Ontario Wait Time Strategy
Visit to South East LHIN
May 26, 2008
Alan R. Hudson, OC, FRCSC
Apr-08
Mar 08
Feb 08
Jan 08
Dec 07
Nov 07
Oct 07
Sep 07
Aug 07
Jun-Jul 07
Apr-May 07
Feb-Mar 07
Dec-Jan 07
Oct-Nov 06
Aug-Sep 06
Jun-Jul 06
Apr-May 06
Feb-Mar 06
Dec-Jan 06
Oct-Nov 05
Aug-Sep 05
Wait Days
Cataract Surgery 90th Percentile Wait Time Trend
350
300
trendline
250
200
Priority 4 Target - 182 days
150
100
50
0
2
Cataract Surgery - Histogram
3
Cataract Surgery Wait Times – LHIN Variation
4
Cancer Surgery 90th Percentile Wait Time Trend
100
90
80
Priority 4 Target - 84 days
70
60
50
40
30
20
10
Apr 08
Feb 08
Dec 07
Oct 07
Aug 07
Apr-May 07
Dec-Jan 07
Aug-Sep 06
Apr-May 06
Dec-Jan 06
0
Aug-Sep 05
Wait Days
trendline
5
Apr 08
Mar 08
Feb 08
Jan 08
Dec 07
Nov 07
Oct 07
Sep 07
Aug 07
Jun-Jul 07
Apr-May 07
Feb-Mar 07
Dec-Jan 07
Oct-Nov 06
Aug-Sep 06
Jun-Jul 06
Apr-May 06
Feb-Mar 06
Dec-Jan 06
Oct-Nov 05
Aug-Sep 05
Wait Days
Hip Replacement 90th Percentile Wait Time Trend
400
350
trendline
300
250
200
Priority 4 Target - 182 days
150
100
50
0
6
Knee Replacement 90th Percentile Wait Time Trend
500
450
400
trendline
300
250
Priority 4 Target - 182 days
200
150
100
50
Apr 08
Feb 08
Dec 07
Oct 07
Aug 07
Apr-May 07
Dec-Jan 07
Aug-Sep 06
Apr-May 06
Dec-Jan 06
0
Aug-Sep 05
Wait Days
350
7
Apr 08
Mar 08
Feb 08
Jan 08
Dec 07
Nov 07
Oct 07
Sep 07
Aug 07
Jun-Jul 07
Apr-May 07
Feb-Mar 07
Dec-Jan 07
Oct-Nov 06
Aug-Sep 06
Jun-Jul 06
Apr-May 06
Feb-Mar 06
Dec-Jan 06
Oct-Nov 05
Aug-Sep 05
Wait Days
MRI 90th Percentile Wait Time Trend
140
120
trendline
100
80
60
40
Priority 4 Target - 28 days
20
0
8
Apr 08
Feb 08
Dec 07
Oct 07
Aug 07
Apr-May 07
Dec-Jan 07
Aug-Sep 06
Apr-May 06
Dec-Jan 06
Aug-Sep 05
Wait Days
CT 90th Percentile Wait Time Trend
90
80
trendline
70
60
50
40
30
Priority 4 Target - 28 days
20
10
0
9
Progress to Date
10
Current State (Apr 2008) - % of cases completed
within target
Cancer Surgery
100%
94%
CT
Bypass Surgery
83%
100%
0%
54%
96%
MRI
Cataract Surgery
84%
Knee Replacement
Target
89%
Hip Replacement
Actual
Note: Based on priority level 4 targets.
