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Emergency Department Waits and Patient Flow Initiative

The Emergency Department Waits and Patient Flow Initiative was created to aggressively address emergency department wait times, in conjunction with other health system efforts to provide sooner, safer, and smarter care for patients.

In 2012, the provincial government’s comprehensive Plan for Growth challenged the health system to provide better health, better care, and better value, by cutting waits in emergency departments (EDs). In response, the Emergency Department Waits and Patient Flow Initiative was created to address ED wait times in Saskatchewan, in conjunction with other improvement efforts underway across the system. It builds upon previous work and aims to address key recommendations in the Patient First Review.

Many factors throughout the health system contribute to the length of ED wait times. There is compelling evidence that hospital overcrowding has a direct impact on the wait times in Emergency. By making improvements in how patients move through other areas of the health system, we are confident we can shorten waits in the ED.

The Initiative’s project team at the Health Quality Council is working with patient advisors, health region representatives and clinical experts in geriatrics, primary care and emergency medicine on a variety of strategies to improve patient flow and care experience. Click on the tabs below to learn more about each strategy.

NEW: Video on Interdisciplinary Bedside Rounding

NEW: Fall 2016 Newsletter


Alternate Level of Care

One of the factors contributing to long waits in the ED is that our system often keeps patients in acute care hospital beds even after they no longer require this intensity of care. Alternate Level of Care (ALC) is the term used to describe patients who have completed the acute care (i.e., hospital) phase of their treatment, but who are still in hospital waiting to be transferred to another type of care, such as long-term care, a personal care home, or their own home (with support).

Unfortunately, we don’t have a clear picture of how many ALC patients there are in our system, nor do we know which patients need what types of care. Representatives from different parts of the health system have developed a standard ALC definition and are now in the process of collecting data on this group of patients.

Having accurate information about the ALC population will identify opportunities to improve how to ensure these patients can receive the care they need in the right place, at the right time, from the right team, all the way through to their recovery.

Alternate Level of Care - Data Collection Form (Updated October 2016)
Alternate Level of Care Video (October 2016)
Alternate Level of Care Module (Updated April 2016)

Alternate Level of Care - Audit Tool
ALC Definitions and Guidelines (CIHI)

Care Coordination

Many different health professionals contribute to a single patient’s care.  It is critical that everyone on the care team, including patients and their family, have the information they need to play their part.

Interdisciplinary rounds are an approach that is widely recognized as a best practice in delivering patient- and family-centred care. These daily huddles involve all members of the care team including the physician. They take place at the bedside to allow discussion of new care issues and to ensure decisions are based on a complete understanding of all aspects of a patient’s care.

As part of the ED Waits and Patient Flow Initiative, a team is working to develop and implement a standard approach to interdisciplinary rounding in Saskatchewan health care facilities.  This will support care teams in delivering effective, efficient care. Interdisciplinary rounding also facilitates better communication between providers and the patient and family. It helps patients and their families play a more active role on the care team.

 

NEW: Video on Interdisciplinary Bedside Rounding

NEW: Download Interdisciplinary Rounding Module

Transfers of Care

Many patients are transferred from rural and remote areas of Saskatchewan to hospitals in one of the larger cities to receive care. After a patient has been treated – a major surgery perhaps – and they no longer need high-intensity hospital care, they are transferred back to their home or home community. In other cases, patients need to be transferred between different health facilities within their health region or into and out of facilities in a neighboring region. The planning and handling of transfers can vary significantly across the province.

Timely and safe patient transfers not only help patients move smoothly between facilities, but also ensure they receive the right care by the right providers, at the right time. Well-coordinated transfers also enable patients to return to their home communities and support networks once it’s safe for them to do so.

As part of the ED Waits and Patient Flow initiative, a team is developing standardized processes for all patient transfers between health facilities and regions in the province. Key to improvement will be ensuring that complete and consistent patient information is sent before and during the transfer, and that both the sending and receiving sites have adequate time to take the steps necessary for a smooth, safe, and efficient transfer.

Our goal is to establish a consistent process for all inter and intra-regional transfers by the spring of 2016.

Transfers of Care Module

Health System Modeling

How do you plan to meet the health care needs of a province? Not only for the day-to-day fluctuations in demand, but also for the long-term needs of Saskatchewan’s growing population?

Health system modeling is one tool that can help planners and policy makers evaluate and compare different strategies without first having to put a specific program or service in place. Modeling also shows how changes in one care area will affect how patients flow elsewhere in the health care system.

As part of the ED Waits and Patient Flow initiative, we are using computer simulation models to explore various “what-if” scenarios, so leaders can make more informed decisions about how best to reduce waits in Emergency and elsewhere in the system.  Health system modeling will help identify and validate cost-effective methods that will improve access to and high-quality health care services for Saskatchewan residents.

Patient and Family Advisory Committee

During the 2008-09 Patient First Review to identify needed health system improvements, many patients reported “feeling inadequately served in hospital emergency rooms.” As we work to shorten Emergency Department waits and improve how patients move throughout the health care system, it’s critical that we tap into the voices and experiences of patients.

This committee is made up of people with past experience using Saskatchewan’s health system, or who have ongoing experiences with the system. Their observations and insights are helping inform changes to policies and practices that will result in better care for all patients.