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Reducing ER wait times our No. 1 priority

Posted Sep 17th, 2010

Most patients begin their hospital journey in the Emergency Room, whether they arrive by ambulance, walk in or are transferred from another healthcare facility.

“Reducing wait times in the Niagara Health System’s three ERs is our No. 1 priority,” says Anne Atkinson, Vice President Patient Services. “Our ultimate goal is to provide patients with the quality care they deserve while at the same time reduce the length of time they have to wait to receive their care. We have made some improvements, but there are still challenges and opportunities for further improvement.”

Doctors and nurses in the ERs assess patients, stabilize them, and get them where they need to go in a timely and safe manner. In many cases, they can diagnose, treat and send the patient home, but in other cases, the patient requires extensive intervention.

Increasing number of patients with serious conditions

“Our ERs are seeing an increasing number of patients with more serious conditions who require extensive assessment from our healthcare team,” says Dr. John McAuley, Regional Chief of Emergency Medicine. “These patients require more time with the doctors and nursing staff and more resources, such as diagnostic imaging and laboratory work, increasing the amount of time they are in the ERs.”

A key reason ER patients are sicker may be the lack of access to primary care in Niagara; many patients do not go to their family doctor or other healthcare providers for care and instead wait until their condition is serious before seeking help at the ERs.

The more involved assessment required for sicker patients unfortunately creates delays for others and has a direct impact on the length of time it takes patients who arrive by ambulance to be transferred from the care of paramedics to the care of ER doctors and nurses. This time is known as an off-load delay.

“In 2009, we made significant headway in decreasing off-load delays, but in 2010 they started creeping back up,” says Anne. “This is due to the increasing amount of time and resources involved in caring for our sicker patients who come to us with chest pain, head injuries, abdominal pain and other serious conditions.”

Every patient who comes through our Emergency Room or Urgent Care Centre doors, whether they walk in or come by ambulance, is assessed or “triaged” according to their level of illness or injury.

Patients who arrive at hospital by ambulance are not seen first by the physicians because they arrive by ambulance. They are seen in the order of priority of condition – life and limb threatening conditions are seen first whether they drive in, walk in or come by ambulance.

No connection with conversion of ERs in Port Colborne and Fort Erie

Niagara Health statistics do not show a connection between the increase in the off-load time at the three large ERs and the conversion of the ERs at Port Colborne and Douglas Memorial (Fort Erie) sites to Urgent Care Centres.

“Overall, we are seeing a two per cent increase in the number of patients coming to the three ERs,” says Anne. “At the same time, the Urgent Care Centres in Fort Erie and Port Colborne are seeing more patients than they did when they were ERs.”

“We encourage patients to continue to use the Urgent Care Centres for treatment for less serious conditions. Wait times in our Urgent Care Centres are significantly lower than in our ERs. This includes our Ontario Street Site Urgent Care Centre in St. Catharines.”

Delays: a ripple effect

Another key impact on wait times in the ERs is the number of patients elsewhere in the hospital who occupy beds but no longer require hospital care. These patients cannot be discharged until the care they require is available elsewhere in the community, creating a ripple effect throughout the hospital. Delays occur in in the ERs as patients continue to be admitted but have to wait for patients elsewhere in the hospital to be discharged. This, in turn, creates a backlog of new patients arriving in the ER by ambulance, car or otherwise.

New initiatives underway

Niagara Health is working closely with ambulance officials and other healthcare partners to decrease wait times and off-load delays in the ERs. These are some of the initiatives underway:

  • A dedicated off-load delay nurse was recently added at each of our three ERs through new provincial funding. This nurse attends to the needs of less urgent patients who arrive by ambulance. The role of this nurse is vital to helping us work hand-in-hand with ambulance officials to meet patient needs in a more timely manner and allow paramedics to get back on the road in the community.
  • Nurse practitioners stationed in the ERs in Niagara Falls and Welland help doctors care for patients, enabling the overall flow of patients through the ERs.
  • Additional physicians have been added to the ER shifts during peak times; more doctors working at the same times means patients can be seen faster.
  • Fast track areas in the ERs opened to meet the needs of patients with non-urgent conditions and reduce congestion for patients waiting to be seen in the ER.
  • New medical directives give nurses the authority to conduct certain tests in advance of the doctor’s assessment. This way, when the doctor sees the patient, they already have test results and information that can lead to a more rapid diagnosis and course of treatment. As a result, patients spend less time in the ER.
  • Enhanced support services (porters/housekeeping) are improving response times for transporting of patients throughout the hospital and cleaning of patient areas.
  • Greater focus on working with community partners ensures patients can access care in the community so they can be discharged from hospital on a timely basis.
  • Re-evaluating a protocol agreed upon a year ago by hospital and ambulance officials to continue bringing certain patients by ambulance to the Urgent Care Centres in Port Colborne and Fort Erie, depending on the seriousness of their condition. There may be opportunities to revise the guidelines so more patients can be safely taken to the Urgent Care Centres. 

Committed to improving wait times

“There are always peaks and valleys with Emergency Department care, in terms of the number of patients coming to the ER on any day as well as the seriousness of their conditions,” says Anne. “We are committed to improving wait times, and we will continue to closely monitor the ERs and introduce new initiatives to enhance care for patients and their loved ones.”

For more information, media may contact:
Caroline Bourque Wiley
Public Affairs Consultant
905-378-4647, ext. 43113

Niagara Health System