11
All Surgery Adult & Paediatric Scope
June 2007
Cardiac
Cancer
ED
NT
Hip and Knee Replacements
E
EM
Cataract
L
P and CT Scans
M
MRI
I
March 2008
2008/09
D
E
Orthopaedic Surgery
NT
E
General
EMSurgery
L
P Surgery Pilot
Paediatric
M
I
Neurosurgery
Ophthalmic Surgery
Vascular Surgery
Thoracic Surgery
Otolaryngic Surgery
Ob/Gyn Surgery
Urologic Surgery
WTIS Adult Group 1
Expansion
Plastics/Reconstruction
Oral Surgery
Paediatric Surgery
• 74 WT funded hospitals (surgery
only)
• Cumulative surgeons: 2,600
WTIS Phase 1-3
• 81 WT funded hospitals
• Surgeons: 1,700
• Total cases 2006/07: 1,301,069
• Total MRI and CT scans
(2006/07): 1.2 million
• Total cumulative cases 2007/08:
1,610,000
Paediatric (Pilot)
• London Health Sciences Centre and
St. Joseph’s Health Care (London)
• All paediatric surgical procedures
WTIS Adult Group 2
Expansion
• ~74 WT funded hospitals
(surgery only)
• Cumulative surgeons: ~3,350
• Total cumulative cases 2008/09:
~2,225,000
12
South East LHIN Wait Time Trend Analysis
April 2008 Data
13
South East LHIN Monthly Trend
Cataract
Surgery
Hip
Replacement
Knee
Replacement
14
South East LHIN Hospital Performance
April 2008 data
15
South East LHIN Priority Analysis – April 08 data
16
Implementation Activities
LHIN #10 – South East
Impact of Concurrent ATC Hospital Implementation Activities
EDRS
EDRS
(TBD)
WTIS-Expansion
Cardiac Module (WTIS-CCN)
EDRS
WTIS – Expansion
Group 1
WTIS-Expansion
Cardiac Module (WTIS-CCN)
EDRS
WTIS – Expansion
Group 2 & All Paed Sites
SET Program Phase 1
WTIS – Expansion
Group 1
SET Program Phase 2
SET Program Phase 2
SET Program Phase 2
SET Program
CCIS Roll-out to all
MSICUs
CCIS Roll-out to all
MSICUs
CCIS Phase 3:
Specialty ICUs
CCIS Phase 3: (Wave 4)
Specialty ICUs
CCIS Phase 3: (Wave 4)
Specialty ICUs
CCIS Phase 3: (Wave 5)
Specialty ICUs
Q2 (07/08)
Q3 (07/08)
Implementation Activities
By Hospital in LHIN #10
Q4 (07/08)
Q1 (08/09)
Q2 (08/09)
Q3 (08/09)
EDRS
Hotel-Dieu Kingston
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation
WTIS-CCN
Kingston General Hospital
WTIS-EXPANSION
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
SETP PHASE 1
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation
CCIS ROLL-OUT
Brockville General Hospital
Quinte Healtcare Corporation
Q2 (07/08)
WTIS-EXPANSION
Brockvill General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Quinte Healthcare Corporation
CCIS ROLL-OUT
Brockville General Hospital
Quinte Healtcare Corporation
Q3 (07/08)
* Belleville General, Trenton Memorial, and Prince Edward County Memorial only.
Quinte Healthcare Corporation
SETP PHASE 2
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation*
CCIS ROLL-OUT
Focus Groups/Design Sessions Underway
Q4 (07/08)
EDRS
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation
WTIS-CCN
Kingston General Hospital
SETP PHASE 2
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation*
CCIS ROLL-OUT
Kingston General Hospital
Q1 (08/09)
EDRS
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation
SETP PHASE 2
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation*
CCIS ROLL-OUT
Kingston General Hospital
Q2 (08/09)
EDRS
TBD
WTIS-EXPANSION
TBD
SETP
Brockville General Hospital
Hotel-Dieu Kingston
Kingston General Hospital
Lennox and Addington County General
Perth and Smith Falls District Hospital
Quinte Healthcare Corporation*
CCIS ROLL-OUT
Kingston General Hospital
Quinte Healthcare Corporation
17
Q3 (08/09)
The ER Strategy calls for System-wide Improvements
Reducing ER Wait Times and Improving Public Satisfaction can only be achieved by
making improvements across the entire system
