A 93-year-old man with a serious bladder infection spent eight days in Abbotsford Regional Hospital’s emergency department without ever being admitted to a proper care ward.

Lex Smid survived his visit in early February, but his granddaughter says his care was compromised by the lack of resources in the notoriously congested hospital.

“I don’t blame any of the staff because they look like they’re run off their feet,” Alexis Toews said. “There’s just only so much they could do in their shift. And the one or two doctors I saw, they’re like efficiency machines.”

Although notable for its weeklong duration, Smid’s multi-day emergency department limbo is hardly unique in Abbotsford, statistics show. Abbotsford Regional Hospital’s patient backlog is one of the worst in the entire country, with one in 10 inpatients spending nearly four days lingering in the emergency department.

And despite assurances from top bureaucrats, it’s not getting better.

A year ago, the head of Fraser Health told The Current that emergency room congestion was getting better. But in the 12 months since, the opposite has occurred.

Smid’s visit to Abbotsford Regional Hospital is a snap-shot of the challenges confronting health care centres across Canada. But it’s also an example of how the patient experience at Abbotsford’s hospital stands out even in comparison to national struggles.

Born in the Netherlands, Leffert Smid and his wife Anne immigrated to Canada in the ’50s, taking the anglicized name Alex, which later became Lex. In 1957, the Smids moved to BC, where Lex started building homes, and raising a family. He and Anne would have four kids and, eventually, nine grandchildren and 15 great-grandkids. His grand-daughter Alexis notes Lex had a big personality, loved attention, “and had a bit of the dramatic in him,” his grand-daughter said.

Today, Smid is 93 and a resident of Menno Home, the long-term care residence next to Abbotsford Regional Hospital. He is showing signs of dementia, his grand-daughter says, and is aware that he’s nearing the end of his life. He sits at the leading edge of the Fraser Valley’s rapidly growing elderly population. Many, like Smid, need significant ongoing medical care and are much more likely to require occasional hospitalization.

In early February, Smid came down with a set of ailments—including an infection, fever, and dehydration—that aren’t particularly uncommon for a man of his age. So he was taken across the street to Abbotsford Regional Hospital for treatment and monitoring. His visit began in the hospital’s emergency department.

Typically, a patient would be assessed in the emergency department, admitted as an inpatient, then placed in an acute care ward. But Smid’s entire eight-day stay in hospital was spent in emergency. Instead of being placed in an inpatient ward, he was simply moved from the most-congested and busiest part of the department to a lower-traffic section deeper in the hospital.

Smid’s grand-daughter visited him regularly during his stay and said the experience was draining on her grandfather.

At the start of his visit, “he was smack dab in the middle of everything,” Toews said. “It was chaotic and there were so many people.”

She didn’t fault the nurses and doctors, saying they were stretched thin. But she said it was evident that a lack of resources was affecting patients.

“There were people there who had needs and they couldn’t be addressed, probably, as quickly as they should have.”

Toews said her grandfather was stuck in bed for long stretches of time and was clearly uncomfortable, but lacked the regular assistance of support staff who would be able to help him get up.

Such “mobilization” activity is critical to prevent bedsores and infections.

The Current reported in late May that hospital acquired pneumonia and urinary infections have increased by more than 40% in Fraser Health hospitals since 2019. During a fundraising push, an occupational therapist at Abbotsford Regional Hospital said that a “dire” shortage of wheelchairs was affecting patient care.

Although tales of days spent in the Abbotsford Regional Hospital emergency department date back more than a decade, the eight-day length of Smid’s still stands out as one of the worst anecdotes of emergency room medicine. But, worryingly, it could be a sign of things to come if Fraser Health cannot actually reverse long-standing trends.

Over the years, ARH’s “hallway medicine” problem has been blamed on many things, from bad flu seasons to a lack of space for elderly patients awaiting transfers to long-term care facilities. But the core issue is a scarcity of acute care beds for admitted patients. Until such beds open up, people have to be treated in the emergency room. In addition to leaving patients with a lack of privacy, such stays can increase risks to their health.

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Fraser Health’s own report cards declare: “In order to provide the best care for our patients, we want them to receive timely treatment and to move to a hospital bed for further care, if needed, within 10 hours.”

