Nearly 430,000 Quebecers leave emergency rooms without having been treated

Hundreds of thousands of Canadians leave emergency rooms every year without receiving treatment, a trend that continues to grow. Quebec is the province with the highest number of patients going home without care, by far.

According to a report by the Montreal Economic Institute (MEI) released Thursday, in 2024-2025, nearly 430,000 Quebecers will have visited the emergency room and left without being treated. This represents 11.6 per cent of the total number of emergency room visits. Quebec, the second most populous province in the country, is the only one of the four major provinces with a pre-treatment departure ratio above 10 per cent.

The emergency rooms with the highest stretcher occupancy rate in Montreal on Thursday afternoon were:

• Royal Victoria Hospital (218 per cent)
• Jewish General Hospital (202 per cent)
• Montreal General Hospital (187 per cent)

Ontario has the lowest proportion of patients leaving the emergency room without being treated, with a rate of 4.9 per cent, which equates to nearly 293,000 Ontarians. Conversely, Prince Edward Island has the highest proportion, at 14.2 per cent for a total of 13,000 patients.

In all provinces, the situation has worsened, with more and more patients leaving without care. In Quebec, this proportion has jumped 8.8 per cent since 2019, the least severe increase in the country. At the other end of the scale, Alberta saw a 77 per cent increase; Manitoba 88 per cent; and Newfoundland and Labrador 94 per cent. The national average change is 35.5 per cent.

Emmanuelle B. Faubert, economist at the MEI and author of the report, does not necessarily interpret this indicator as an encouraging sign for Quebec.

“What this means is that the increase may be lower in Quebec over five years compared to other provinces, but it also means that in Quebec, it was higher in 2019 than in other provinces. […] It’s not that it’s doing better, it’s because it was already very high; the others have simply caught up more with Quebec,” she explains.

Montrealer Judie Riddell said a visit to an ER can really depend on the condition of the patient, “Sometimes it’s eight hours. That’s like, I mean, if you’re sick, it works. If you’re not sick, go home.”

“It’s socialized medicine. You know, if you’re really sick, you’ll get, my brother-in-law went in and he was seen like that via cancer. So, you know, if you go in with a splinter, forget it. So it all depends on your degree of wellness and the emergency,” Riddell added.

Symptom of Lack of Access to Primary Care

Across Canada, more than 1.2 million patients left emergency rooms without receiving treatment last year, or about one in thirteen visits. This data excludes patients in Saskatchewan and those in the Vitalité Santé network in New Brunswick, as health authorities did not provide their 2024 data in time for the study’s publication.

This is the first time the MEI has analyzed Canadian data on this reality, and the report concludes that it is a consequence of the country’s lack of access to care.

Another Montrealer Laura Olivia went to the ER last year and had a long wait. “I found it was really hard to [wait]. I spent eight hours and there were a lot of people there as well, like me. But there are not really a lot of assistants,” she said.

“It’s not just an emergency room problem. What’s happening is that emergency room wait times are a symptom of several other problems, including access to primary care. And what we’re seeing is that it’s becoming increasingly difficult to access a family doctor. We agree that there are truly many Quebecers and Canadians who cannot access primary care. When you have a lot of patients who don’t have access to primary care, they have no choice but to turn to the emergency room,” explains Faubert.

This is why approximately half of the patients who leave the ER without treatment are P4 and P5 patients, meaning patients with a low-urgent or non-urgent priority level. This could be, for example, a person with a cut whose bleeding is controlled but requires stitches (P4) or a person who needs a dressing changed (P5).

“Whether it’s for a prescription refill, stitches, a broken arm, or a heart attack, someone who leaves the ER without receiving treatment is someone who is falling through the cracks of the healthcare system,” says Faubert.

Patients who leave without being assessed by a doctor may underestimate the true severity of their situation.

“Studies have shown that a large proportion of people that leave the ER untreated end up coming back later on in the next three weeks, often for problems related to their initial visit,” Faubert adds. “And if we continue, we’re going to have people that die in the emergency room for things that could have been prevented because they do not have access to care.”

To improve the situation, the MEI recommends, among other things, increasing the use of clinics run by nurse practitioners and expanding pharmacists’ scope of practice.

In these areas, Faubert believes that Quebec is moving in the right direction. The province has, among other things, expanded pharmacists’ scope of practice, but according to the expert, this should be extended even further and across Canada. She points out that nearly one in ten people go to the emergency room for preventive reasons, often related to prescription issues.

“If pharmacists are better able to renew and prescribe […] it can not only ease the burden on front-line physicians, but also prevent people from having to go to the emergency room for prescription issues,” she concludes.

— With files from Katrine Desautels, The Canadian Press