Emergency Department Wait Times

Overview

The NE LHIN continues to work to ensure timely access to care in hospital emergency departments (ED).  Reducing the length of stay in the ED for non-urgent visits is related to both efficient hospital operations and reducing the number of visits that could be managed well elsewhere.  Improving efficiency includes initiatives like establishing rapid assessment zones and ensuring laboratory and other testing is done quickly.  Reducing visits that could be managed well outside of an ED is closely linked to improving access to primary care settings for fellow Northerners.   For patients who are assessed in an ED and require admission to hospital, it is important that any barriers to admission are eliminated.  Reducing the number of patients in hospital who are designated as requiring an “alternate level of care” (ALC) is about improving patient flow in the hospital from the ED to patient floors.  Thus the NE LHIN’s efforts to improve ALC rates are closely aligned with improving ED length of stay for patients requiring admission.  

Current Status (2015)

  • There are 27 Emergency Departments across Northeastern Ontario. Nine hospital corporations are part of the Emergency Room NACRS Initiative (ERNI) reporting system in Northeastern Ontario.  The ERNI reporting system documents ED length of stay for participating hospitals in Ontario.
  • As a whole, the NE LHIN ED length of stay for high and low acuity patients who are not admitted to hospital are at, or near, provincial targets.  For admitted patients, overall patient flow in some hospitals has been challenged by high levels of ALC.
  • The rate/1000 population of unscheduled ED visits in Northeastern Ontario continues to be nearly twice that of the province as a whole. This reflects the lack of primary care services (such as after hours) and community support services in our communities that could assist in avoidance of visits to the Emergency Departments particularly for those conditions that are well managed by primary care
  • Based on 2014/15 data, EDs in Northeastern Ontario had 457,000 emergency visits of which 229,000 or 50% were non-urgent or less urgent visits.  Of this total, 28,000 visits were comprised of those conditions that can be well managed in primary care.
  • Key issues that impact the reduction of non-urgent and less urgent visits to the Emergency Department are: lack of primary care services; lack of community support services; shortage of human resources; and lack of residential housing to support these patients.
  • LHIN interventions to date: CCAC case managers in EDs to assist with  assessing  and moving patients out of EDs and back home or to appropriate placement; Geriatric Emergency Management nurses, Nurse Led Outreach Teams in long-term care homes to support acute illness/injury; and enhanced community supports and access to services such as Rapid Response Nurses supporting discharge of patients with chronic diseases to assisted living for high risk seniors to support seniors safely in the community. 
  • ED Pay for Results (P4R): In Ontario, hospitals with greater than 30,000 ED visits per year participate in the P4R program of the Ministry of Health and Long-Term Care.  The P4R program provides one-time funds to support improvement in ED length of stay.  In the NE LHIN four hospitals including Health Sciences North, North Bay Regional Health Centre, Sault Area Hospital and Timmins and District Hospital are “P4R” hospitals.  Each year in partnership with the NE LHIN, these hospitals develop Action Plans to address improving ED length of stay.  The NE LHIN funds these Action Plans and hospitals compete across Ontario based on performance across 5 key ED metrics.  High performance (improvement in ED length of stay) is rewarded with higher performance scores and linked to total ED visits results in funding be awarded based on this competitive model each year.  

Goals

NE LHIN goals regarding Emergency Department Wait Times are:

  1. To improve NE LHIN ED length of stay performance across individual hospitals and the LHIN as a whole.
  2. To reduce the rate of unscheduled ED visits, particularly for those visits that can be well-managed in primary care.

Actions

The NE LHIN’s 2013-2016 Integrated Health Services Plan (IHSP) identified four key priorities including:  Increase Primary Care Coordination; Enhance Care Coordination and Transitions to Improve the Patient Experience; Make Mental Health and Substance Abuse Treatment Services More Accessible and Target the Needs of Culturally Diverse Population Groups.  Each priority contains actions that support improvements to patient care and the ED.  Some of these actions include:

  • Primary care: Promote Health Care Connect and work to increase patient rostering which will enhance access to primary care for NE LHIN residents
  • Primary care: Promote Advanced Access and after hours care across NE LHIN primary care physicians
  • Transitions of Care: Ensure timely sharing of patient information as high-risk clients/patients are discharged from hospital by linking electronic health records from hospitals to primary care providers
  • Mental Health/Substance Abuse: Work with partners to develop programs that incorporate the use of peer support workers to assist patients with mental health and addictions conditions to reduce reliance on the ED
  • Needs of Culturally Diverse Populations: Enhance access to health care services that are linguistically and culturally appropriate and deemed culturally safe for Aboriginal/ First Nation/Métis population.  
The NE LHIN will also focus on system “enablers” with a focus on technologies that improve access to care across the region. The Telehomecare program supports patients with congestive heart failure and enables them to be connected to nurses via technology.  The program teaches patients to enhance their ability to self-manage their condition and symptoms.  By focusing on such technologies patients receive care where they live and can avoid unnecessary trips to the ED.