Points clés à retenir
- ED demand is becoming more clinically complex: CTAS 4–5 visits now represent a smaller share of Canadian ED activity, while CTAS 1–3 cases are growing showing a better alignment of lower-acuity care.
- Primary care capacity is essential to sustaining progress: Family physician stress and burnout have improved since 2022, but access gaps and workforce pressures remain. Keeping appropriate care outside the ED depends on making primary care both accessible to patients and sustainable for clinicians.
- ED performance increasingly depends on the entire care network: Inpatient beds, home care, long-term care, and connected digital infrastructure all influence emergency department flow. Improving wait times therefore requires better movement of patients, information and capacity across settings.
Emergency department wait times are often treated as an ED problem: too many patients, too few clinicians, not enough beds.
The latest data from the Canadian Institute for Health Information (CIHI) suggests a more complicated reality. In 2024–2025, 16.1 million ED visits were reported to CIHI’s National Ambulatory Care Reporting System. But the composition of those visits is changing. Two-thirds of patients were classified as high acuity (CTAS levels 1 to 3), and nearly one-third of visits involved patients with multiple comorbidities.
Taken together, the data indicates an important shift in how Canada should think about emergency care.
The ED can’t be optimized in isolation. Its performance increasingly reflects what happens before a patient arrives, how effectively care moves through the hospital, and whether the broader network can receive the patient when acute care is no longer the right setting.
Trend 1: EDs are seeing fewer low-acuity cases but a more complex patient population
One of the most significant changes in Canadian emergency care is happening in patient acuity.
Between 2018–2019 and 2024–2025, the proportion of ED visits classified as CTAS 4 or 5— these are less urgent and non-urgent patients—fell from 41% to 34%. Over the same period, CTAS 3 visits increased from 42% to 46%, while the highest-acuity CTAS 1 and 2 cases increased from 17% to 20%. Overall, high-acuity visits rose from 59% to 66% of ED activity, representing 1.7 million additional visits.
That’s an encouraging development in one respect. If more lower-acuity needs can be addressed outside the ED, emergency resources can be better concentrated on patients who need urgent assessment, diagnostics and treatment.
But it also exposes a new challenge: reducing lower-acuity demand does not automatically reduce ED pressure.
There’s no doubt that this frees up need capacity and resources for more urgent cases, but nearly 32% of ED visits in 2024–2025 involved patients with multiple comorbidities. This means more complexity.
Older patients and those living with chronic conditions are also more likely to require diagnostic testing, specialist involvement, admission, and coordination between multiple care providers. Even within the same hospital.
In other words, Canada may be seeing progress in where lower-acuity care is delivered while simultaneously facing greater complexity among the patients who remain in emergency departments.
Québec offers an important example of what the first half of this equation looks like:
- Since the implementation of the Hub Patient in 2022, the platform has grown to connect 850 clinics and more than 19,000 healthcare professionals, providing real-time visibility into primary care capacity and supporting the redirection of patients toward more appropriate care settings.
Petal’s analysis found 8.7% fewer CTAS 4–5 ED visits compared with pre-Patient Hub levels, alongside 353,000 redirected visits to primary care.
A more detailed economic analysis of the initiative shows that Québec’s overall ED utilization per capita declined from 0.4402 visits per person in 2018–2019 to 0.4104 in 2024–2025, a 6.8% reduction, even as the province’s population grew. At the same time, the proportion of ED visits redirected elsewhere increased from 4.5% to 8.0%.
The lesson is bigger than redirection: Alternative care only reduces pressure when patients can actually be connected to it.
Trend 2: Primary care capacity—and the well-being of the people delivering it—is part of ED capacity
The decline in lower-acuity ED activity raises an obvious question: can primary care continue absorbing more appropriate demand?
Canada still faces significant access gaps. CIHI reports that 17% of Canadian adults do not have a regular healthcare provider. Among those who do, only 27% report being able to see their provider the same or next day, while just 23% can access care during evenings or weekends.
Those gaps matter because primary care is one of the principal alternatives to the ED for patients with lower-acuity needs.
Here, the data contains some positive indicators.
In 2025, 50% of Canadian family doctors reported that their job was very or extremely stressful, down from 59% in 2022. Frequent emotional distress fell from 55% to 44%, while reported burnout declined from 47% to 38%.
Those improvements are meaningful, although job-related stress has not yet returned to its pre-pandemic level of 46%.
Retention indicators have also moved in a favourable direction. The proportion of Canadian family doctors who said they planned to stop seeing patients regularly within the next three years fell from 33% in 2022 to 22% in 2025. Yet burnout remains tightly connected to that risk: physicians planning to stop regular patient care were almost twice as likely to report burnout symptoms as those without such plans.
- Note: The rise in patient demand and the requirements set about physicians in the form of administrative burden are a potent combination for ongoing cognitive load and work-life balance.
Primary care helps manage chronic disease before it escalates, provides an alternative for lower-acuity needs and supports patients following acute episodes. It’s at the heart of the desire to move towards a value-based health care model. If Canada succeeds in shifting more appropriate care out of emergency departments but does so by adding unsustainable workload to already constrained primary care teams, the improvement will be difficult to maintain.
The goal therefore can’t simply be to send patients somewhere else.
