On August 26, CAEP President Dr. Rob Primavesi and members of the Public Affairs Committee met with Julie Harb, Health Portfolio Advisor to the Prime Minister, to discuss CAEP’s priorities. One key focus was requiring provinces to report emergency department data through the National Ambulatory Care Reporting System (NACRS) to help create stronger, system-wide accountability for emergency care.

Below are the notes and talking points used for the meeting.

Endorsed by the National Emergency Nurses Association (NENA).

The Problem

Canadian emergency departments (EDs) are in a constant state of overcrowding, and system constraints prevent physicians and nurses from providing safe and timely care.

The Specifics

Canada’s EDs are facing unprecedented overcrowding¹, and ED physicians and nurses are unable to provide safe and timely care for patients with life threatening conditions².

Last year 1 in 13 patients left Canadian EDs without seeing a physician due to prolonged waits³, and patients who left experienced unacceptable rates of preventable disability and death⁴.

The main driver is hospital overcapacity, resulting in boarding admitted patients in EDs, and limiting space and personnel for arriving patients¹,³,⁵,⁶. These stays are prolonged by inadequate long-term care and community supports¹,³,⁷, while rising complexity means 1 in 10 ED visits now last over 14 hours³..

Few ED beds remain unoccupied, leaving patients waiting for hours, and sometimes days, in chairs and hallway stretchers, often receiving substandard care that can lead to tragic outcomes.⁸,⁹ The toll falls on staff as well as patients: a recent study found Canadian ED physicians are experiencing moral injury, prompting roughly 50% to reduce their shift load and 10% to leave the field.²

Amidst this ongoing crisis, there is no government accountability framework: no articulation of who is responsible for adverse outcomes and increasing lengths of stay, no defined deliverables, and no rewards or penalties tied to performance. Data are also incomplete. Eight provinces (PEI, Nova Scotia, Quebec, Manitoba, Saskatchewan, BC, New Brunswick, and Newfoundland and Labrador) are not fully required to report ED metrics, including time to physician assessment, length of stay, and time to an inpatient bed, to the National Ambulatory Care Reporting System (NACRS).¹⁰

Unconditional Canada Health Transfers (CHTs) and one-time top-ups have increased provincial health spending without improving access to emergency care.¹,³ As the federal government negotiates bilateral CHT agreements with the provinces, it has a direct lever to change this: make ED data reporting and accountability a condition of funding. As Canada’s population ages, with rising health complexity, climate-related disasters, and international conflict all adding pressure, all levels of government should urgently prioritize safe, timely emergency care.⁹

Short Term Target

Mandatory ED data reporting to NACRS as a condition of receipt of the CHT.

Long Term Target

Mandatory accountability frameworks for health care provision by provinces, including defined responsibility, deliverables and incentives for performance. These frameworks should be publicly accessible and give a clear articulation of time-bound ED and healthcare system improvements. CHT funding would be positively or negatively affected by performance.