ED Overcrowding: solutions that work

1
ED Overcrowding solutions that work

• CAEP 2009 Annual Meeting
• June 7th, 2009
• Michael Schull

2
Disclosure

• I do not have an affiliation (financial or
  otherwise) with any commercial organization that
  may have a direct or indirect connection to the
  content of my presentation.
• Advisor to Ontario Ministry of Health and
  Long-Term Care

3
Objective

• Discuss macro or system level intervention that
  addresses ED overcrowding
• waiting time total ED length-of-stay

4
The ER/ALC Strategy The Big Picture
Actions to reduce ER Wait Times must be applied
across the entire health care system
Community Appropriate Alternatives to ER
Services
Faster Discharge for ALC Patients
Improving Processes within the ER
OR
Alternate Levels
Alternate Levels
of Care
of Care






Community and home-based services
ED
ER
Home
Home
Home








H






H






Rehabilitation
Rehabilitation
Rehabilitation
Rehabilitation














Complex and Continuing Care



















Long Term
Long Term Care
Long Term
Long Term
Care
Care
Care
5
Ontarios ER/ALC Strategy

• Strategies focused on key chronic diseases and
  mental illness/addiction to reduce/prevent ER
  visits
• Increasing access to family health care
• Public provided with information on alternatives
  to the ER and time spent in the ER

Appropriate Alternatives to ER Services

• Reduced wait times
• Improved satisfaction
• Increased predictability for patients

Build ER Capacity and Improve ER Processes

• Paying designated hospitals incentives for
  measurable improvements in ER performance.
• Setting targets for time spent in the ER
• Creating process improvement programs to assist
  hospitals in improving patient flow

• Investments to increase home care and community
  supports
• Linking hospital ERs with Community Care Access
  Centres
• Increasing long-term care capacity and outreach
  services.

Faster Discharge for Alternate Levels of Care
(ALC) Patients
6
Principles in Ontarios ER/ALC strategy

• Clear performance metrics and targets
• Explicit accountability
• Transparency through public reporting of
  performance
• Reward good performance

7
Provincial ED LOS targets (ED arrival to physical
departure)
8
Provincial ED LOS incremental improvement target
for 2009/10

• 10 absolute improvement in proportion of
  patients meeting these targets over 2008/09
• Performance tied to Pay-for-Results scheme

9
ER Wait Times - Time Spent in Emergency
RoomsThis is the place to start if you are
interested in learning about how much time
Ontarians spend in Emergency Rooms (ER). While
you are spending time in the emergency room,
doctors and nurses may be treating your
condition, ordering tests or waiting for results
in order to determine the best treatment for you.
Sometimes patients are admitted to a bed in the
hospital if they need care for a longer period of
time. The information on this site tells you
about wait times in hospital emergency rooms in
your community and across Ontario. The Health
Care Professionals section provides a full
summary of Ontarios ER wait time statistics,
strategy, and resources.
Patients/Public
Health Care Professionals More in-depth details
and resources
Disclaimer Please note that the time spent in
ER information on this site is not real-time
information and should not be used to determine
the time you will spend in the ER today. If you
need immediate emergency care for your health
problem or injury, please go to your nearest ER.
http//www.ontariowaittimes.ca
10
(No Transcript)
11
Patient Side Main Search Page
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
Ontario ED LOS performance to target (Q1, Q2
FY2008)
Provincial target 90
16
Questions?
17
Early results of P4P

• ?ED LOS has decreased more in P4R hospitals than
  in non-P4R hospitals in 08/09
• Unprecedented attention to ED LOS issue at all
  levels of hospital, competitive, cooperative
  spirit
• Great interest/anxiety about becoming a P4R site,
  most effective catalyst

18
The Initiatives
19
How did hospitals spend the money?
20
How did hospitals spend the money?