Fraser Health’s target is to have 65% of patients admitted within 10 hours. It has never come close to that figure over the last decade. And instead of making progress, it has consistently gotten further from that goal. In 2017/18, a year in which its hospitals were already drawing bad publicity for emergency room congestion, 35% of patients were admitted to a bed within 10 hours. Last year, the figure dipped below 20% for the first time ever.

Langley Memorial Hospital and Chilliwack General Hospital were among the worst performing in Fraser Health. Abbotsford Regional Hospital actually fared slightly better on that measure, even as other statistics show that its emergency department is increasingly used for long-term patient stays.

Every day at 2pm, staff at Fraser Health hospitals count the number of inpatients in places, like the emergency department, that aren’t designated for clinical care. The tracking is, in part, because the health authority is continually seeking to reduce the number of people, like Smid, who are treated in emergency departments.

“Patients who are waiting to move to an inpatient room have higher risk of adverse safety and quality of care events,” the health authority said in one online statistical document. “Moving admitted patients quickly out of the Emergency Department (ED) also allows our ED teams to respond to patients who require emergency care.”

But last year, the health authority’s emergency departments were filled with an average of 270 inpatients waiting for an acute care bed. Typically, 50 such patients were located in Abbotsford. That’s second only to Surrey Memorial Hospital and four times higher than the target set for the facility by the health authority. The figure has grown progressively higher each of the last three years and now means that approximately one in every eight inpatients is treated not in a ward, but in the emergency department. (By comparison, Chilliwack had 15 inpatients waiting for a bed, on average, while Langley had 22.)

A year ago, The Current interviewed Fraser Health CEO Dr. Victoria Lee about the congestion issues. She said progress had been made, noting that the average number of patients waiting for beds was once higher than 300, even though the last time the figure had been that high was a decade ago.

“It’s still not an ideal state, but there has been significant progress made,” she said.

One year later, the statistics—both those released by Fraser Health and those collected by the Canadian Institute for Health Information (CIHI)—continue to suggest that the problem is getting worse, not better.

CIHI’s figures lag those released by Fraser Health, but they show the incredible length of time thousands of patients end up spending in local emergency rooms.

In the 2022/23 fiscal year, 10% of patients in Fraser Health spent 71 hours—nearly three days—in the emergency department before being admitted to a bed elsewhere in the hospital. That’s a full day worse than the national average. The situation at Abbotsford Regional Hospital was even worse. There, one-in-10 patients spent 94 hours in the ER—nearly four whole days: double the provincial average. That figure is not only the highest in British Columbia, it’s the third-worst in the entire country.

Last year, the hospital admitted more than 12,000 “urgent and emergent” patients. That suggests that, over the course of a year, upwards of 1,000 patients will spend four days or longer in the emergency room and in conditions detrimental to their care and recovery.

Over the last decade, Fraser Health and its leaders have repeatedly been asked how they are addressing their persistent hospital congestion issues. Generally, they have stressed attempts to overhaul (or “transform”) how and where care is administered, pointing to the need to care for more patients out of hospital. They’ve regularly pointed to work focused on increasing efficiencies in hospitals and emergency rooms.

The response to The Current’s inquiries this time was notably different. When The Current contacted Fraser Health to ask what was being done to reduce the number of patients lingering in its emergency departments, a communications staffer replied with a long response that focused not just on efficiency processes, but on funding for actual beds and staff members.

The statement said 100 new beds have been added at hospitals in the Fraser Valley over the last year, with new staffing positions to match. Twenty-five of those were in Abbotsford. Since the start of last year, Fraser Health said 106 more physicians and 325 nurses are working at hospitals in the Fraser Valley—although those figures also include additions in Surrey. The response also cited work being done to attract more nurses, alluding to the difficulty to fill the health care jobs necessary to actually support patients in those new funded beds.

Eight days after he was admitted, Smid returned to his quarters at Menno Home, across the road.

But Smid has survived COVID, cancer, pneumonia, and falls in recent years and there’s a good chance he’ll be back.

Even if he doesn’t return to ARH, there will be many other patients like him.

After years of hoping more patients will fit into a static number of beds, the capacity of local hospitals is finally growing. But getting inpatients out of emergency departments will not only require capacity to keep up to a growing number of patients, but for health officials to recruit and retrain enough nurses and doctors to turn the tide.