Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 107
Specialized ambulatory services are generally provided in outpatient
departments of hospitals. Although there is a noticeable trend towards
providing such services in specialized clinics and physician practices, this has
not yet become the dominant mode of delivery in part because of the public
reaction to switching from delivery by non-profit-making hospitals to delivery
by profit-making clinics. Organized labour, in particular, has been hostile to
this development since it may involve moving from a unionized workforce to a
non-unionized workforce, and one of the largest public sector unions in Canada,
the Canadian Union of Public Employees, has been vocal in its opposition to
private-sector contracting out (Canadian Union of Public Employees, 2005). In
addition, the Canadian Health Coalition, a civil society organization dedicated
to defending universal medicare in Canada, has also lobbied against provincial
privatization initiatives including hospital public-private partnerships (P3s in
Canada) (Shrybman, 2007).
5.5 Emergency care
Emergency care in Canada generally refers to the care provided in an
emergency department, sometimes also referred to as an emergency ward
or emergency room, of a hospital, staffed for 24 hours a day by emergency
physicians and emergency nurses. Emergency care also includes the emergency
medical services that provide transportation (e.g. road or air ambulance) and
the pre-hospital or inter-hospital patient care during transportation, including
the certified first responders and emergency medical technicians who
stabilize the patient before and during transportation. Physicians who practise
emergency medicine are either specialist fellows of the RCPSC or specialist
family physicians who are certified through the College of Family Physicians
of Canada. RNs can be certified as emergency nurses through the Canadian
Nurses Association.
There has been much concern about ED overcrowding and long waiting
times in the past decade. In a 2004–2005 survey, 62% of ED directors perceived
overcrowding to be a major or severe problem (CADTH, 2006). The evidence,
although limited, supports the prevalent perception that the time from ED triage
to treatment has increased significantly and the time patients spend in ED
departments has also increased steadily (Bullard et al., 2009).
In Canada, a man with acute appendicitis on a Sunday morning would take
the following steps: