Skip to main content Accessibility help
Hostname: page-component-768ffcd9cc-5sfl8 Total loading time: 0.244 Render date: 2022-12-02T17:57:13.843Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

No room at the inn: overcrowding in Ontario’s emergency departments

Published online by Cambridge University Press:  21 May 2015

Alan J. Drummond*
Section on Emergency Medicine, Ontario Medical Association, Toronto, Ont., Department of Family Medicine, University of Ottawa, Ottawa, Ont., and Department of Family Medicine, Queen’s University, Kingston, Ont.
20 Drummond St. W, Perth ON K7H 2J5; fax 613 267-8770,


Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
ED Administration • Administration du DU
Copyright © Canadian Association of Emergency Physicians 2002


1.Canadian Association of Emergency Physicians and National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding. CJEM 2001;3(2):824.CrossRefGoogle Scholar
2.Drummond, A.No room at the inn: emergency department overcrowding in Ontario. A review of the medical literature and suggestions for potential solutions. Toronto (ON): Section on Emergency Medicine, Ontario Medical Association; 2000 Dec 14.Google Scholar
3.Saunders, CE, Makens, P, Leblanc, L.Modeling emergency department operations using advanced computer simulation systems. Ann Emerg.Med 1989;18:13440.CrossRefGoogle ScholarPubMed
4.Graff, L.Overcrowding in the ED: an international symptom of health care system failure [editorial]. Am J Emerg Med 1999; 17:2089.CrossRefGoogle Scholar
5.Graff, L.Emergency physician workload: a time study. Ann Emerg Med 1993;22:115663.CrossRefGoogle ScholarPubMed
6.Shih, F, Huei-Ming, M, Chen, SC, Wang, HP, Fang, CC, Shyu, RS.overcrowding in Taiwan: facts and strategies. Am J Emerg Med 1999;17:196202.CrossRefGoogle ScholarPubMed
7.Miro, O.Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 1999; 6:1057.CrossRefGoogle ScholarPubMed
8.Kohn, M.Medical gridlock [editorial]. J Emerg Med 1990;8:7734.CrossRefGoogle Scholar
9.Gallagher, EJ, Lynn, S.The etiology of medical gridlock: causes of emergency department overcrowding in New York City. J Emerg Med 1990;8:78590.CrossRefGoogle ScholarPubMed
10.McNamara, P.The sagging safety net: emergency departments on the brink of crisis. Hospitals 1992;Feb 20:2640.Google Scholar
11.Kellerman, A.Too sick to wait [editorial]. JAMA 1991; 266:11234.CrossRefGoogle Scholar
12.Andrulis, D, Kellermann, A, Hintz, E, Hackman, B, Weslowski, V.Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med 1991; 20: 9806.CrossRefGoogle ScholarPubMed
13.American College of Emergency Physicians Overcrowding Task Force. Measures to deal with emergency department overcrowding. Ann Emerg Med 1990;19:9445.CrossRefGoogle Scholar
14.Feferman, I, Cornell, C.How we solved the overcrowding problem in our emergency department. CMAJ 1989;140:2736.Google ScholarPubMed
15.Dickinson, G.Emergency department overcrowding. CMAJ 1989;140:2701.Google ScholarPubMed
16.Brown, E, Goel, V.Factors related to emergency department use: results from the Ontario Health Survey 1990. Ann Emerg Med 1994; 24:108391.CrossRefGoogle ScholarPubMed
17.Kollek, D.Overwhelmed in emergency: examining ER status at Hamilton Civic Hospitals. Ont Med Rev 1990;Dec:113.Google Scholar
18.Maloney, J.Hospital emergency department closures: a position statement. Ottawa General Hospital 1989;Jan 12.Google Scholar
19.Lyver, M.Emergency unit overcrowding. Toronto (ON): Provincial (Ontario) EHS Advisory Committee on ED Overcrowding; 1988.Google Scholar
20.Kondro, W.Relief at a price for emergency wards in Ontario. Lancet 1998;352:1451.CrossRefGoogle Scholar
21.Ontario Hospital Association (OHA), Ontario Ministry of Health (OMA). OHA Region 3: Emergency Services Working Group final report. 1998 April.Google Scholar
22.Ontario Hospital Association. A matter of hospital resources: an emergency care action plan. Ontario Hospital Association. August 2000.Google Scholar
23.Pinker, S.Latest ER crisis hit communities large and small. CMAJ 2000;162:55960.Google ScholarPubMed
24.Derlet, RW, Richards, JR.Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000;35(1):637.CrossRefGoogle ScholarPubMed
25.Kellermann, A.Déjà vu [editorial]. Ann Emerg Med 2000; 35(1):835.CrossRefGoogle Scholar
26.Richard, J, Navarro, M.Survey of directors of emergency departments in California on overcrowding. Western J Med 2000; 172:3858.CrossRefGoogle Scholar
27.Bagust, A, Place, M, Posnett, J.Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ 1999;319:1558.CrossRefGoogle ScholarPubMed
28.Lynn, S, Kellermann, A.Critical decision making: managing the emergency department in an overcrowded hospital. Ann Emerg Med 1991;20:10510.CrossRefGoogle Scholar
29.Fromm, RE, Gibbs, LR, McCallum, WG, Niziol, C, Babcock, J, Gueler, AC, et al. Critical care in the emergency department: a time-based study. Crit Care Med 1993;21:9706.CrossRefGoogle ScholarPubMed
30.Davis, B, Sullivan, S, Levine, A, Dallara, J.Factors affecting ED length-of-stay in surgical critical care patients. Am J Emerg Med 1995;13:495500.CrossRefGoogle ScholarPubMed
