Population growth and aging strain capacity of Ontario's emergency departments

TORONTO, Nov. 15, 2016 /CNW/ - People are seeing doctors more quickly when they arrive in Ontario's emergency departments (EDs) and overall their visits are shorter. This is despite an ever-increasing flow of patients who are becoming collectively older and sicker.   Most Ontario residents are also satisfied with the care they receive in emergency.

But emergency departments are under a great deal of pressure. While progress has been made in overall performance, an emergency department could be strained by a bad flu season, or if a hospital nearby has to temporarily close its emergency department.

Those are the findings of Under Pressure: Emergency Department Performance in Ontario, a report released today by Health Quality Ontario, the provincial advisor on health care quality.

The good news includes a 10% drop over the last seven years in the maximum amount of time nine out of 10 patients spent in the ED – to 7.8 hours from 8.7 hours. There was also more than a 16% decrease in the maximum amount of time nine out of 10 patients waited in the emergency department to see a doctor ­– to 3 hours from 3.6.

However, the data also show that urban residents spend longer in the emergency department and wait longer to see a doctor in emergency than people living in rural areas. As well, many of the sickest patients in the province – those who need to be admitted to hospital – have to wait a long time in the emergency department for a bed in an inpatient ward. This is often because patients who should be receiving more appropriate care in other settings such as long term care remain in hospital. This is called alternate level of care and can impact the ability of hospital to move patients from the EDs to an inpatient ward.

"Patients may spend hours and sometimes even days lying on stretchers in emergency examination rooms or hallways," said Dr. Joshua Tepper, President and CEO of Health Quality Ontario.

Overcrowding can lead to poor quality of care, increased distress, illness and mortality among patients, and increased risk of medical errors by overworked staff. Under Pressure finds these stressors and others are likely to continue to affect emergency departments for many years to come as the province's population both grows in size and ages overall.

The report shows growth in emergency department visits is outpacing population growth. Over the past seven years, the number of annual visits to Ontario's emergency departments increased 13.4% – more than double the 6.2% increase in the province's population.

Patients are also sicker overall. Visits by more seriously ill or "high-acuity" patients who were not admitted to hospital increased by 44.1%, and visits by patients who were admitted rose 17.5%.

Some of this increase in patient acuity can be attributed to a rise in visits by older patients, who tend to require more complex care. There was a 29.1% increase in visits by people aged 65 and over.

The report also outlines some of the programs and strategies that have been implemented to relieve the pressure on emergency departments in the province. These include the Emergency Room Wait Time Strategylaunched in 2008, the Ministry of Health and Long-Term Care's Patients First action plan, and Health Quality Ontario's Emergency Department Return Visit Quality Program.

"Even with the demographic challenges the province is facing, the concerted efforts made by government, hospitals and others to improve the performance of Ontario's emergency departments have brought many positive changes," said Dr. Tepper. "But it's clear that much work still needs to be done to make emergency departments work better for all patients."

OTHER KEY REPORT FINDINGS:

More emergency visits are meeting overall provincial targets for length of stay and wait to see a doctor. Between 2008/09 and 2014/15:

• The proportion of visits completed within the four-hour target for non-admitted low-acuity patients increased to 89.9% from 84.6%, and the proportion of visits completed within the eight-hour target for high-acuity patients and admitted patients taken together as a group rose to 85.7% from 79.8%

The majority of people in Ontario appear to be satisfied with the emergency care they receive. In a 2014/15 patient experience survey:

• 72.6% of respondents reported receiving excellent, very good or good care, with the other 27.4% rating their care as fair or poor

Some admitted patients spend a long time in emergency. In 2014/15:

• The maximum amount of time nine out of 10 admitted patients spent in emergency – was 29.4 hours

Some patients who are more seriously ill wait longer to see a doctor than less seriously ill patients. In 2014/15:

• The maximum amount of time nine out 10 patients waited in emergency to see a doctor was 3.1 hours for admitted patients and 3.2 hours for high-acuity discharged patients, compared to 2.7 hours for low-acuity discharged patients

Urban residents spend more time in emergency and wait longer to see a doctor. In 2014/15:

• The maximum amount of time nine out of 10 urban residents spent in emergency was 8.3 hours, compared to 5.6 hours for rural residents
• The maximum amount of time nine out of 10 urban residents waited in emergency to see a doctor was 3.1 hours overall for all acuity levels, and 2.6 hours for rural residents

Many patients visit the emergency department for less serious health issues. In 2013:

• 47% of adult Ontarians reported going to emergency for a condition they thought could have been treated by their primary care provider, if that doctor, nurse practitioner or other provider had been available. This rate was higher for Ontario than for its socioeconomically similar international counterparts, with Switzerland coming in at 36% and France lowest at 24%.

To read the full report visit, www.hqontario.ca/underpressure

About Health Quality Ontario

Health Quality Ontario (HQO) is the provincial advisor on the quality of health care. HQO reports to the public on the quality of the health care system, evaluates the effectiveness of new health care technologies and services, and supports quality improvement throughout the system. Visit www.hqontario.ca for more information.