Reducing waits in emergency and improving patient flow

Many factors throughout the health system influence how long patients wait for care in the emergency department. There is compelling evidence that, of these factors, hospital overcrowding is one of the most significant.

The provincial Emergency Department Waits and Patient Flow Initiative is working to improve how patients move through hospitals and other parts of the health system. Housed at the Health Quality Council, this Initiative was created in response to a challenge from the provincial government for Saskatchewan’s health system to aggressively reduce emergency department wait times.

The Initiative is guided by a collaborative team made up of patient advisors, health region representatives, and clinical experts in geriatrics, primary/community care, and emergency medicine.  Together, they are developing and testing a variety of strategies for improving patient flow across the health system. See the different sections below for more information about each of these strategies.

Connected Care

It seems logical that if there are long waits in the Emergency Department, the answer is to improve care delivery in that part of the health system. As it turns out, however, this approach is not the most effective or efficient solution.

Research has proven that wait times in Emergency are, in fact, a symptom of congestion elsewhere in the health care system. By using computer modelling to “virtually” test various possible interventions to improve flow, HQC has determined the best solution is to shorten patients’ length of stay in hospital.

Many patients remain in hospital after they’re ready to be discharged, because the services or supports they need are not readily available in the community. These community supports could include home visits by nurses, nurse practitioners, community paramedics, pharmacists, and therapists, and access to chronic disease management programs.

Studies show you can safely shorten hospital stays and prevent readmissions by changing how care teams work together in both the hospital and in the community, to ensure patients move between the two care settings in a consistent, coordinated way. HQC has begun working with its health system partners to apply this evidence, through an approach called Connected Care.

Connected Care has three key components:

  • Connected Hospital Care: Research on a team-based, collaborative approach to hospital care, called Accountable Care Units (ACU), has found patients experience better-coordinated care, reduced length-of-stay, higher patient and family satisfaction and better health outcomes. Several ACUs are in place or in development in Saskatoon and Regina, and are already showing signs of improved teamwork, communication, and patient outcomes. Both centres report shorter lengths of stays on their Accountable Care Units, which is easing hospital overcapacity pressures.
  • Connected Community Care: Patients will be supported to manage their care in the community, and will be admitted to hospital only when they need this level of service.
  • High-Quality Care Transitions: Improved transitions between the community and hospital will help patients regain independence and reduce the number of hospital readmissions.

Resources & Downloads: Connected Care

Alternate Level 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 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).

As a system, we’re not doing a good job moving patients from emergency into the hospital, and then from the hospital to home or other community-based services. One factor contributing to long waits in the emergency department is that patients are often stuck in acute care hospital beds after they no longer require this intensity of care. This means patients in emergency often have to wait a long time for a bed to become available before they can be admitted.

Part of the work of the Emergency Department Waits and Patient Flow Initiative is to determine the extent of this problem here in Saskatchewan. Since April 2017, most acute care hospitals have been collecting data on this group of patients, including the type of care they need outside of the hospital. This information will help leaders and decision-makers determine how best to meet patient care needs. This is just one example of how we’re helping the system understand and respond in new ways to a long-standing problem in health care.

Care coordination

Many different health professionals contribute to the care of one patient. It is critical that everyone on the care team, including patients and family members, have the information they need to participate in decisions.

As part of the Emergency Department Waits and Patient Flow Initiative, we are coordinating province-wide adoption of interdisciplinary rounding, which involves daily huddles attended by all members of the care team, including the physician. Rounds in hospital 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. Widely regarded as a best practice in delivering patient and family-centred care, interdisciplinary rounding has been shown to improve many aspects of patient care, including care coordination, shorter hospital stays, and increased patient safety.

Health system modelling

Meeting the health care needs of a province means understanding day-to-day fluctuations in demand as well as planning for the future to ensure the province can take care of growing, changing populations.

We are using a tool called health system modelling to evaluate and compare different strategies without actually having to implement them. Modelling is helping us understand how changes in one care area will affect patients elsewhere in the health care system. We can explore various “what-if” scenarios, so leaders can make more informed decisions about how to best reduce waits in emergency rooms and throughout the health system.

Latest news: Reducing waits in emergency and improving patient flow

Latest news from Emergency Department Waits and Patient Flow Initiative
Tuesday, Jul 11, 2017

Latest news from Emergency Department Waits and Patient Flow Initiative

The Summer 2017 update from the provincial Emergency Department Waits and Patient Flow Initiative is now available. Inside this edition of the newsletter, you'll find articles about: The...

Continue Reading

New videos highlight interdisciplinary rounding on Saskatchewan hospital units
Monday, May 8, 2017

New videos highlight interdisciplinary rounding on Saskatchewan hospital units

Interdisciplinary bedside rounding (IDR) is a key improvement strategy of Saskatchewan’s Emergency Department Waits and Patient Flow initiative. This “best practice” form of...

Continue Reading

Patient Flow Toolkit now available
Thursday, May 5, 2016

Patient Flow Toolkit now available

Over the next few years, Saskatchewan is focusing on three key strategies to shorten ED waits and improve patient flow across the health care system: interdisciplinary rounding, alternate level of...

Continue Reading

For more information about our work to reduce waits in emergency and improve patient flow, please contact