Therefore, accountability for improvement must rest with Hospital Boards
and CEOs, LHIN Boards and CEOs and community partners such as
CCACs
Reducing Demand for Services Improving Processes within the ER
Increasing Supply of Services
OR
d bd
bdbb
d bdbd
bdbbdbb
d bdbd
bdbb
d bd
• Aging at Home
• Family Health Care for All
• Chronic Disease Prevention and
Management (Diabetes)
• Mental Health and Addiction
ED
ER
b
b
b
b
b
b
d
d
d
b
b
b
d b
d
b
b
b
b
b
b
d
d
d
• Emergency Room Strategy
• HHR - Emergency Department
Coverage
d
b
b
H
Alternate Levels
of Care
Community
and home-based
Home
Home
services
d
Rehabilitation
Rehabilitation
Rehabilitation
d
d
Complex and
Continuing
Care
d
Long
Term
Long Term
Long
Term
Care
Care
Care
• Aging at Home (ALC)
• High Growth Hospital Funding
The infrastructure and resources to reduce demand and increase supply cannot be put in place overnight, therefore,
efforts must start early and will take time to show results
18
ER
Transfer
ALC
Institution
Booked
Admission
Communities
*
*
*
*
*
19
20
21
Number of Patients in Emergency
Waiting for an In-patient Bed
By LHIN (at any given point in time)
136
Hamilton Niagara Haldimand Brant
121
Toronto Central
104
Central
82
Mississauga Halton
71
Central East
55
South West
49
Champlain
45
Waterloo Wellington
42
North East
South East
31
Erie St. Clair
31
North West
28
North Simcoe Muskoka
28
Central West
Source: OHA April 2008 ALC Survey Results
Ontario = 849
26
22
Number of Patients in Emergency
Waiting for an In-patient Bed
Since December 2007 (at any given point in time)
860
849
840
819
820
800
791
780
760
740
720
723
700
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08
17% increase
ALC Survey Results – December 2007 to April 2008
Source: OHA April 2008 ALC Survey Results
23
Most LHINs are experiencing their highest levels of ALC days in recent years
25%
% ALC days in hospitals by LHIN
% ALC Days
20%
15%
10%
5%
0%
1999
2000
Erie St. Clair
Central West
Central East
North-East
2001
2002
South West
Mississauga Halton
South East
North-West
2003
2004
Waterloo Wellington
Toronto Central
Champlain
2005
2006
HNHB
Central
North Simcoe
24
Data source: Inpatient Discharges Table, Ontario Provincial Health Planning Database (PHPDB), V. 17.07
Percent of Acute Care Beds
Occupied by ALC Patients
By LHIN
33%
North East
29%
Waterloo Wellington
25%
Hamilton Niagara Haldimand Brant
22%
North West
20%
Champlain
19%
Central East
17%
Central
16%
Mississauga Halton
15%
South West
South East
12%
Central West
12%
Toronto Central
Erie St. Clair
About 2,900 patients
are waiting daily in
acute care for ALC
15%
North Simcoe Muskoka
12%
11%
19%
Ontario
Percent of Acute Care Beds Occupied by ALC Patients = Number of patients in an acute care bed waiting for an ALC
Total acute care beds
Source: OHA April 2008 ALC Survey Results
25
South East LHIN
Percentage ALC Days per Quarter
25.00
20.00
15.00
10.00
5.00
0.00
Q1
Q2
Q3
2006-07
Q4
Q1
Q2
Q3
2007-08
South East 14.80 17.43 21.48 20.28 16.89 16.59 14.11
LHIN
Provincial
10.73 11.37 12.57 13.72 12.64 12.96 14.28
26
15,587 IP Acute Beds (*)
8.84%
ALC
2.18%
Other
Community /
Home care
Rehabilitation
13.71%
81.43% IP Acute Beds
18.57% IP
Acute Beds
7.39%
Complex
Continuing Care
unit
57.89%
Long-Term Care
Home
5.35%
Palliative care
unit or hospice
12.1% admissions/year (**)
3.39%
1.24%
Sub-acute or
convalescent
care
Home
5,216,000 visits/year (***)
ED
(*) “Alternate Level of Care ALC”, OHA ALC Survey
Results, Feb 2008
(**) “Review of ED Services in Waterloo Wellington”,
Waterloo Wellington LHIN, Dec 2006
(***) “Hospital Report : Emergency Department
27 Care”,
HRRC 2007.
