Hospital Emergency Departments
Link to full report:
- Ministry of Health and Long-Term Care
- Various Hospitals and Emergency Medical Services
- 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.
- On-site audit work at three hospitals
- Surveyed 40 hospitals of varying sizes
- Surveyed 14 ambulance Emergency Medical Services
- 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.