ED Overcrowding: The Ontario Approach

Abstract

Ontario is Canada's most populous province, with approximately 12 million people and 130 emergency departments (EDs). Canada has a national single-payer universal health care system, but provinces are responsible for administration. After years of problems and failed attempts to address chronic ED overcrowding, in April 2008 Ontario embarked on an ambitious program to improve system performance through targeted investments (initially CAN$500 million over 3 years) and realigned incentives. Supporting the program were requirements for hospitals to submit timely data and targets for length of stay (LOS) and annual improvements; results are publicly reported. The program has been continued this year. While not all our provincial level targets have been met as yet, major improvements have been made, especially in access to care and LOS in the ED for patients eventually discharged home. The greatest improvements were made among the cohort of mainly urban, high-volume EDs that had the worst performance at baseline. This presentation will highlight some of the controversies and challenges and key lessons learned. Overall, the Ontario experience suggests ED overcrowding is a soluble problem, but requires a system-level intervention.

Quality Measurement In The Emergency Department: Past And Future

“…EDs have been held accountable for waiting time to varying degrees through public reporting of their performance and through hospital performance incentives, penalties, or both. [28][29][30] Although success at reducing crowding varies across jurisdictions, 27,28 the implementation of these benchmarks and targets has resulted in an unprecedented focus on the problem of overcrowding by hospital and regional decision makers. 30 This focus has led some US observers to advocate that either the Joint Commission or CMS should impose similar strict timing targets.…”

Association Between Emergency Department Length of Stay and Rates of Admission to Inpatient and Observation Services

“…1 There is concern, however, that eventual implementation of these benchmarks as part of ED LOS quality measures or tying them to reimbursements could lead to adverse consequences, including rising numbers of brief admissions that have been observed in other nations with similar programs. 2-4 …”

National Reporting of Emergency Department Length of Stay

“…There seems to have been limited change in the time to place admitted patients into their inpatient beds (ie, boarding time), thought to be due to limited changes in practice on the inpatient units. 10 Several US hospitals are now embarking on a similar federally mandated effort to report various measures of emergency departments performance. Pilot projects as part of the Agency for Healthcare Research and Quality Health Research & Educational Trust have provided some insight into the efforts that hospitals must make to comply with the new measures.…”