{"id":966046,"date":"2026-11-11T01:38:32","date_gmt":"2026-11-11T01:38:32","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/966046\/"},"modified":"2026-11-11T01:38:32","modified_gmt":"2026-11-11T01:38:32","slug":"whos-being-hurt-the-most-in-the-er-crisis","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/966046\/","title":{"rendered":"Who\u2019s Being Hurt the Most in the ER Crisis?"},"content":{"rendered":"

People who visit emergency departments but leave without their care completed are often assumed not to have been ill enough to require that care. <\/p>\n

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However, the high rates of people who leave without completed care are a symptom of the mismatch between the Canadian promise of health care for all and the current capacity of the health-care system. The most profound effects of this mismatch fall on people who are structurally disadvantaged. <\/p>\n

Our research shows that the people who rely the most on emergency departments report the poorest care experiences, and often leave without their care completed. This creates a cycle of worsening health and increasing costs. <\/p>\n

Studying the care experiences of nearly 1,700 patients across three British Columbia emergency departments, our research team found that people facing the greatest social and economic disadvantages were more likely to report<\/a> discrimination, lack access to primary care, depend on emergency departments for ongoing health problems and rate their care poorly. They were also the most frequent users of emergency departments. <\/p>\n

In a different analysis, our research also showed that emergency departments can significantly interrupt this cycle<\/a>.<\/p>\n


\n <\/p>\n

Promoting equity<\/p>\n

Our team at EQUIP Health Care<\/a> has been researching how to increase effectiveness by supporting health-care organizations to focus on people least well-served by the health-care system. In other words, researching ways to promote equity.<\/p>\n

Studying primary care clinics that serve people marginalized by poverty, racism and other forms of stigma and discrimination, we identified three key dimensions to doing so: trauma- and violence-informed care<\/a>, cultural safety\/anti-racism and substance-use health. We also identified 10 implementation strategies. <\/p>\n

Our findings showed that patients who received care that promoted equity were more comfortable and confident in their care, leading to increased confidence in preventing and managing their health problems. This, in turn, improved their health outcomes<\/a>, including depression and trauma symptoms, chronic pain and quality of life. <\/p>\n

We learned that although education and addressing biases were useful for many providers, interprofessional conversations<\/a> were needed to develop policy and practices to address racism, stigma and discrimination. We learned that disruption<\/a> was inevitable and necessary, and that policy change<\/a> was as important as changes to health-care providers\u2019 practice.<\/p>\n

More effective care<\/p>\n

Based on these lessons, we partnered with three B.C. emergency departments to design an intervention<\/a> to support leaders and staff to deliver care more effectively. <\/p>\n

Emergency departments are under immense and increasing pressure, evident in long waits for care<\/a> and high levels of staff turnover and burnout<\/a>, fostering a focus on optimizing short-term efficiency. However, the intervention was designed to align with the quintuple aim of health-care improvement<\/a>, which optimizes effectiveness by enhancing:<\/p>\n


\nPatient experiences and outcomes
\nHealth-care provider well-being
\nHealth equity
\nService efficiency
\nHealth system efficiency <\/p>\n

Despite significant challenges related to COVID-19 and the worsening epidemic of overdoses and deaths related to the toxic drug supply, staff at two of the emergency departments mounted intervention strategies. Results showed encouraging trends in patients\u2019 perceptions of the quality of their care and discrimination in the emergency department, but there were no significant changes in staff sick time. <\/p>\n

However, most importantly, there was a significant decrease<\/a> in the percentage of patients who left without their care being completed at the site with the most robust intervention activities. This is crucial because patients who leave the emergency department before their care is complete often return when their health concerns are more urgent, resulting in significant harms to patients and costs to the health-care system. It\u2019s also demoralizing for staff.<\/p>\n

We examined how to build on and strengthen these results. Staff and leaders were committed to focusing on those with greatest needs. <\/p>\n

However, other priorities \u2014 such as recruiting and orienting new staff, and responding to escalating crises such as violence against staff, the toxic unregulated drug supply and COVID-19 \u2014 overshadowed their efforts and curtailed the staff and resources needed.<\/p>\n


\n <\/p>\n

Resources and recommendations<\/p>\n

We identified 10 recommendations<\/a> for systematically improving care for those who need it most:<\/p>\n

<\/a> <\/p>\n

\"image<\/p>\n

BC\u2019s Hospital Crowding Problem Isn\u2019t Improving, Data Shows<\/p>\n

\t\t\t\tread more <\/p>\n

<\/a><\/p>\n


\nInitiate interventions within care delivery organizations
\nConceptualize equity as foundational to health-care quality, not as an \u201cadd-on\u201d
\n\u201cHook\u201d participation by linking equity to the organization\u2019s most pressing \u201cpain points\u201d
\nSeek commitment to effectiveness from leaders across all employment groups
\nCommit sufficient resources to ensure representation from service-users and all employment groups and sufficient leadership and expertise
\nCompose implementation teams of people from all levels and roles, including service-users
\nAssign leadership responsibility to those with leadership roles at executive and clinical levels in alignment with their skills and responsibilities
\nTailor the intervention to align with the realities of the context
\nProvide some level of education and opportunities for interprofessional dialogue for all
\nReconsider how time is used to support effectiveness and other elements of the quintuple aim, not efficiency alone <\/p>\n

To support these recommendations, we created the EQUIP Equity Action Kit<\/a>, which includes step-by-step directions, assessment and evaluation tools, discussion tools, action tools, videos and animations. We have free online courses<\/a> to support the action kit and tools to support the well-being of health-care providers<\/a> as they face challenging workloads, high stress levels and violence daily. <\/p>\n

Some resources are available in both English and French. In addition to emergency departments, many resources have been tailored to other health-care settings such as primary care and cancer care.\"The \"<\/p>\n","protected":false},"excerpt":{"rendered":"People who visit emergency departments but leave without their care completed are often assumed not to have been…\n","protected":false},"author":2,"featured_media":966047,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[329419,49,48,329420,329421,26234,84,329422,392,1058,329423,41975,19970],"class_list":["post-966046","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-bc-emergency-departments","tag-ca","tag-canada","tag-equip-equity-action-kit","tag-equip-health-care","tag-healing","tag-health","tag-health-care-equity-bc","tag-healthcare","tag-medicine","tag-quintuple-aim","tag-sickness","tag-therapy"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/966046","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=966046"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/966046\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/966047"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=966046"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=966046"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=966046"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}