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ED overcrowding: the Ontario approach.

¹Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Ontario, Canada. howard.ovens@utoronto.ca

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine

|December 16, 2011

Summary

Ontario

Area of Science:

Health Services Research
Public Health Policy
Emergency Medicine

Background:

Canada's universal healthcare system places provincial administration responsibility on provinces.
Ontario, Canada's most populous province, faced persistent emergency department (ED) overcrowding.
Previous attempts to alleviate ED overcrowding were unsuccessful.

Purpose of the Study:

To evaluate the impact of Ontario's 2008 system-wide intervention aimed at reducing emergency department overcrowding.
To identify key lessons learned from this large-scale healthcare system improvement initiative.

Main Methods:

Implementation of a provincial program with targeted investments and incentive realignment.
Mandatory timely data submission from hospitals with public reporting of performance.

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Setting targets for length of stay (LOS) and annual improvement.

Main Results:

Significant improvements in emergency department access and length of stay for discharged patients.
Greatest improvements observed in high-volume urban emergency departments that initially performed poorly.
While not all targets were met, substantial progress was made in system performance.

Conclusions:

Emergency department overcrowding is a solvable problem through systemic interventions.
Ontario's experience demonstrates the effectiveness of a coordinated, data-driven approach to improving emergency care.