ER visits in FY2006
Figure 1: Number of ER visits in FY2006 by CTAS
Figure 2: Number of ER visits by age group
Figure 3: Number of ED visits by age group
Total visits in FY2006 = 5,247,338
40%
364,300
7%
CTAS 2
11%
CTAS 3
859,217
16%
1,293,347
25%
000-019
020-039
CTAS 4
040-059
CTAS 5
060-079
11%
38%
1,323,180
25%
080+
1,407,294
27%
Figure 3: Number of times Ontarians visit ER per year
1 visit per year (63%)
2 visits per year (20%)
3 visits per year (8%)
4 visits per year (4%)
5 or more visits per year
(5%)
Total number of unique visitors – 2,860,598
28
Emergency Department Lengths of Stay in FY2006
ED LOS Distribution
700,000
Number of visits
600,000
500,000
400,000
300,000
200,000
100,000
00
0-
03
03 0
106
06 0
109
09 0
112
12 0
115
15 0
118
18 0
121
21 0
124
24 0
127
27 0
130
30 0
133
33 0
136
36 0
139
39 0
142
42 0
145
45 0
148
O
VE 0
R
48
0
0
Source: NACRS, 2006
Time spent in ED (minutes)
29
Source: NACRS, 2006
03
0
1,000
Source: NACRS, 2006
Time spent in ED (minutes)
100,000
50,000
0
Time spent in ED (minutes)
00
003
03 0
106
06 0
109
09 0
112
12 0
115
15 0
118
18 0
121
21 0
124
24 0
127
27 0
130
30 0
133
33 0
136
36 0
139
39 0
142
42 0
145
45 0
148
O
VE 0
R
48
0
1,500
Number of visits
2,000
03
03 0
106
06 0
109
09 0
112
12 0
115
15 0
118
18 0
121
21 0
124
24 0
127
27 0
130
30 0
133
33 0
136
36 0
139
39 0
142
42 0
145
45 0
148
O
VE 0
R
48
0
150,000
Number of visits
00
003
03 0
106
06 0
109
09 0
112
12 0
115
15 0
118
18 0
121
21 0
124
24 0
127
27 0
130
30 0
133
33 0
136
36 0
139
39 0
142
42 0
145
45 0
148
O
VE 0
R
48
0
Number of visits
2,500
00
0-
06
06 0
109
09 0
112
12 0
115
15 0
118
18 0
121
21 0
124
24 0
127
27 0
130
30 0
133
33 0
136
36 0
139
39 0
142
42 0
145
45 0
14
8
O
VE 0
R
48
0
03
1-
00
0-
Number of visits
Distribution of ED Lengths of Stay in FY2006, by CTAS level
ED LOS Distribution, CTAS 1
ED LOS Distribution, CTAS 2
3,500
120,000
3,000
100,000
250,000
200,000
80,000
60,000
40,000
500
20,000
0
0
Source: NACRS, 2006
ED LOS Distribution, CTAS 3
Source: NACRS, 2006
Time spent in ED (minutes)
ED LOS Distribution, CTAS 4
400,000
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
Time spent in ED (minutes)
30
Distribution of ED Lengths of Stay in FY2600, by CTAS level (cont’d)
ED LOS Distribution, CTAS 5
140,000
Number of visits
120,000
100,000
80,000
60,000
40,000
20,000
00
003
03 0
106
06 0
109
09 0
112
12 0
115
15 0
118
18 0
121
21 0
124
24 0
127
27 0
130
30 0
133
33 0
136
36 0
139
39 0
142
42 0
145
45 0
148
O
VE 0
R
48
0
0
Source: NACRS, 2006
Time spent in ED (minutes)
31
Academic centres and large community hospitals have the worst ER-Length of Stay
across all urgency (triage) levels
Percentage of patients meeting ER-LOS goals* by triage level
Best performing hospitals (>=95% of
patients are treated within LOS goals)
70
•
Number of EDs (Total N=100)
60
•
•
•
•
•
•
•
•
•
•
•
50
40
30
20
Carleton Place and District Memorial
Hospital
Glengarry Memorial Hospital
Haldimand War Memorial Hospital
Niagara Health System – Port Colborne Site
Perth & Smiths Falls District – Perth Site
Perth & Smiths Falls District – Smiths Falls
Quinte Healthcare Corporation – Picton
Renfrew Victoria Hospital
Sensenbrenner Hospital
Stevenson Memorial Hospital Alliston
Temiskaming Hospital
West Parry Sound Health Centre
Worst performing hospitals (<70% of
patients are treated within LOS goals)
10
0
<
70>
<
70>
<
70>
<
70>
70% 90% 90% 70% 90% 90% 70% 90% 90% 70% 90% 90%
