This is an opinion column by Chief of Emergency Medicine Dr. Rafi Setrak, published in the Niagara dailies.
Dr. Rafi Setrak, Chief of Emergency Medicine.
If you’ve visited an Emergency Department lately, you’ve likely felt what many people across the province are experiencing: long waits, busy waiting rooms and uncertainty about when you’ll be seen. As a physician who has worked in Niagara’s Emergency Departments for years, I understand how stressful this can feel — and I want to explain what’s happening behind the scenes, why waits can be long and how Niagara Health is working to make the experience better.
The most important thing to know is that emergency care does not work like a traditional lineup. Patients are not seen in the order they arrive. They are seen based on acuity — the urgency and severity of their condition. Someone with signs of a stroke, chest pain, trouble breathing or a serious injury will always be treated first, even if others have been waiting longer. This system saves lives, but it also means people with less urgent concerns may face longer waits, especially during busy periods.
But acuity isn’t the only factor affecting wait times. One of the biggest challenges we face is hospital capacity. When inpatient beds are full, admitted patients remain in the ED until space becomes available. These patients still require care and monitoring, and they occupy treatment areas originally designed for incoming emergencies. When this happens, patient flow slows throughout the entire department, creating bottlenecks that affect everyone.
"I want to explain what’s happening behind the scenes, why waits can be long and how Niagara Health is working to make the experience better."
A major contributor to this gridlock is the number of patients who are medically ready for discharge but waiting for community supports such as long‑term care, rehab, home care or mental health services. When those resources aren’t available, hospital beds stay occupied longer, and ED patients who need admission must wait. This situation is happening across Ontario, and its impact is felt most visibly in the Emergency Department.
"We’re working hard to improve the experience for every person who walks through our doors."
Despite these system‑level challenges, we’re working hard to improve the experience for every person who walks through our doors. One of the most successful enhancements has been the launch of our ED waiting room ambassador program at the Marotta Family Hospital.
A senior personal support worker stationed in the waiting room now helps support patients, identify concerns sooner, provide updates and even prevent falls or medical emergencies. The difference has been remarkable, and we’re working to expand this role across other sites.
We’re also looking closely at how to make our waiting areas more comfortable and supportive. Research shows that well‑designed environments can reduce anxiety and improve the overall care experience. We’re exploring options such as softer lighting, charging stations, family‑friendly zones and more welcoming décor — small changes that can make long waits easier.
Clear communication is another priority. We know that not knowing what’s happening can be the hardest part of an ED visit. We’re focusing on improving how we explain wait times, reassessments and next steps as the visit unfolds.
Finally, we’re strengthening partnerships across Niagara to safely transition patients out of hospital and ensure they receive the right care in the right setting. Better flow means better ED access for everyone.
We also encourage the community to know their healthcare options. Not every illness requires emergency care. Family doctors, nurse practitioner clinics, walk‑in clinics, pharmacists, Health811 and Virtual Urgent Care can often provide faster access for non‑emergency issues. Choosing the right option helps keep ED resources available for those who truly need them.
"I know waiting is hard. I see your frustration, and I share it. But Niagara Health is committed to providing safe, compassionate care — and to improving your ED experience, one step at a time."
I know waiting is hard. I see your frustration, and I share it. But Niagara Health is committed to providing safe, compassionate care — and to improving your ED experience, one step at a time.
Know your healthcare options
Health811
Call 811 to speak with a registered nurse for free, confidential advice on where to seek care.
Primary care providers
Family doctors, walk-in clinics, and nurse practitioner clinics for common illnesses, prescriptions and chronic conditions.
Pharmacies
Ontario pharmacists can prescribe for a range of minor ailments, including UTIs and some cold-related conditions.
Virtual Urgent Care
Same-day care from home for non-emergency concerns. Visit UrgentCareOntario.ca
Urgent Care Centres
For sprains, minor cuts, mild asthma, fevers and illnesses that can’t wait for an appointment. Open 10 a.m. to 8 p.m. daily in Port Colborne and Fort Erie. Make sure to check the Niagara Health website before visiting as hours are subject to change.
Emergency Departments
For chest pain, trouble breathing, stroke symptoms, severe injuries, loss of consciousness, serious mental health crises and other life-threatening emergencies. Call 9-1-1 or go to the nearest ED.
