Staff shortages crippled some emergency departments in Ontario: auditor general

The number of emergency department closures and a crisis in health-care staffing has increased and compounded in recent years, largely driven by the province’s inability to properly staff hospitals, Ontario’s auditor general has found.

A new probe into emergency departments by the province’s acting auditor general has found wait times are up, closures have become increasingly common, and some hospitals are being crippled with as many as one in four jobs left unfilled.

The audit found unplanned emergency department closures were “very rare” before 2019 and the beginning of 2020. In recent years, however, the number of closures has skyrocketed, with a lack of staff a key driver.

In a year from July 2022 to June 2023, the report recorded 203 emergency department closures in the province taking place at 23 hospitals, which were mainly in rural and remote parts of Ontario.

Despite the rising closures, the Ministry of Health has “never collected or tracked” information on staffing shortages or vacancies in emergency rooms. The acting auditor general’s team reached out to several hospitals and “all of them experienced a significant increase in nursing vacancies” between 2019-2020 and 2023.

At some hospitals the jump in unfilled nursing jobs was stark.

William Osler Health System, which runs hospitals in Brampton and Etobicoke, had a nursing vacancy rate of six per cent in 2019-2020; by 2022-2023, it had risen to 26 per cent. Sinai Health System in Toronto saw its unfilled jobs jump from three per cent to 19 per cent. And Sick Kids in Toronto went from an eight per cent vacancy rate to 22 per cent for full-time registered nurses.

“We noted multiple reasons for high staff turnover at emergency departments, especially among nurses,” the auditor general’s report said. “Factors included the higher pay and flexibility offered by private staffing agencies, as well as the introduction in 2019 of Bill 124.”

The Ford government has been under pressure through the pandemic for policies that critics say have led to a mass exodus of nurses from frontline roles.

Bill 124 capped wages for public sector workers at a one per cent increase per year for three years and was decried by nursing unions and advocacy agencies, who said it had forced many from the profession.

The government has also faced criticism from the same groups for its decision early in the year to allow private clinics to take on more diagnostics, imaging and simple surgeries in an effort to clear a health-care backlog that reached a crunch point during the COVID-19 pandemic.

Responding to the report, Minister of Health Sylvia Jones said the province had seen a “historic high” in the number of nurses registered.

She said the shortages of nurses at hospitals “speaks to exactly why” the province is spending money on training and tweaking licensing requirements.

A survey of hospitals by the Ministry of Health — and referenced in the auditor general’s report — found 69 per cent of hospitals in the province said staffing shortages were moderate, while 14 per cent said the situation was severe or critical.

“Despite this, at the time of our audit neither the Ministry nor Ontario Health had developed a long-term strategy or acted upon this information to take specific actions related to hospitals with significant staffing shortages,” the audit said.

Staffing shortages opened the door to private nursing agencies charging public hospitals fees that could be more than double the hourly wage for a nurse at the hospital.

In one example, the report found a standard nurse would be paid between $35 and $50 per hour, while an agency nurse could be paid more than $75 per hour.

“There was a huge shift of nurses post-COVID-pandemic and right now that (agency nurses) is their solution,” the auditor general said Wednesday.

“And we don’t think that’s a long-term solution. It’s a temporary solution to get them through right now, but we don’t think that that’s a permanent solution.”

One hospital spent $8 million in a single year on agency nurses for its emergency department, the audit found in 2022-2023. That number jumped from $2.4 million the year before and $1 million the year before that.

“We did identify that agency nurses are costing, at times, two to three times higher than what a nurse would be paid currently working (for) the government,” the auditor general added.

The Ministry of Health, however, does not track the cost of agency staff and “relied on hospitals to manage their own budgets,” the audit found.

In its response, included within the audit, the province said it understood the “difficult position” hospitals and emergency departments find themselves in.

“Hospitals provided high-quality patient care throughout the pandemic response, and the effect of the unprecedented global crisis continues to put strain on the delivery of care in emergency departments,” the Ministry of Health said.

2:14 Ford government didn’t track emergency room closures