Hospital Emergency Departments

Audited Entities

• Ministry of Health and Long-Term Care
• Various Hospitals and Emergency Medical Services

Audit Objective(s)

• The objective of the audit was to assess whether selected emergency departments had adequate systems and procedures in place to ensure that:
  • services were managed and co-ordinated effi­ciently to meet patients’ needs;
  • services were delivered in compliance with applicable legislation and policies in a cost-effective manner; and
  • performance was reliably measured and reported.

Audit Scope

• On-site audit work at three hospitals
• Surveyed 40 hospitals of varying sizes
• Surveyed 14 ambulance Emergency Medical Services

Audit Criteria

• Not available

Main Audit Findings

• Significant province-wide progress has not yet been made in reducing emergency-department wait times. At the time of the audit, emergency-department wait times did not yet meet provincial targets.
• Prov­incially, actual times to physician assessment did not meet the CTAS-recommended times by a wide margin, especially for high-acuity patients in CTAS levels 2 and 3: only 10% to 15% of the patients in these levels were seen by physicians within the recommended timelines.
• Over three-quarters of the hospitals that responded to our survey indicated that limited hours and types of specialists and diagnostic services available on-site were key barriers to efficient patient flow.
• Delays in transferring patients from emergency departments to hospital beds frequently occurred because empty beds had not been identified or hospital rooms cleaned on a timely basis.
• Patients with less urgent or non-urgent conditions took up 30% of emergency-department physician time, which could have been spent on patients with more urgent conditions.

Selected Audit Recommendations

• To ensure that emergency departments are operating in the most effective way to provide high-quality emergency care as quickly as pos­sible to all patients:
  • hospitals should identify causes of delays in patient flow and examine ways of reducing wait times in emergency departments accordingly;
  • the Ministry of Health and Long-Term Care should work with the LHINs and with hospi­tals to identify and disseminate best practices from Ontario and other jurisdictions; and
  • the Ministry should provide funding to hospi­tals in a timely manner to enable hospitals to have adequate time to implement the funded initiatives cost-effectively.
• To ensure that triaging is done appropriately and consistently within the recommended time frame:
  • hospitals should conduct periodic audits to monitor the quality and accuracy of triage and identify areas for improvements;
  • hospitals should consider performing a quick “pre-triage” on patients who cannot be tri­aged immediately upon arrival at emergency departments; and
  • the Ministry should work with the Emer­gency Medical Services (EMS) to provide updated training for paramedics to ensure that hospitals and paramedics are using con­sistent triage practices.
• To better allow hospitals to assess the impact that timely specialist consultation and diag­nostic services have on patient care, especially for high-acuity patients, hospitals should track targeted and actual wait times for specialist con­sultation and diagnostic services for emergency patients, so that the impact of these wait times on providing timely and appropriate patient care can be periodically assessed.

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