At This ER, Patients Wait at Home

Just eight months ago, a non-urgent patient at Sault Ste. Marie’s Sault Area Hospital’s ER might have waited more than six hours before being seen. The hospital, where I work as an ER physician and the vice-president of medical affairs, serves a population of 115,000 people. As the only ER in the community, we manage a wide range of cases every day: cuts, broken bones, seizures, food poisonings, respiratory illnesses, trauma wounds, allergic reactions, heart attacks and strokes. 

Our staff triage to ensure that patients with the most serious conditions get seen first. If someone arrives with symptoms of a severe heart attack or a major stroke, for instance, they’re assigned a CTAS 1 score on the Canadian Triage and Acuity Scale. This triggers an immediate, coordinated all-hands-on-deck response from our team. Less urgent cases get a lower CTAS score. Someone who shows up at the ER looking to refill their prescription because they don’t have a primary care provider—or the community clinics are full—gets the lowest. As the day goes on, those on the less-urgent end of the CTAS can experience longer wait times. For patients, the extended wait can be uncomfortable and stressful, particularly for seniors and families with young children. It causes frustration and strained exchanges between patients and care providers. And wait times fluctuated dramatically depending on the severity of patients waiting in the ER. 

Long ER wait times have been a major issue in the Canadian health-care system for decades; the COVID-19 pandemic made the crisis impossible to ignore. As an ER physician working on the frontlines, I often thought about how we could improve the patient experience if we were more deliberate about when and how people with less-urgent needs enter the system.

That’s why, on a family vacation to Disney World in 2023, I couldn’t stop thinking about wait times and ways to improve efficiency while waiting for hours to try a new ride. Because the ride was popular, the queue was estimated to be over four hours long. Instead of languishing in line, we used Disney’s FastPass system, which placed us in a virtual queue and would alert us when we should return to the ride and join a much shorter line. In the meantime, we were free to explore the park. I realized this could be a game-changer in an emergency setting. But an ER isn’t a theme-park ride: making it work in tandem with the triage system would be challenging.

I started by fielding the idea with our physicians and nurses, and we landed on a model that would allow certain patients to wait at home and be called in when the ER was most able to accommodate their needs. Similar to Disney, it would be a text notification system that patients would register for through the hospital’s website. 

Related: State of Emergency: Inside Canada’s ER Crisis

We spent the next 12 months working with software companies Meditech and Luma Health to build a digital queuing system that would be fully integrated with our existing electronic health records. Once we had the program up and working, we spent months conducting tests and improving the system based on feedback from nurse champions and educators, as well as patient and family advisers. Then, in August of 2025, we launched our virtual home waiting room pilot.

Today, a non-urgent patient can join the virtual home waiting room on Sault Area Hospital’s website after reviewing a disclaimer that lists ailments that qualify them to join the queue—minor cuts, coughs, sore throat, earache, rashes, strains and sprains, prescription renewals, staple or suture removal, burning with urination and dental pain. For any condition not listed, we specify that those patients should present at the ER to be triaged in person. Anyone who qualifies enters their phone number and joins the queue. Once they’re in the virtual queue, patients are free to go about their day or await care in the comfort of home. In the back end, an ER nurse monitors the waiting room and alerts patients via SMS when it’s time to come to the ER.

Since launching last summer, the program has been a resounding success. For roughly 90 per cent of patients who join the virtual queue, the time from triage to a physician’s initial assessment has dropped from more than six hours to about three. The share of patients who leave without being treated fell from 13 per cent among those who didn’t use the virtual queue to three for those who did. Nearly 500 patients have used the virtual waiting room so far, and 87 per cent reported being very satisfied. Staff and health-care providers have also praised the system. It’s improved their workflow and reduced stress, giving them greater control over who walks through the ER doors and when. 

Our only challenge now is accommodating increased demand. When we launched, we delayed any widespread marketing of the tool out of concern that the emergency department would be overwhelmed. As it becomes more popular, I’ve been in talks with local community leaders about expanding to leverage all available health-care providers in Sault Ste. Marie. Down the line, patients could opt to virtually line up for appointments not just at the ER, but also at community walk-ins or with family practitioners. That way, demand would be triaged across multiple health-care services, not just in the emergency department at Sault Area Hospital.

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Long wait times and overcrowding in ERs across Canada consistently rank as the biggest complaints Canadians have about our health-care system. Many regions of our country are even worse off than our hospital was before the queue. In Ontario, for example, the average wait time in 2024 was a staggering 22 hours, according to data from Ontario Health. 

Wait times don’t exist in isolation. They reflect systemic challenges, including 6.5 million Canadians without access to primary care, a shortage of hospital beds and widespread worker shortages that have led to ER closures. While the health-care leaders work to address these issues, it remains critical to improve patient care wherever possible. Our virtual home waiting room offers patients faster access to care, providing reassurance and greater certainty during difficult and distressing moments. If similar programs were implemented nationwide, more Canadians could receive the care they need when and where they need it.

Stephen Smith is the vice-president of medical affairs and an emergency department physician at Sault Area Hospital.