Too Many Canadians Are Leaving Emergency Rooms Untreated
Economic Note examining the number of people who leave emergency rooms untreated in each Canadian province and the need to address upstream problems accessing care in order to reduce ER overcrowding
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This Economic Note was prepared by Emmanuelle B. Faubert, Economist at the MEI. The MEI’s Health Policy Series aims to examine the extent to which freedom of choice and entrepreneurship lead to improvements in the quality and efficiency of health care services for all patients.
Whether to find a family doctor, consult a specialist, or get emergency care, wait times in Canada are infamously long. When Canadians show up at an emergency room, it’s often because they have no other options. Yet, in spite of this, hundreds of thousands of Canadians leave emergency rooms without being treated every year.
This phenomenon is one of the most worrisome symptoms of the lack of access to care in Canada. Below are Canadian data capturing this reality, presented and analyzed for the first time.
How Many Canadians Leave ERs Untreated?
In order to sketch a picture of the situation in Canada, we collected data on the number of people who leave emergency rooms before having been treated in each Canadian province. We looked specifically at the proportion of patients who leave ERs untreated, compared to the total number of visits. This provides a telling indicator of access to emergency care: the less the health system is able to meet the needs of the population in terms of care, the higher this ratio will be.
Requests for access to information were sent to the provincial and regional health authorities of the ten provinces. At the time of publication, the data analyzed cover all provinces, with the exception of New Brunswick’s francophone network, which was omitted for data quality reasons. The data nonetheless cover almost the entire Canadian population.(1)
When Canadians show up at an emergency room, it’s often because they have no other options. Yet, hundreds of thousands leave without being treated every year.
According to the data collected, out of 16,297,628 emergency room visits in 2024, 1,267,736 patients left without having been treated, which is 7.78% of the total, or around one in every 13 visits.(2) The situation varies considerably from province to province, however. Ontario has the lowest proportion of patients leaving an ER untreated, with a rate of 4.9%. At the other extreme, Prince Edward Island has the highest proportion, at 14.2% (see Table 1). Quebec, the second most populous province in the country, is the only one of the four big provinces with a ratio of departures before treatment that is greater than 10%.
The situation has also deteriorated considerably over the past five years across the country (see Figure 1). In certain cases, the ratio has nearly doubled: in Alberta, for example, it increased by 77%; in Newfoundland and Labrador, by 94%; and in Manitoba, by 88%. Even in Ontario, the province with the lowest ratio in 2024, the situation nonetheless worsened by 31% between 2019 and 2024.
Distribution of Untreated Patients by Priority Level
Canadian hospitals sort patients visiting emergency rooms according to their level of priority using the Canadian Triage Acuity Scale (CTAS), a standardized classification system(3) (see Table 2).
The analysis of this distribution of patients having left an ER untreated is a second useful indicator to better understand the situation in the country’s emergency rooms. In 2024, one in two patients leaving an ER before being treated was classified as a semi-urgent or non-urgent case(4) (see Figure 2). This result is hardly surprising in so far as these patients are not prioritized by health professionals, given the relatively mild nature of their condition. They must therefore wait longer than those in more urgent need of care.
This pattern, observed in Manitoba, Quebec, New Brunswick, Prince Edward Island, and Newfoundland and Labrador, testifies to a lack of access to primary care and minor emergency care. While these patients do not have the most pressing of medical needs, they still need care, without which their condition may worsen. Among these typical cases are a patient showing up with a cut requiring stitches where bleeding is controlled (level 4) or a patient needing a dressing changed or a prescription renewed (level 5) who then leaves without having been treated.
In Ontario, Alberta, and Nova Scotia,(5) however, contrary to the other provinces, around half of patients having left an ER untreated were classified as level three (51.4%, 48.5%, and 45.9% respectively). These three provinces also had the highest proportion of patients having left prematurely and classified as level two (13.4% in Ontario, 13.5% in Alberta, and 11% in Nova Scotia).
While some cases are more severe than others, each patient who leaves prematurely is a Canadian who needed care and whom the health system was unable to treat.
This testifies to another underlying problem. Indeed, patients classified as level three, despite the very real risk of deterioration, are sent back into the waiting room due to emergency services being overwhelmed.(6) Studies have shown that an overcrowded ER, and the ensuing treatment slowdown, is one of the most important risk factors for premature ER departure.(7)
While some cases are more severe than others, each patient who leaves prematurely is a Canadian who needed care and whom the health system was unable to treat. These departures can have serious consequences.
The Consequences of Premature Departures
Patients who leave without having been evaluated or treated can underestimate the true gravity of their situation, thus running the risk that their condition will deteriorate. Studies have shown that these patients are more susceptible to return to the hospital in the days or weeks that follow, compared to those who leave after having been treated and discharged.(8) This premature departure can increase the risk of complications, or even death.(9)
In an observational study conducted in the United States in 2019-2020, 55.4% of patients having left an ER without being treated consulted a health professional in the three weeks following their initial visit, and the majority of these consultations (73.2%) were related to their initial health problem.(10)
Leaving an emergency room before having been treated only to return a few days later not only has direct consequences on the patients themselves, but also for the health system as a whole.
Leaving an emergency room before having been treated only to return a few days later, their situation having deteriorated, not only has direct consequences on the patients themselves, but also for the health system as a whole. Indeed, it entails higher costs due to an inefficient use of resources. Improving the care provided in emergency rooms across Canada is therefore critical in order to keep patients from leaving untreated.
