Hallway medicine in Canada: what it is, why it happens, and why it matters

Written by Elle Tencer

If you have ever visited an emergency department and seen patients on stretchers lined up in corridors, you have already seen the reality behind the phrase hallway medicine. In simple terms, hallway medicine happens when hospitals cannot move admitted patients out of the emergency department into inpatient beds, so care spills into hallways and other spaces that were never designed for treatment (Ontario Ministry of Health, 2019). It is not just uncomfortable. This shows that Canada’s health care system cannot keep up with demand, and both patients and providers are affected.

Why does hallway medicine really happen?

This problem is tied to gaps in access and navigation across the health system. When primary care and community services are hard to reach because of limited hours, long wait lists, or unclear pathways, people turn to the emergency department because it is always open (Affleck et al., 2013).

This is especially true for mental health and addictions, where delays in community supports can allow symptoms to worsen until a crisis makes the emergency department the only option (Affleck et al., 2013).

At the same time, emergency departments are built for short term stabilization, not ongoing inpatient care. When admitted patients cannot be moved to hospital units, they stay in the emergency department for hours or days. This access block means stretchers are occupied, leaving less space and fewer staff resources for new patients, which increases crowding, lengthens waits, and pushes care into hallways (Affleck et al., 2013).

How it impacts patients

1. Higher death risk when waits are longer.

An Ontario study looked at emergency department crowding and found that when crowding was worse, patients had a slightly higher risk of death within 7 days after their ED visit (Guttmann et al., 2011).

2. Delayed treatment for serious conditions.

Patients with serious conditions such as hip fractures or appendicitis may wait longer to see a specialist or receive surgery. These delays can worsen their condition and increase the risk of complications (Forero et al., 2011).

3. Delays in basic emergency care steps.

Canadian emergency medicine workers describe how crowding and boarding can delay assessment and treatment and make monitoring harder, which increases the chance of preventable complications (Affleck et al., 2013).

4. Hallway medicine reduces privacy and dignity.

Patients may have private conversations where others can hear, receive care in crowded hallways, and have trouble resting and recovering because of constant noise and interruptions (Ontario Ministry of Health, 2019).

How does this impact providers:

1. Provider burnout and higher risk of mistakes.

When the emergency department is overcrowded, staff have to treat emergencies while also caring for admitted patients stuck waiting for beds. This creates constant interruptions, heavier workload, and less time per patient, which increases the chance of errors and contributes to burnout (Affleck et al., 2013).

2. Staffing gets worse over time.

Crowding increases stress for staff, which can lead to sick days and people quitting. With fewer staff available, the emergency department cannot handle as many patients, so crowding and hallway medicine get even worse (CADTH, 2023).

What this means going forward

Hallway medicine is a symptom of a system that is not moving patients to the right place at the right time. Reducing it requires more than emergency department fixes. It requires improving inpatient flow and discharge pathways, and strengthening long term care, home care, and community services so that fewer people become stuck in hospital beds when they could be cared for safely elsewhere. Until those bottlenecks ease, hallway medicine in Canada will remain a visible sign that emergency departments are being asked to do more than they were built to do.

References

Affleck, A., Parks, P., Drummond, A., Rowe, B. H., & Ovens, H. J. (2013). Emergency department overcrowding and access block.

Canadian Agency for Drugs and Technologies in Health. (2023, November). Emergency department overcrowding in Canada: Expert guidance.

Canadian Institute for Health Information. (2024, December 5). Emergency department crowding: Beyond primary care access.

Forero, R., McCarthy, S., & Hillman, K. (2011). Access block and emergency department overcrowding.

Guttmann, A., Schull, M. J., Vermeulen, M. J., & Stukel, T. A. (2011). Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario, Canada.

Ontario Ministry of Health. (2019). Hallway health care: A system under strain.

Rader, T., Bush, K., & CADTH. (2023). Emergency department overcrowding in Canada.