Ontario hospital tries virtual waiting room to address wait times, overcrowding in ER

When Dr. Stephen Smith visited Disney World a few years ago, his family didn't have to stand in line for hours waiting for their favourite rides and shows.

Instead, they joined a digital waiting room that provided real-time updates and notified the family when the queues were the shortest. 

"It made our vacation experience much better," he said.

Smith, an emergency department physician in Sault Ste. Marie, Ont., thought a similar tool could be useful to address overcrowding and long wait times at Sault Area Hospital, where he is the vice-president for medical affairs.

"And from there, we sort of grew the idea into an actual usable product," he said. 

The hospital launched its virtual ER waiting room project last August and the results have been encouraging for patients with less urgent concerns, Smith said. 

The wait time to see a physician, nurse practitioner or physician assistant for patients using the virtual queue has been reduced by half, he said, compared to those with similar symptoms and health issues who physically wait at the hospital. 

The amount of time spent in the emergency room has also dropped by half for patients using the tool, he said.

Out of nearly six million ER visits in Ontario in 2024, close to 300,000 patients – or 4.92 per cent – left without being treated, according to Montreal Economic Institute, a non-profit research organization. 

Smith said his hospital's data show that using the virtual waiting room for certain health concerns is helping reduce the likelihood that patients will leave the hospital before seeing a health-care professional. 

"We had really positive results," he said. 

According to the hospital’s website, the tool requires a device that can receive text messages, and the patient has to be at least three months old. 

Coughs or sore throat, dental pain, minor cuts and scrapes, rashes and earache are among the complaints eligible for the virtual waiting room. 

For patients with these kinds of concerns, waiting in a virtual room can let them carry on with their day-to-day activities, Smith said. 

"They can continue with whatever hobby they were doing or activities they had to run in the community, so they can stay productive rather than just wait in a waiting room and be unproductive," he said. 

The hospital is asking people with concerns that fall outside the list to physically present to the emergency room or call 911 if they need urgent help.

Smith said the planning and implementation of the pilot project took around two years. There was involvement from physicians, nurses, finance, procurement and legal experts to explore the idea, secure funding and make sure it was being rolled out safely. 

Patients who sign up for the service review a disclaimer and agree to receive regular text updates to know where they are in the queue. 

"When the emergency department team feels the resources are aligned to see them in the shortest possible time, they receive a text telling them that they should arrive to the emergency room," he said. 

Once at the hospital, they go through similar steps to get triaged and ultimately seen by a physician.

"However, the time they spend waiting between each of those individual steps is much less because they'll have spent most of their time waiting at home," Smith said. 

The hospital's experience has also improved significantly, Smith said, particularly for nurses working in the triage and waiting room areas because the tool allows them to manage patient arrivals and crowding. 

"This is control they've never had before and this has really led to an improved sense of engagement and ownership in their work," he said. 

The annual subscription cost for the product is $40,000 annually and the local Ontario Health team has helped with the funding, he said. 

Smith said other hospitals have also reached out to ask about how it works. 

He said the plan is to expand the next generation of the tool so that it integrates the city's primary care providers and walk-in clinics into the existing tool at the hospital, so patients can choose where to go when they need care. 

Health experts are largely welcoming the initiative, but they say it isn't a silver bullet that will fully address the problem. 

Alan Drummond, a rural emergency doctor in Perth, Ont., said it is "refreshing" to see a hospital taking its "customer care" seriously. 

"It is an anxiety-provoking experience to be in an emergency department … wondering if you're ever going to get through the door" to be seen by a provider, he said. 

"Good for them for trying something relatively new to try and improve the patient experience, and yes, we should celebrate every little victory."

But Drummond said more needs to be done at the provincial and federal levels to address the underlying problems causing overcrowding in ERs, such as a lack of beds and medical equipment, hallway medicine and staffing shortages. 

There is no coherent "grand national plan" to address these issues, which has left hospitals to explore solutions of their own, he said.

"We are never going to fix that as a province or as a country until we kind of understand the big picture," he said. 

Iris Gorfinkel, a family physician and clinical researcher in Toronto, also hailed the initiative, saying she is "super excited" by the idea. 

"I think that takes down one of the major barriers that makes patients hesitate to go," she said. "So, they're having pain, they're in distress, and a lot of them worry that going to the ER and sitting is going to add distress."

Reducing the physical wait time in the ER also slows the spread of infectious diseases, Gorfinkel said. 

But she cautioned against rolling out the program to other hospitals unless it is backed up by thorough research conducted by experts who are not involved in its development.

Smith said he sees the virtual waiting room as just one piece of the puzzle.

"I think this is one tool in a toolbox that our teams in the emergency rooms can use," he said. 

"But is it the ultimate solution to fix some of the challenges in the health-care system? No, it's not."