Wait Times
The NHS has made significant progress in its patient wait times for key procedures under the provincial government's new Wait Time Strategy and anticipates wait times will improve.
The graphs below display the 90th percentile wait in days (except for Cardiac Catheterization) against the Ministry of Health & Long Term Care (MoHLTC) wait time targets.
90th Percentile represents the point at which the majority (90%) of patients have completed surgery or have had their exam. Median is the measure of central tendency. It is the middle score above which half of the distribution lies.
Click HERE to go to the MoHLTC Wait Times website.
Emergency Department Wait Times
Wait times for both minor and complex patients in Emergency Room Departments are now posted publicly for hospitals across Ontario, including the Niagara Health System. This Ministry of Health and Long-Term Care (MOHLTC) initiative is the first of its kind in North America.
The total time spent in an ER is measured beginning when a patient registers, continues as the patient receives diagnostic/lab tests and treatment, and ends when the patient is either discharged or admitted to a hospital bed.
Based on the trend from October 2008 to December 2008, 90% of patients have experienced the following wait time trend:
- The target wait time for minor/uncomplicated patients is 4 hours and Ontario average is 4.7 hours and the NHS is experiencing 2.4 to 6.3 hour wait in December, which has decreased by 3.1% to 15.4% from October at 2.6 to 6.9 hours depending on the site.
- For complex/complicated patients, the target wait time is 8 hours, the Ontario average was 13.1 hours and the NHS is experiencing 6.2 to 18.6 hour wait in December, which has decreased by 1.6% to 29.5% from October at 5.9 to 26.4 hours depending on the site.
These numbers are not surprising, particularly when considering the very high numbers of Alternate Level of Care (ALC) patients across NHS sites. ALC patients no longer require acute care but remain in hospital beds while awaiting appropriate placement in long-term care, a rehab bed or home-care services.
On a daily basis average, the NHS admits 20 to 40 patients directly to our ERs because there are no beds. When this happens, they experience a much longer wait in the ER than is ideal. This is particularly pronounced at NHS large sites where the sickest, most complex patients are seen.
One of highest percentages of ALC patients
Niagara has one of the highest percentages in Ontario of ALC patients occupying acute care beds.
NHS ALC bed pressures climbed in October/08 to 32% of our acute bed capacity, compared to the provincial average of 19%. As a result, there were as many as 45 admit-no-bed patients in our ERs waiting for an acute care bed each day in the month of October.
New strategies
To counter the above-average wait times, the NHS has received $1.2 million to implement a number of strategies, focusing on St. Catharines’ ER. This innovative Pay-for-Results Program is part of the province’s Wait Time Strategy. To continue to receive this funding, the ER must reduce wait times for higher-acuity patients, reduce the number of patients with waits greater than 24 hours and ensure wait times for lower-acuity patients do not get worse. NHS is also required to regularly track patient satisfaction and monitor quality of care.
Other improvement strategies include the hiring of off-load delay nurses dedicated to managing patients coming in by ambulance to the St. Catharines, Welland and Niagara Falls ERs. These nurses started in February 2009.
Enhanced support services (porter/housekeeping) are now in place to improve response times, there is improved patient access to ultrasound, and an admission/discharge holding unit was established at St. Catharines General in November 2008.
We are hopeful that in upcoming months we will see improvements in our NHS ER wait times as our new ER strategies come on stream and new community initiatives to support ALC patients outside of hospitals are realized in the community. Already, early review of our latest wait time data is very positive.
Rapid Assessment in New Clinical Systems Investigation Units
Another key initiative for ER wait time improvements are the new Clinical Systems Investigation (CSI) units now open at our 3 ERs. These rapid assessment units provide faster care by making the best use of dedicated stretchers. Rather than patients occupying the stretchers throughout the time they are in the ER, they are only in the stretcher while receiving direct care from the physicians or nurses. Diagnostic tests and lab work is ordered by CSI nurses so the physician has the results when he/she comes to see the patient for the first time. This reduces the patient’s wait time considerably.