It must be to build sustainable capacity around clinicians: appropriate team-based models, less administrative friction, alternative healthcare outlets like pharmacies, better visibility into available resources, and easier ways for different parts of the health system to coordinate care.
CIHI similarly points to organizational support, greater physician control over workload, reduced administrative burden, and adequate resources as potential strategies for strengthening physician well-being.
For health system leaders, that creates an important connection between two datasets that might otherwise be viewed separately.
Lower-acuity ED utilization and physician well-being are both signals of whether the surrounding care network has enough capacity. And, at the same time, determine if that capacity can be accessed efficiently.
Québec’s experience reinforces the access side of the equation. Unattached patients continue to use emergency care disproportionately: in 2024–2025, they represented 15.9% of the population but accounted for 23.6% of ED visits. Their utilization was particularly elevated for CTAS 4–5 conditions.
A shift is happening: Yet the gap has narrowed. The broader Patient Hub analysis found that ED utilization among unattached patients declined following implementation of the Hub and related access initiatives, particularly for lower-acuity visits.
That’s an important direction for the rest of Canada: improving emergency care doesn’t only require more capacity. It requires making existing capacity easier to find, access, and coordinate.
Physicians using Petal earned $34,346 more annually on average compared to manual billing.
Trend 3: The biggest ED bottlenecks increasingly sit outside the ED
Perhaps the clearest message in CIHI’s latest report is that emergency department wait times are a whole-system metric.
Consider admitted patients.
In 2024–2025, one in 10 patients admitted through an ED waited more than 36 hours for an inpatient bed, a 45% increase from 2018–2019.
The bottleneck is further downstream the healthcare system, rather than at the hospital level.
CIHI found that 8% of acute-care patients were designated alternate level of care (ALC). While non-ALC patients had a median inpatient stay of four days, ALC patients remained for a median of 24 days.
Among those patients, 19% were waiting for long-term care and 20% for home care. Patients waiting specifically for LTC placement had a median hospital stay of 44 days.
The implications for emergency medicine are immediate. A patient who can’t move to home care or LTC continues occupying an inpatient bed. When that inpatient bed remains occupied, another patient who has already been admitted may remain in the ED.
That patient continues to require ED space, monitoring, and clinical resources, reducing capacity for the next person arriving through the door. The waiting room may be in the emergency department, but the constraint may be anywhere across the care continuum.
That makes collaboration across hospitals, primary care, specialists, home care, and long-term care essential. But collaboration alone is not enough.
These organizations also need timely information about demand, capacity, and patient needs.
CIHI’s recommendations emphasize breaking down data barriers, expanding community-based information, strengthening analytics, and making data linkable across care settings.
The objective isn’t digitization for its own sake. It’s giving health system leaders the visibility required to understand bottlenecks, anticipate demand, and provide frontline care providers with the tools to move patients toward the most appropriate available resource.
At the same time, ED teams and 811 services can then use those connections, resources, and information to turn the idea of a referral into an actual appointment. No more “go see your family physician” over the phone. Instead, the triage nurse or 811 operator is there to book it with you.
- The economic implications are significant as well. Petal’s executive report estimates $339 million in cumulative economic value since 2022 from avoided and redirected ED visits, including approximately $121 million in 2024–2025.
Canada has spent years digitizing individual parts of healthcare.
The next challenge is connecting those parts well enough to orchestrate care across them.
The next phase of ED improvement happens across the network
There’s no single intervention that will solve emergency department overcrowding.
But the latest data provides a clearer picture of where progress is happening—and where the next constraints are emerging:
- Lower-acuity patients represent a smaller share of Canadian ED visits. That’s a positive signal and an opportunity to continue strengthening appropriate alternatives to emergency care.
- Yet the patients who remain are increasingly complex, making emergency departments more resource intensive even as demand becomes better aligned with clinical urgency.
- Primary care workforce indicators are improving from their pandemic-era lows. But access challenges and burnout remain significant enough that those gains can’t be taken for granted.
- Once a patient needs admission, the defining constraint may have little to do with the emergency department itself. Inpatient capacity, home care, LTC and the ability to coordinate between them all determine whether patients can keep moving.
The emergency department is where many of Canada’s health system pressures become visible.
Addressing them means looking beyond its walls.
Discover how smarter patient flow can save your health system’s resources:
Sources
- Canadian Institute for Health Information (CIHI), Emergency Department Wait Times in Canada: Insights From a Health System Perspective, 2026.
- CIHI, Wait Times Reflect Patient Acuity as Complexity Increases in EDs, 2026.
- CIHI, Longer ED Stays Reflect Growing Patient Complexity and Delays in Admission, 2026.
- CIHI, Availability of LTC Beds and Community Supports Needed for Smooth ED Patient Flow, 2026.
- CIHI, Stress, Distress and Burnout Among Family Doctors in Canada, 2026.
- CIHI, Family Doctors’ Plans to Stop Seeing Patients, 2026.
- Petal, The Right Care, Right Now: Unlocking Healthcare Capacity and $339M in Economic Value.
- Lafeuille, M-H., Use of Emergency Department Services and Trends in Access to Primary Care Since the Implementation of the Patient Hub in Québec: An Updated Economic Study, November 2025.
