Ontario patients visiting the emergency
departments (EDs) of busy community and teaching hospitals
can expect to be there up to three times longer than
those who present at one of the less crowded facilities,
according to new data from the Canadian Institute of
Health Information (CIHI) released January 24. If they
end up being admitted, they can spend as long as 17
hours in the ED before settling into an inpatient bed.
The report, which follows up a
2005 CIHI study of national ED usage trends, looks at
four key areas: overall time spent in the ED in relation
to volume/hospital type; location; wait times to initial
physician assessment; and a look at admission rates
by triage level.
Not surprisingly, the big teaching
hospitals in and around Toronto saw the biggest volumes
and the longest wait times — frequently in the
nine-hour range. Seventy percent of Ontario's ED visits
occurred in teaching and high-volume community hospitals
like these, which also handle the sickest patients,
with 63% classified as level I, II or III under the
Canadian Triage and Acuity Scale (CTAS).
TIME
TO MD ASSESSMENT
Half of patients visiting the busier EDs wait around
an hour before being assessed by a physician; in lower-volume
settings, the same number are seen in the first 30 minutes.
The sickest (CTAS I) patients,
however, normally get in to see a doctor within six
minutes, no matter the setting. "It's reassuring that
the data does confirm people with the most urgent conditions
are treated first, in the shortest time frames," CIHI
researcher Greg Webster told the CBC.
The new data has already had a
perhaps not entirely desirable effect. Soon after the
study was released, Ontario's health minister George
Smitherman announced he was putting the ED wait time
targets announced in October on hold. "We're already
having a difficult time," the minister said at a press
conference. "Applying a standard that may in fact be
artificial is not something that we have an interest
in."
The targets were part of a joint
effort by the Ontario Hospital Association, the OMA
and the Ontario Ministry of Health. Their report, Improving
Access to Emergency Care: Addressing the System Issues
— which takes the UK's ED wait time benchmarks
as its model — recommended CTAS I, II and III (the
most urgent cases, like MIs, head injuries and gunshot
wounds) patients spend no more than six hours in the
ED. Less urgent cases (CTAS IV and V) should be discharged
within four hours. It's not clear yet if Minister Smitherman's
announcement will thwart the report's aim to have these
targets met for 95% of patients by 2010.
MY
KINGDOM FOR A BED
It's widely agreed that one of the biggest causes for
long ED stays is the dearth of beds "upstairs" for admitted
patients, not the time it takes to see a doctor. "Patients
are waiting too long to be seen in emergency rooms because
of overcrowding and backlogs elsewhere in the system,"
noted Dr Tim Rutledge, of North York General Hospital
in Toronto, in the Globe and Mail. In Ontario,
the number of acute inpatient hospital beds fell by
22% during the 90s. The October report included recommendations
that the government provide funds to redress this. It
also included the provision that hospitals that regularly
fail to meet ED length of stay targets should be funded
for extra acute care beds. In addition, ED patient volumes
should be linked directly to the number of acute beds
funded per hospital. The new local health integration
networks (LHINs) would play an important role in this
and other changes, including community-based management
of chronic care to keep patients with chronic diseases
like COPD and type II diabetes out of acute care beds.
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