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Care in emergency departments

In addition to frustration with wait times, complaints about emergency departments touched on poor communication, being prematurely discharged, and lack of caring, sensitivity, courtesy and respect.

Patient story

The complainant’s elderly family member was taken to the hospital by ambulance. The complainant understood that the hospital needed to manage risks related to COVID-19 and that the pandemic had increased stress on the health care system but was concerned about the communication by staff in the emergency department.

They reported that hospital staff discouraged the patient from seeking treatment based on risks related to COVID-19, leaving the family fearful. The family was told that no one could enter the emergency department with the patient, even though the patient did not speak English.

The assessment in the emergency department revealed that the patient was failing rapidly and would likely not survive. The family was informed that they could visit once the patient was admitted to a room.

After two days, the patient died in the emergency department and the family never had the opportunity to say goodbye. The family was not informed until several hours after the patient’s death. The complainant expressed sorrow that the patient’s last words to the family were about their fear of being abandoned.

The Patient Ombudsman Early Resolution Specialist expressed condolences, facilitated a referral to the hospitals patient relations department and invited them to return to Patient Ombudsman if issues remained after the hospital’s investigation and response.

Hospital emergency departments have become the crucible where many of the pressures on the health care system ignite.

In 2021/22 Patient Ombudsman received more than 300 complaints about the experiences of patients and caregivers in emergency departments. In addition to frustration with wait times, patients and caregivers reported poor communication, a lack of caring, sensitivity, courtesy and respect, feeling dismissed and being prematurely discharged. Caregivers reported concerns with their inability to stay with vulnerable, elderly family members, despite visitor policies that supported their presence. Of particular concern was the number of patients who reported they would be reluctant to return to hospital, even for emergency care, given their experiences.

Some complainants also acknowledged that their own behaviour, in response to their frustrations, had led to consequences including security interventions and loss of access.

Many of these complaints to Patient Ombudsman had not yet been reviewed by hospital patient relations departments or are still open and undergoing resolution. Some of these complaints reflect concerns with clinical conduct and decision-making and may ultimately fall primarily under the jurisdiction of the health professional regulatory colleges. However, the stories illustrate the challenges being experienced in emergency departments.

Patient story

An elderly patient came to the emergency department by ambulance with blood in their urine. The patient’s daughter reported that the patient was in the emergency department for nine hours and received no communication about their condition or wait times. The patient was ultimately told the bleeding had stopped and they were discharged home with an antibiotic. The bleeding returned days later, but the patient refused to go back to hospital because of their previous experience.

The patient’s daughter noted that the patient was scared and alone and no one cared.

Patient Ombudsman determined that the hospital had not yet had an opportunity to address the concerns and provided a referral to the hospital’s patient relations department.

Our recommendations

The pressures on emergency departments are unlikely to lessen in the near future. Emergency department physicians and staff have been at the forefront of these pressures for more than two years, and the level of fatigue combined with ongoing staffing shortages, capacity issues and frustrated patients and caregivers make the work even more challenging. Despite these pressures, the complaints received by Patient Ombudsman highlight 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.
Listening to patients and family members with a caring and courteous manner.

Patient story

A patient visited the emergency department with a high fever and shortness of breath. When the patient’s COVID-19 test came back positive, the physician shared the test results in a loud voice in the crowded emergency room, causing other patients to panic.

After being left alone overnight in a cubical in the emergency department, treated rudely by the attending nurse and denied medication to treat their fever, the patient left and went to another hospital.

At the second hospital, the patient was assessed, admitted, and ultimately spent more than a week in the intensive care unit. The patient expressed concern that they could have died if they had not made the decision to leave and go to another hospital.