Province to cut ER waits

Posted on February 20, 2009 in Governance Debates, Health Debates – – Province to cut ER waits: New website shows average wait times in each hospital’s emergency room
February 20, 2009.   Tanya Talaga and Megan Ogilvie

The first question on everyone’s mind when they walk into an emergency room is usually, “How long is the wait?”

A new government website that lists average waits in 128 emergency rooms around the province may bring some clarity to that question.

In order to get a handle on the situation inside emergency rooms, the province began collecting data last year on time spent in emergency by two types of patients – those with relatively minor ailments and those with more complex medical problems who might need a bed.

The poorest performing hospital emergency rooms for patients with minor health issues in the Toronto area include Toronto East General Hospital, with a 6.5-hour wait for nine out of 10 patients, and Mount Sinai Hospital, at 6.2 hours.

For complicated cases, some of the longest waits are at the University Health Network’s Toronto Western site and Humber River Regional Hospital’s Church St. and Finch Ave. sites.

“We aren’t where we want to be yet, but we are better than where we were,” said UHN president Dr. Bob Bell in an interview yesterday.

At the UHN Western site, the 23.7-hour wait in April for complex cases has been reduced to 21.8 hours, according to the latest figures available. It’s high because Western is the province’s neurological site – the hospital takes patients with serious neurological injuries so they don’t have to be flown out of the country for care. “We provide care to the local community and to the entire province,” he said.

Provincial health officials say it takes an average of 4.6 hours for patients with minor ailments to be seen, diagnosed and moved out of emergency, in 90 per cent of cases. The province’s target is four hours.

Those with more serious problems, such as cancer, or cardiac patients whose diagnosis and treatment takes longer, and who might need a hospital bed, the wait is 13.5 hours for 90 per cent of patients.

Hospitals across the GTA say they are working hard to reduce emergency department wait times. Many, especially in the booming 905, say they are operating under numerous pressures.

Communities are growing, especially at the edges of the GTA, which means hospitals see an increasing number of patients even as they implement strategies to reduce wait times. Populations are aging, so patients are arriving at emergency departments with more complex illnesses. And a shortage of beds in long-term care or rehab centres is creating a bottleneck in hospitals – patients who could be transferred to these “alternate levels of care” are taking up beds needed for incoming emergency patients.

Dr. Rueben Devlin, president and CEO of Humber River Regional Hospital, said the hospital faces two obstacles to reducing ER wait times: sicker patients and more patients waiting for long-term care beds. In October, the hospital’s Church St. site had an emergency-room wait time of 22.8 hours for complex patients and the Finch Ave. site, 20.8 hours.

The hospital is seeing a greater number of patients with acute illnesses who require admission – such as those suffering heart attacks or organ failure. The hospital has 27 intensive-care beds but needs many more to keep up with demand, Devlin said. Humber River has been approved for 46 intensive-care beds when it opens its new hospital in 2015, he said.

At Trillium Health Centre in Mississauga, hospital administrators say they are “kept up at night” by the pressure to keep their emergency-room wait times low. In October, nine out of 10 complex cases waited an average of 21.6 hours.

The greatest pressure comes from the rising numbers of “alternate level of care” patients, said Patti Cochrane, vice-president of patient services and quality at the hospital.

“Most of these patients are waiting for nursing home placement,” she said. “We have proven there is a direct relationship between the ED length of stay for patients admitted to hospital and the number of ALC patient days.”

Some of the wait numbers will “open a lot of eyes in the province,” Health Minister David Caplan told reporters at Queen’s Park. “This shows why this is the appropriate next step in our health-care plan.”

“We’ve been very successful on surgical and diagnostic wait times. This one is going to be more complex. It is going to be the focus of considered action on all three of those continuums – access, performance within the ER and discharge to a hospital bed. I’m determined to get those lengthy numbers down.”

The drive to reduce waits is part of the government’s $109 million strategy to direct patients away from emergency rooms if they don’t need to be there.

About 23 hospitals with poor performing times are receiving $39.5 million to enhance their computer systems, and for coaching teams.

The extra money should encourage hospitals to act, not to mention the posting of wait times on the public website,

Emergency room wait times are a symptom of how the system is working overall, said Tom Closson, president of the Ontario Hospital Association. “Getting the right mix of capacity of services out there and having the right processes to move people so they are cared for in the most appropriate setting, is what this is all about.”

Dr. Alan Hudson, the neurologist and former president of the University Health Network charged by the province with reducing wait times, said yesterday “the issue of wait times in emergency departments has been a problem for a long time. Collecting and reporting this information will help us monitor our progress in improving emergency room performance,” he said at a news conference at St. Michael’s Hospital announcing the launch of the website yesterday.

The province is also encouraging patients to use family health teams, nurse practitioner clinics and walk-in clinics. Locations and information on these options is available at

Ontario’s former health minister, Conservative MPP Elizabeth Witmer, was quick to denounce the ER targets as meaningless.

“They’ve ignored the problem and suddenly they are going to introduce wait time targets? They are meaningless because there is no capacity in the system,” she said.

Twenty-four thousand people need long-term care in Ontario and there are not enough beds, she said, adding that is higher than when she was health minister. Unless more home care, community support and long-term care is created, targets won’t help, she said.

“The joke is you hurry up and wait,” said Toronto paramedic Jesse MacNevin of emergency-department waits. He is hopeful the drive to reduce these times spent in emergency works. “This is a great help,” he said of the strategy.

Emergency room wait times in the GTA (pdf):  < >

Priority procedures in Ontario (pdf): < >

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