All Patients
All Patients
Res uscitationCTAS
I/II
Em ergent
Urgent
CTAS III
•
Les s/Non-Urgent
CTAS IV/V
Triage Level / Percentage Within ER-LOS goal
All ERs with Annual Volumes >= 20,000, Ontario, NACRS 2006-07
* Recommended LOS Goals per ER Expert Panel, JPPC
ER-LOS Goals: CTAS I/II – within 8 hours
CTAS III – within 6 hours
CTAS IV/V – within 4 hours
•
•
•
•
•
•
•
•
•
•
•
•
Grand River Hospital Corp – Waterloo
Hopital Montfort
Humber River Regional Hospital – Humber
Memorial
Humber River Regional Hospital – YorkFinch
Mount Sinai Hospital
North York General Hospital
Ottawa Hospital – Civic Site
St Joseph’s Health Care System – Hamilton
St Michael’s Hospital
Sunnybrook Health Sciences
Toronto East General Hospital
University Health Network – General
University Health Network – Western
32
EDRS Indicators – Process Flow Diagram
33
EDRS Implementation Timeline
Q2 07/08
Q3 07/08
Q4 07/08
Q1 08/09
Q2 08/09
Q3 08/09
Q4 08/09
Technical Development
Beta Testing
Hospital Training
Wave 1 and Wave 2 Implementation
All Hospitals submitting
data to EDRS
Public Reporting of ED Wait Times
% of EDRS hospitals
Beta
Wave 1
Wave 2
6%
55%
26%
34
Patient Satisfaction Survey
Ontario Emergency Department by Hospital Location in LHIN
Source: National Ambulatory Care Reporting System 2005-2006, CIHI
Survey Results Summary (2005-2006):
Overall Impressions – Patients’ assessments, overall, of their hospital stays.
74.4
Communication – Patients’ assessments of how well information was communicated to them or family during ER stay.
66.9
Consideration – Patients’ assessments of whether they were treated with respect and courtesy by doctors, nurses and other
staff during their stays in the ED.
72.8
Responsiveness – Patients’ assessments of the amount of time they waited to see doctors and nurses and receive test results;
assessments of pain management; assessments of team work; and the staff’s responsiveness to their needs.
65.4
35
Proposed ER Strategy Timeline
Premier commits to reduce ER wait times (Oct. 2007)
Minister announces ER/ALC policy changes to public and stakeholders (Apr. 2008)
Pay-for-Results Y1 allocation (Jul. 2008)
CCAC demonstration projects for ER diversion begin (Jul. 2008)
Target Communication to key stakeholders (Jul. 2008-Jan.2009)
Public awareness campaign begins (Aug. 2008-Jul. 2009)
Preliminary EDIS results available; re-calibrate ER Strategy (Oct. 2008)
Hospitals selected for Expert Teams (Oct. 2008)
ER HHR plan complete, implementation begins (Nov. 2008)
Online ED patient flow Toolkit and expert program launched (Nov. 2008)
Readiness to announce multi-year ER-LOS targets (Dec. 2008)
ER wait times publicly reported (Feb. 2009)
Pay-for-Results Y2 allocation including expanded list of hospitals (Mar. 2009)
Increase ER/CCAC resources (Apr. 2009)
Hospitals selected for Expert Teams (Apr. 2009)
Expand CCAC/ER diversion demonstration projects (Jul. 2009)
Pay-for-Results Y3 allocation (Apr. 2010)
Hospitals selected for Expert Teams (Apr. 2010)
Hospitals selected for
Expert Teams (Apr. 2011)
Pay-for-Results Y4
allocation (Apr.2011)
ER wait time goals
achieved (Jul. 2011)
Provincial election
(Oct. 2011)
Hospitals submit public satisfaction survey results (Jan. 2009 and quarterly from Jul. 2009)
January
2008
July
2008
January
2009
July
2009
January
2010
July
2010
January
2011
July
2011
36
January
2012
www.ontariowaittimes.com
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