Quantitative results from an Ontario hospital patient flow improvement program pilot to improve emergency department waiting times

Introduction: Ontario adopted an emergency department (ED) strategy to reduce waiting times which includes a patient flow improvement program. A pilot version was tested at a large community hospital and evaluated quantitatively to determine the effect of the program on reducing emergency department waiting times. Methods: A pre-post evaluation compared institutional ED data from the pilot hospital from July-November 2007 (pre), December 2007-March 2008 (intervention), and April-June 2008 (post). All patients registered in the emergency department during the study period were included. Results are reported with a focus to the proportion of patients meeting the Ontario Ministry of Health ED waiting time (defined as total time in the ED) targets specific for their level of acuity (high < 6 h; medium < 8 h; low < 4 h). Results: The ED census at the pilot hospital was 66 336 patient visits for the year under study. Across pre-, peri- and postintervention periods, the admission rate was similar (14% v. 14%; 13%). The 90th percentile time to physician initial assessment (h) for patient acuity groups postintervention was 3.5; 3.8; and 2.8 v. 3.5; 3.5; 2.8 at baseline. Nintieth percentile ED-LOS (h) was (14.8, 8.1, 4.5 v. 14.8; 7.8; 4.6). Overall, the majority of ED visits across patient groups were within the MOH EDLOS targets (77.9%, 82.5%; 86.7%) at baseline, with no observable change in the proportion of overall (78.7%, 82.1%; 85.6%) and admitted patients (42.5 v. 42.5; 19.8 v. 20.25; 19.7 v. 18.6) within EDLOS targets following the pilot intervention. Statistical trends are reported. Conclusion: Results suggest no substantive increase in the proportion of patients meeting ED length of stay targets 3 months following the pilot intervention. The evaluative approach requires substantive longitudinal data and an increased period of follow-up to effectively examine statistical trends to account for known seasonal variation and institutional factors. Keywords: Ontario ED waiting time strategy, ED crowding, pre-post evaluation