Improving Upstream Access to Care
Increased reliance on the following three resources would reduce the number of patients visiting emergency rooms for minor health problems, thereby helping to accelerate treatment for truly urgent cases:
- The nurse practitioner clinic model can bolster primary care, and has proven its worth in Quebec (where several new clinics are projected to open by 2028(11)) and in Ontario.(12) Other provinces like British Columbia, Alberta, Saskatchewan, and Nova Scotia, are at various stages of planification, pilot projects, or deployment for such clinics.(13) These facilities can provide a range of treatments, make diagnoses, order tests, and in certain cases prescribe drugs.(14) They provide services to patients who might otherwise have visited emergency rooms, thereby helping take some of the pressure off of those facilities.
- Other health professionals can also facilitate access to primary care, notably pharmacists. Alberta led the way by opening the country’s first pharmacist clinic in 2022, all while providing them with the broadest scope of practice of any province.(15) Since then, other provinces have started to explore this model, including by enlarging pharmacists’ scope of practice.(16)
- As for minor emergencies, immediate medical care centres like those that exist in France could help reduce the number of less urgent cases treated in hospital emergency rooms.(17) These clinics, specialized in minor ailments, have developed an expertise in the treatment of non-life-threatening emergencies. They are often equipped with technical facilities and test centres, allowing them not only to ease crowding in ERs, but also to support the hospital system more generally.
Although minor emergency clinics exist in several Canadian provinces, their current structure is quite restricted. Indeed, as these clinics are generally publicly administered, they are subject to the same bureaucratic burdens as the rest of the system. In contrast, France’s immediate medical care centres are characterized by their independent administration. This independence allows them not only to avoid the public system’s administrative straitjacket, but also to innovate without having to wait for permission from the entire administrative hierarchy.
To reduce the number of people who leave emergency rooms untreated, the upstream problems accessing care need to be addressed.
Conclusion
To reduce the number of people who leave emergency rooms untreated, the upstream problems accessing care need to be addressed in order to limit ER visits for health problems that could be dealt with elsewhere. Increasing the number of alternatives to emergency rooms would help ease the pressure on the hospital system, thereby reducing wait times. This kind of approach would also help reduce the risk of patients leaving emergency rooms untreated, which can worsen their condition and then require the mobilization of even more resources from Canada’s healthcare systems.
References
- Adding up only the populations of the provinces for which data are available and complete (all provinces except New Brunswick and Saskatchewan), 94.6% of the country’s population is represented. Author’s calculations. Statistics Canada, Table 17-10-0009-01: Population estimates, quarterly, June 18, 2025.
- This calculation excludes Saskatchewan, as 2024 data were unavailable. The data for New Brunswick are incomplete, meaning that the total number of patients having left an ER untreated is higher in this province, as is the total number of visits. Author’s calculations. Request for access to information from provincial and regional health authorities.
- Canadian Association of Emergency Physicians, The Canadian Triage Acuity Scale—Combined Adult/Pediatric Educational Program—Participant’s Manual, 2013, pp. 17-19.
- P4 and P5 patients represented 49.5% of total cases in the provinces and regions where data on such distribution was available. Author’s calculations.
- It must be noted that the data provided by Alberta include not only patients having left an ER without having been seen by a doctor, but also those having initially been seen but having left before treatment was completed, against the physician’s advice, which may contribute to the relatively high proportion of patients classified as level one, two, or three compared to the other provinces.
- Canadian Association of Emergency Physicians, op. cit., endnote 3, p. 18.
- Francesca Mataloni et al., “Patients who leave Emergency Department without being seen or during treatment in the Lazio Region (Central Italy): Determinants and short term outcomes,” PLoS ONE, Vol. 13, No. 12, December 2018, p. 2.
- Ibid., p. 11.
- Candace D. McNaughton et al., “Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020,” Journal of the American College of Emergency Physicians Open, Vol. 5, No. 6, December 2024, p. 7.
- Nathan Roby et al., “Characteristics and retention of emergency department patients who left without being seen (LWBS),” Internal and Emergency Medicine, June 2021, p. 3.
- Government of Quebec, Health, Health system and services, Service organization, Specialized nurse practitioners, Public specialized nurse practitioner (SNP) clinics, April 15, 2024.
- Alliance for Healthier Communities, Nurse Practitioner-Led Clinics, consulted on July 22, 2025.
- CKOM News, “Saskatchewan to expand role of nurse practitioners with new health clinics,” March 12, 2024; Damien Contandriopoulos et al., “Pre–post analysis of the impact of British Columbia nurse practitioner primary care clinics on patient health and care experience,” BMJ Open, Vol. 13, No. 10, October 2018; Healthcare Excellence Canada, What We Do, All Programs, Strengthening Primary Care, Promising Practices for Strengthening Primary Care in Northern, Rural and Remote Communities, consulted on July 22, 2025; Government of Alberta, All services, Health, Supports and resources, Health professional and delivery resources, Nurse Practitioner Primary Care Program, consulted on July 22, 2025.
- Youri Chassin and Alexandre Moreau, “Super Nurse Clinics: A Flexible Solution for Improving Access to Health Care,” Economic Note, MEI, April 2016, p. 2.
- Krystle Wittevrongel, “Pharmacist-Led Clinics Improve Access to Primary Care: Alberta Paves the Way,” Viewpoint, MEI, May 2024, p. 2.
- Ordre des pharmaciens du Québec, “Un élargissement du rôle des pharmacien(ne)s au bénéfice du public,” Press release, June 4, 2024; British Columbia Pharmacy Association, “B.C. government reviewing clinic model for community pharmacies,” Press release, August 4, 2024 (August 6, 2024).
- Emmanuelle B. Faubert et al., “Canadians Are Waiting Too Long in the Emergency Room,” Economic Note, MEI, June 2025.