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2024 worst year for Ontario ER closures, CBC analysis finds

1 out of every 5 hospitals with an ER or urgent care centre had unplanned shutdowns

Timing was everything for Bruce Pieroway when he suffered a heart attack in late October in the rural farming community of Chesley, Ont., about two hours north of Kitchener.

It happened early on a Monday afternoon when the town’s only emergency room was still open.

“The worst thing about the hospital here is you don’t know whether it’s open or closed,” said Pieroway, referring to Chesley’s ER, which has faced chronic closures since 2022 and now only operates between 7 a.m. and 5 p.m., Monday to Friday.

 

For Pieroway, who is 70, the next closest emergency department is a 25-minute drive away.

But fortunately, at 2 p.m. that October day, the Chesley ER was open and hospital staff were able to get him stabilized.

Over the past three years, at least 38 Ontario hospitals with emergency rooms or urgent care centres (UCCs) have experienced closures — about one in five of 176 publicly funded facilities. 

Most are in rural areas. And Chesley’s ER tops the list with the highest number of hours closed.

That’s according to CBC’s new compilation of all temporary closures and service interruptions announced by ER and UCC departments between Jan. 1, 2022, and Nov. 30, 2024.

CBC’s analysis tracked the hours they were closed and the number of days with a partial closure.

Even though 2024 isn’t over, the data shows this will be the province’s worst year for ER closures, a phenomenon that was “very rare” before 2019-20, according to a report by the Office of the Auditor General of Ontario.

 

Top 10 ERs with the most days of partial closures or reduced hours

“What it’s meant here is a lot of anxiety from people in the community [and] frustration sometimes boiling over into anger,” said Brenda Scott, co-chair of the Save the Chesley Hospital Committee.

“I’ve always said, you love to be number one, but not in this contest,” she said. “You can feel that tension in the community.” 

Since hospital emergency departments are considered 24-hour operations, any disruptions or changes to those hours, either temporary or permanent, were counted as closures in CBC’s analysis. 

 

“What an emergency department is, it’s an access point for 24/7 care for patients of any acuity,” said Dr. David Savage, an ER physician in Thunder Bay. “I think it’s challenging to call a centre an ER if it’s closing during certain parts of the day.”

If a patient shows up to an ER and they’re still waiting at closing time, medical staff tell CBC that they will attend to their care even after locking the doors for the night. 

 

How many hours have Ontario ERs and urgent care centres been closed since 2022?

Reduced hours at 6 urgent care centres

'Great progress': OHA

Nurse shortage top reason for closures

CBC’s data also shows the primary cause of ER closures has been a shortage of nurses, accounting for more than 85 per cent of all closure hours. 

“Nurses are leaving the profession. Nurses aren’t entering the profession. They’re not staying in the profession, and I don’t think anyone can blame them when there’s not much to keep us here,” said Erin Ariss, an ER nurse and the president of the Ontario Nurses’ Association.

According to Ariss, rural hospitals have been chronically understaffed for years. As ER wait times grow, staff are too often subjected to violent behaviour, Ariss said, and the resulting stress has led to widespread burnout.

While some hospital CEOs report improvements in nursing recruitment, the reliance on agency nurses — temporary staff contracted through private agencies — is helping keep ERs open at a high cost. 

For example, one northeastern Ontario hospital has spent nearly a million dollars on agency nurses this year to maintain emergency services.

“They charge hospitals three or four times the amount of money that it would cost to provide the same unionized nurse,” said Ariss. “You can’t blame the nurse. This is a systems issue.”

On Nov. 20, the province pledged more than $500 million to educate new nurses and provide specialized training to current ones. 

Meanwhile, a lack of physicians was the most common factor for service interruptions in UCCs, representing over 69 per cent of all centre closure hours, CBC’s data shows.

 

Most closures in rural hospitals

The ten ERs closed for the most hours since 2022 are all in rural communities with populations under 8,000, and each facility has fewer than 50 beds.

“You’re impacting people that are already marginalized … making their access to health care more difficult,” said Park.

In fact, the bulk of the ER closures tracked in 2024 are connected to rural hospitals in Chesley, Clinton and Durham, all in southwestern Ontario and all currently closed at night.

At recent public meetings, residents in that region made it clear to Nancy Shaw, CEO of the South Bruce Grey Health Centre, that they want 24/7 emergency services. 

 

Shaw said the dearth of nurses prevents the hospital authority from operating all its ERs full-time.

“We know we can’t provide that right now,” said Shaw. “We have to use agency staff or agency nurses to fill those gaps in our nursing requirements.”  

'Worsening across the country'

This trend of frequent ER closures is not limited to Ontario, with rural hospitals from Nova Scotia to Quebec to British Columbia grappling with the issue. 

“The situation is worsening across the country. We are seeing more closures year by year,” said Dr. Aimee Kernick, president of the Canadian Association of Emergency Physicians.

Kernick practices at the Saanich Peninsula Hospital on Vancouver Island. It’s been closed overnight for a year.

Patients have told her they’ve endured chest pain at home because the ER was closed, Kernick said, choosing to wait until it reopened in the morning rather than traveling further to another hospital. 

“Without a doubt there will be poor patient outcomes across the country with closures and inaccessibility to care,” said Kernick.

Back in Chesley, Bruce Pieroway had heart surgery in late October and is now recovering well. He hopes he won’t need to visit his local ER again, but if he does, it can still only be during daytime hours. 

Mehra, with the Ontario Health Coalition, has travelled the province, talking to residents. She’s also concerned about the potential consequences of closed emergency departments.

“When you’re having a heart attack, are you supposed to be looking up on the internet or phoning around to figure out what emergency department is open? That’s ridiculous,” said Mehra. 

 

Meanwhile, ER physicians like Park wonder what happens to those who don’t seek emergency help because of long waits or closures.

“A lot of times we don’t even hear about the ones that couldn’t get care, because they die at home or they have really bad outcomes,” said Park. 

“My hope is that we’re not waiting till people die, till we make these really structural and foundational changes.”