31.Kellerman, A.Nonurgent emergency department visits: meeting an unmet need [editorial]. JAMA 1994;271:19534.CrossRefGoogle Scholar
32.Nonurgent emergency department visits — Whose definition? [editorial]. Ann Emerg Med 1994;24:9612.CrossRefGoogle Scholar
33.O’Brien, G, Shapiro, M, Woolard, R, O’Sullivan, P, Stein, M.“Inappropriate” emergency department use: a comparison of three methodologies for identification. Acad Emerg Med 1996;3:2527.CrossRefGoogle ScholarPubMed
34.Afilalo, M.Emergency department use and misuse. J Emerg Med 1995;13:25964.CrossRefGoogle ScholarPubMed
35.Baker, D, Stevens, C, Brock, R.Regular source of ambulatory care and medical care: utilization by patients presenting to a public hospital emergency department. JAMA 1994;271:190912.CrossRefGoogle ScholarPubMed
36.Lucas, R, Sanford, S.An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med 1998; 32:5638.CrossRefGoogle ScholarPubMed
37.Williams, R.The costs of visits to emergency departments. N Engl J Med 1996;334:6426.CrossRefGoogle ScholarPubMed
38.Selby, J.Effect of a co-payment on use of the emergency department in a health maintenance organization. N Engl J Med 1996;334:63541.CrossRefGoogle Scholar
39.Drummond, A.Urgency in the emergency [letter]. CMAJ 1996; 155:1038.Google Scholar
40.Thompson, J.Health care reform and emergency outpatient use of rural hospitals in Alberta, Canada. J Emerg Med 1995;13:41521.CrossRefGoogle ScholarPubMed
41.Gill, J.Nonurgent use of the emergency department: Appropriate or not? Ann Emerg Med 1994;24:9537.CrossRefGoogle ScholarPubMed
42.Steinbrook, R.The role of the emergency department [editorial]. N Engl J Med 1996;334:6578.CrossRefGoogle Scholar
43.Vosk, A.Response of consultants to the emergency department: a preliminary report. Ann Emerg Med 1998;32:5747.CrossRefGoogle ScholarPubMed
44.Miro, O, Antonio, MT, Jimenez, S, De Dios, A, Sanchez, M, Borras, A, et al: Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 1999;6:1057.CrossRefGoogle ScholarPubMed
45.Hansagi, H.Trial of a method of reducing inappropriate demands on a hospital emergency department. Public Health 1987;101:99105.CrossRefGoogle ScholarPubMed
46.Krochmal, P, Riley, T.Increased health care costs associated with ED overcrowding. Am J Emerg Med 1994;12:2656.CrossRefGoogle ScholarPubMed
47.Redelmeier, D.No place to unload: a preliminary analysis of the prevalence, risk factors and consequences of ambulance diversion. Ann Emerg Med 1994;23:437.CrossRefGoogle ScholarPubMed
48.Fernandes, C, Bouthillette, F, Raboud, J, Bullock, L, Moore, C, Christenson, J, et al: Violence in the emergency department: a survey of health care workers. CMAJ 1999;161:12458.Google ScholarPubMed
49.Morrison, L.Abuse of emergency department workers: An inherent career risk or a barometer of the evolving health care system? CMAJ 1999;161:12623.Google ScholarPubMed
50.Andrews, L.Wellness for emergency physicians. Dallas (TX): American College of Emergency Physicians; 1995.Google Scholar
51.Harrison, P.Life in the ER: wild nights, mounting stress and mid-40s burnout. CMAJ 1993;148:1598600.Google ScholarPubMed
52.Lloyd, S.Burnout, depression, life and job satisfaction among Canadian emergency physicians. J Emerg Med 1994;12:55965.CrossRefGoogle ScholarPubMed
53.Drummond, A.A review of the draft standards for hospital emergency services in Ontario. Toronto (ON): Section on Emergency Medicine, Ontario Medical Association: 1999.Google Scholar
54.Drummond, AJ, Drummond, R.The Alternative Funding Agreement for emergency services in Ontario: a new compensation method for rural emergency departments [commentary]. CJEM 2000;2(4):2326.Google Scholar
55.Fernandes, C.Use of continuous quality improvement to facilitate patient flow through the triage and fast-track areas of an emergency department. J Emerg Med 1995;13:84755.CrossRefGoogle ScholarPubMed
56.Fernandes, C.Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician. J Emerg Med 1997;15:3979.CrossRefGoogle ScholarPubMed
57.Meislin, H, Coates, S, Cyr, J, Valenzuela, T.Fast track: urgent care within a teaching hospital emergency department: Can it work? Ann Emerg Med 1988;17:4536.CrossRefGoogle ScholarPubMed
58.Ellis, G.Use of physician extenders and fast tracks in United States emergency departments. Am J Emerg Med 1997;15:22932.CrossRefGoogle ScholarPubMed
59.Brillman, J.Management of observation units. Ann Emerg Med 1995;25:82330.CrossRefGoogle ScholarPubMed
60.Brennan, J.Guidelines for ambulance diversion. Ann Emerg Med 2000;36:3767.CrossRefGoogle ScholarPubMed
You have Access

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

No room at the inn: overcrowding in Ontario’s emergency departments
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

No room at the inn: overcrowding in Ontario’s emergency departments
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

No room at the inn: overcrowding in Ontario’s emergency departments
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *