Ontario's acting auditor general says one in five patients who visited the province's emergency departments were only there because they did not have a family doctor.
Nick Stavropoulos has released an annual report that focuses on 12 value-for-money audits.
Four of those audits focused on health care, including an examination of emergency departments, health care in northern Ontario, the state of long-term care homes and Public Health Ontario.
Stavropoulos says Ontario did not have a provincewide strategy to help hospitals prevent temporary emergency department closures.
He has found hospitals continue to struggle with shortages of nurses and doctors and that patients are waiting an average of two hours before a physician assessment and there's a 24-hour wait for an in-patient.
Stavropoulos also says hospitals are becoming more reliant on nursing agencies to fill gaps, which comes at a significantly higher cost.
"The lack of a provincewide strategy to help hospitals prevent emergency department closures, in addition to ongoing staffing shortages, continues to put a strain on hospitals," Stavropoulos wrote in a statement.
"This means that patients are less likely to receive timely care when they need it."
Patients who needed life-saving care are still able to receive timely care, Stavropoulos found, but he noted that the average wait to first see a doctor is up by 30 minutes over the last 10 years.
There were more than 200 unplanned temporary emergency department closures in 23 hospitals between July 2022 and June 2023 due to doctor and nurse shortages.
The lack of triage nurses for patients coming in by ambulance prevents paramedics from returning to the road quickly, leading to what's known as off-load delays, Stavropoulos said.
Some hospitals have worked with paramedic services to improve turnaround times, but not all hospitals have done so.