Go to content

Restrictions on hospital use during SARS led to modest decreases in elective admissions, but also affected some urgent services


Restrictions on non-urgent hospital use during the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 led to only modest decreases in overall elective hospital admissions, and briefly affected admissions for some potentially seriously ill patients, a new Institute for Clinical Evaluative Sciences (ICES) study shows.

“Toronto’s SARS outbreak in 2003 was the largest outside Asia and transmission was largely confined to hospitals through contact with infected patients. To limit the spread of SARS, a provincial health emergency was declared with widespread restrictions on non-urgent use of hospital-based services at all 32 hospitals in the Greater Toronto Area (GTA),” said Dr. Michael Schull, ICES scientist.

“In our report, we describe the impact that these restrictions had on healthcare use and offer lessons learned that may assist healthcare planners in designing large healthcare systems with greater adaptability in future epidemics.”

The ICES study determined rates of hospital admissions, emergency department (ED) and outpatient visits, diagnostic testing, and drug prescribing within the GTA, and compared them with other regions in Ontario (Ottawa and London) that were not subject to the restrictions. This was done for the time periods before SARS (April 1, 2001 to March 14, 2003), in the early phase of SARS restrictions (March 15 to May 14, 2003), and in the late phase (May 15 to July 14, 2003).

The results showed that:

  • High urgency ED visits fell by 37% in the GTA.
  • During early and late SARS restrictions, hospital admission rates for medical conditions decreased by 10-12% overall in the GTA, while no changes were seen in the comparator regions.
  • Hospital admission rates for some serious medical conditions such as heart attacks, gastrointestinal bleeding and pulmonary embolus decreased by 15-21% in the GTA.
  • Rates of elective surgery in the GTA fell by 22% (early SARS) and 15% (late SARS), and by 8% in the comparator regions, while urgent surgical admission rates remained unchanged in all regions.
  • Elective cardiac procedure rates declined by up to 66% in the GTA and 71% in the comparator regions; those for urgent and semi-urgent procedures barely declined or increased.
  • Transfers of emergency patients from neighbouring hospitals to GTA hospitals declined by 44%.
  • Drug prescribing and primary care visits were unchanged.

“Our findings suggest that restrictions on non-urgent hospital use during SARS resulted in only a modest decrease in the rate of elective admissions, while having had some unintended consequences on urgent services,” said Dr. Schull.

“During a major community-based outbreak, the ability of hospitals to admit large numbers of affected patients will be limited by hospital occupancy rates, which are continually high.

“Therefore, when required, restrictions on hospital use should be accompanied by public health initiatives that encourage the continued use of the healthcare system by patients with potentially serious conditions. Policies are also needed to ensure continued access to highly specialized and regionalized services,” added Dr. Schull.

The study “Effect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome” is in the June 19, 2007 issue of the Canadian Medical Association Journal (CMAJ).

Author affiliations: ICES (Drs. Schull, Stukel, Zwarenstein, Alter, Manuel, Guttmann, Laupacis, and Ms. Vermeulen); Clinical Epidemiology Unit (Drs. Schull, Stukel), Department of Emergency Services (Drs. Schull and Schwartz), and Sunnybrook-Osler Centre for Pre-Hospital Care (Dr. Schwartz), Sunnybrook Health Sciences Centre; Department of Medicine (Drs. Schull, Alter), Department of Health Policy, Management and Evaluation (Drs. Schull, Stukel, Zwarenstein, Alter, Manuel, Guttmann, and Laupacis), University of Toronto; Division of Paediatric Medicine (Dr. Guttmann), The Hospital for Sick Children.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Dowdie
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143


Contributing ICES Scientists

Research Programs

Associated Sites

Read the Journal Article