The major impact of this new area is on the flow of Canadian Triage Acuity Scale Level 3 patients through the ER, who have been triaged with urgent care needs. Fully 57% of all patients presenting daily our St. Catharines ER are a Level 3 (Level 1 is life-threatening, Level 5 is non-urgent).
The CSI unit allows more patients to receive treatment in the ER at the same time.
ED Wait Times
*Please note that the ER information is not real-time information and should not be used to assess the time you may spend in the ER today. If you believe you need immediate emergency care, please go to your nearest emergency room.
*Please note that the ER information is not real-time information and should not be used to assess the time you may spend in the ER today. If you believe you need immediate emergency care, please go to your nearest emergency room.
Number of ER visits:
| Month | SCG SITE | GNG SITE | WHS SITE |
|---|---|---|---|
| Oct-08 | 3,689 | 3,757 | 2,149 |
| Nov-08 | 3,628 | 3,574 | 2,048 |
| Dec-08 | 3,666 | 3,516 | 2,175 |
| Jan-09 | 3,648 | 3,574 | 2,047 |
| Feb-09 | 3,610 | 3,363 | 1,982 |
| Mar-09 | 3,937 | 3,754 | 2,245 |
| Apr-09 | 3,797 | 3,831 | 2,190 |
| May-09 | 3,794 | 3,996 | 2,329 |
| Jun-09 | 3,695 | 3,897 | 2,288 |
| Jul-09 | 3,762 | 4,082 | 2,305 |
| Sep-09 | 3,651 | 3,624 | 2,164 |
ED/UCC Wait Times
*Please note that the ER information is not real-time information and should not be used to assess the time you may spend in the ER today. If you believe you need immediate emergency care, please go to your nearest emergency room.
*Please note that the ER information is not real-time information and should not be used to assess the time you may spend in the ER today. If you believe you need immediate emergency care, please go to your nearest emergency room.
Number of ER/UCC visits:
| Month | PCG SITE | DMH SITE | OSS SITE |
|---|---|---|---|
| Oct-08 | 1,716 | 1,665 | 2,897 |
| Nov-08 | 1,572 | 1,515 | 2,608 |
| Dec-08 | 1,529 | 1,382 | 2,652 |
| Jan-09 | 1,484 | 1,387 | 2,715 |
| Feb-09 | 1,518 | 1,359 | 2,705 |
| Mar-09 | 1,630 | 1,664 | 3,150 |
| Apr-09 | 1,579 | 1,683 | 2,895 |
| May-09 | 1,616 | 1,555 | 2,965 |
| Jun-09 | 1,567 | 1,498 | 2,857 |
| Jul-09 | 1,639 | 1,708 | 2,882 |
| Sep-09 | 1,577 | 1,459 | 2,863 |
Definitions:
Total Time Spent in ER: The maximum amount of time 9 out of 10 patients spend in an ER being diagnosed, receiving treatment or waiting for admission to a hospital bed. Most patients spend less time, while one out of ten patients will spend more time.
Provincial Target: Ontario has two targets for time spent in ER:
- up to 8 hours for patients with complex conditions requiring more time for diagnosis, treatment or hospital bed admission
- up to 4 hours for patients who have minor or uncomplicated conditions requiring less time for diagnosis, treatment or observation
Provincial Average (Time Spent in ER): The time spent in ER value calculated from all time spent in ER data submitted in Ontario.
Complex conditions/requiring more time for diagnosis, treatment or hospital bed admission: Refers to the maximum amount of time 9 out of 10 patients with complex conditions requiring more time for diagnosis, treatment or hospital bed admission spent within the ER from the time they register to the time they leave the ER.
Minor or uncomplicated conditions/requiring less time for diagnosis, treatment or observation: Refers to the maximum amount of time 9 out of 10 patients with minor or uncomplicated conditions requiring less time for diagnosis, treatment or observation spent within the ER from the time they register to the time their visit is complete and they leave the ER.