In a one-of-a-kind North American initiative, Ontario is setting clear targets for reducing the total amount of time patients spend in emergency rooms - and is publicly posting data about local ERs online.

The province is setting two targets:

• For patients with minor or uncomplicated conditions, which require less time for diagnosis, treatment and observation: the latest data from October shows that 90 per cent of patients spent a maximum of 4.6 hours in the ER; the target is 4 hours.
• For patients with complex conditions, which require more time for diagnosis, treatment or hospital bed admission: the latest data from October shows that 90 per cent of patients spent a maximum of 13.5 hours in the ER; the target is 8 hours.

Total time spent in the ER begins when a patient registers at the ER and continues as the patient receives treatment. It ends when the patient is discharged home or admitted to a hospital bed.

Ontario has a three-pronged strategy for reaching these targets:

• Providing Ontarians with appropriate alternatives to ER care: providing more options where people can seek care such as local family health teams and nurse practitioner clinics and making it easier for people to access information about walk-in clinics, after-hours clinics, and urgent care centres through the new web site www.ontario.ca/healthcareoptions
• Increasing capacity and improving processes within the ER: programs such as the Hospital Performance Fund give hospitals with high emergency room volumes financial incentives to lower their times
• Speeding the flow of patients from the ER: ensuring that acute care beds are available for those who need them - this requires faster discharge of patients occupying hospital beds that are better suited to alternative levels of care such as long-term care or home care.

Ontarians can visit www.ontariowaittimes.com to access information about their local ER - data is current as of October 2008.

ONTARIO'S EMERGENCY ROOM STRATEGY

Reducing the time patients spend in emergency rooms (ER) is a complex issue that requires improvements throughout the entire health system. That is why Ontario is taking a comprehensive approach to reducing the amount of time patients are spending in emergency rooms. The strategy includes:

Providing Ontarians appropriate alternatives to the ER - supporting patients with chronic conditions, creating more family health teams and nurse practitioner clinics, and enhancing public awareness of alternative health care options will help to ease pressures across the system. Some of these initiatives include:

• Public education, with emphasis on alternatives to the ER. The new Your Health Care Options website - www.ontario.ca/healthcareoptions - is a one-stop source of information that will enable Ontarians to make informed decisions about where to go for immediate care in their communities.
• Health Care Connect - an innovative, made-in-Ontario program devoted to helping Ontarians without a family health care provider find one in their community. Ontarians can call 1-800-445-1822 to register.
• A comprehensive four year strategy to prevent, manage and treat diabetes.
• Long Term Care Nurse Outreach Teams - teams of nurse practitioners and registered nurses provide residents of long-term care homes timely and appropriate care and provide interventions in cases where unnecessary visits to the hospital and ER can be avoided.

Increasing capacity and improving performance within the ER - programs and initiatives include:

• Hospital Performance Fund - an incentive program that is designed to improve performance at 23 hospital ERs facing the greatest challenges. LHINs work with local hospitals and community health care partners to help hospitals improve their ER access and reduce the time patients spend in the ER.
• Process Improvement Programs - programs to help hospitals improve processes and patient flow in the ERs. The programs, which include specialized coaching teams to visit all hospitals, will provide staff the ability to quickly diagnose flow problems and then help implement new processes that improve patient flow.
• Dedicated nurses to ease ambulance offload - Funding has been provided to put in place nurses dedicated to care for patients who arrive by ambulance. This allows paramedics to return more quickly to the community and be able to respond to other calls.
• Measuring and reporting the time patients spend in ERs - collecting information, reporting the time people spend in the ER on a public website, measuring and rewarding improved performance, so that Ontarians can see the steady progress being made.

Speeding the flow of patients from the ER - close to 19 per cent of patients who are currently in a hospital bed in Ontario are in need of an alternate level of care (ALC), such as a long-term care bed or a rehabilitation care bed. An ALC patient occupying an acute care bed can create a domino effect in hospitals when there are no other beds available, causing people to spend a longer time in the ER. That's why the government is investing in a number of initiatives that are working to relieve the ALC pressures in Ontario hospitals. In 2008/09, the government has invested:

• $94 million as part of the Aging at Home Strategy - an unprecedented four-year, $1.1 billion initiative to provide support to seniors and their caregivers to stay healthy and live with dignity and independence
• $38.5 million for increased home care, personal support and homemaking services and enhanced integration between hospitals and Community Care Access Centres
• $22 million in new priority funding for Ontario's 14 Local Health Integration Networks (LHINs) to invest in local solutions to further address ALC pressures

The government is adding 1,750 new long-term care home beds in selected communities across the province.

REPORTING TIME SPENT IN HOSPITAL EMERGENCY ROOMS

The Ontario government is publicly reporting time spent in hospital emergency rooms (ERs) on www.ontariowaittimes.com.

The site provides detailed information on "total time spent in the ER." This is maximum time spent by 9 of 10 patients in the ER and is measured from the time patients register or initially see a triage nurse (who assesses the level of urgency for treatment), until the time they leave the ER. The time patients leave the ER may be when they are sent home after being treated or when they are admitted to a hospital ward or inpatient bed, if medically necessary.

While a patient is spending time in the emergency room, doctors and nurses may be diagnosing or treating their condition, or ordering tests and waiting for results in order to determine the best treatment. Sometimes treatment for a condition requires admission to a bed in the hospital, which may result in a patient spending more time being cared for in the ER before a bed becomes available.

The Emergency Department Reporting System was developed and implemented across the province in early 2008 to collect information about time spent in ERs. The data is being collected from 128 hospital ERs. This data represents almost 90 per cent of all ER visits in the province.

The ER data being reported is not real-time information and is four months old. Ontario is continuously enhancing its reporting process, which will enable us to report more recent ER information to Ontarians.

This information (the time spent by nine out of 10 patients) is being reported in three categories:

• All ER patients
• Patients whose conditions are minor or uncomplicated that require less time for diagnosis treatment or observation.
• Patients who have complex and/or life-threatening conditions that may require more time for diagnosis, treatment or admission to a hospital bed

The data in the table below is based on ER visits completed for the most current time period (October 2008) at hospital sites that have implemented the reporting system. The table shows an analysis between the current total time spent in ER versus the baseline (April 2008), total time spent, and a comparison against provincial targets where it applies.

	Baseline - April 2008 (Hours)	Current - October 2008 (Hours)	Target (Hours)	Percentage Completed Within Target	Current vs. Baseline Net Change (Hours)	Current vs. Baseline Percentage Change
All patients	9.4	9.2	N/A	N/A	-0.3	-2.7
Patients with minor or uncomplicated conditions	4.8	4.6	4.0	86.0	-0.2	-3.8
Patients with complex conditions	13.9	13.5	8.0	80.0	-0.4	-3.0

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