staff that had resulted in falls and contributed to at least two patient deaths.

Patient Experience

The complainant reported that a family member had been taken to the hospital emergency department several times over the course of a week for shortness of breath and chest heaviness, and was examined and discharged. The family member was found dead at home less than 24 hours after the last visit to the emergency department.

Patient Experience

A patient was brought to the emergency department with symptoms of a heart attack including pain, pressure in the chest, fatigue, clamminess, and difficulty breathing. The patient’s condition continued to deteriorate while waiting in line to be triaged. When the patient’s caregiver left the line to advise the triage nurse of the patient’s deteriorating state the triage’s nurse’s response was that there were 10 other people in line that could be having a heart attack and they needed to wait their turn. The nurse announced to the waiting room that they were the only triage nurse and had already worked a 12-hour shift. The nurse told the waiting patients that if they haven't watched the news all Ontario hospitals are short staffed and overly full so everyone will have to wait in line to be triaged. The patient and caregiver made the decision to leave and drive over 100 kilometres to the next closest hospital. At the second hospital, the patient was quickly triaged and testing confirmed a heart attack. The patient was transferred to a cardiac care unit for surgery.

References

¹ Making Connections: Supporting a better health system for everyone. Patient Ombudsman Annual Report 2021/22.
² Aljohani B, Burkholder J, Tran QK, Chen C, Beisenova K, Pourmand A. Workplace violence in the emergency department: a systematic review and meta-analysis. Public Health. 2021 Jul;196:186-197; Zhang S, Zhao Z, Zhang H, Zhu Y, Xi Z, Xiang K. Workplace violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2023 May 20:1–15.
³ Alameddine M, Clinton M, Bou-Karroum K, Richa N, Doumit MAA. Factors Associated With the Resilience of Nurses During the COVID-19 Pandemic. Worldviews Evid Based Nurs. 2021 Dec;18(6):320-331; Phillips K, Knowlton M, Riseden J. Emergency Department Nursing Burnout and Resilience. Adv Emerg Nurs J. 2022 Jan-Mar 01;44(1):54-62; Ma H, Huang SQ, We B, Zhong Y. Compassion fatigue, burnout, compassion satisfaction and depression among emergency department physicians and nurses: a cross-sectional study. BMJ Open. 2022 Apr 28;12(4); Bales M, DeAlmeida K, Oei CE, Hampton D, Bohr NL. Quantifying Compassion Fatigue in Ancillary and Clinical Staff in an Adult Emergency Department. West J Emerg Med. 2022 Oct 18;23(6):841-845.