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 authority 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

Saskatchewan’s Connected Care Strategy is about improving team-based care in hospital and community settings and improving the way we communicate with patients and providers when patients move between these settings. The Connected Care Strategy has evolved out of the Emergency Department Waits and Patient Flow Initiative.

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 enhance safe, efficient transitions out of hospital. Fundamental to these transitions are strong teams in both hospital and community settings.

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 shows that hospital patients who receive team-based, collaborative care experience better care coordination, shorter lengths of stay, improved health outcomes, and higher satisfaction. One example of this team-based approach to care is called an Accountable Care Unit (ACU). Several ACUs are in place or in development in Saskatoon and Regina, and are already showing signs of improved teamwork, communication, and patient outcomes. 
  • Connected Community Care: Community based teams work collaboratively to prevent admissions to the hospital, prevent premature admissions into Long Term Care, help patients have more timely discharge from the hospital, and maximize the time patients can live independently in their homes. Patients are 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: An evidence-informed approach to ensuring patients, and their relevant information, are transitioned safely and seamlessly across all care settings. Improved transitions between the community and hospital will help patients regain independence and reduce the number of hospital readmissions, and help ensure people get the right health care, from the right providers, at the right time in the right location.

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 for another type of care, such as temporary supports or rehabilitation to get them home again, long-term care, a personal care home, or their own home with ongoing support. Other jurisdictions across the world use the terms "unnecessary bed days" or "delayed discharges" to describe the effects of this problem.

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 for various types of care, as well as planning for the future to ensure the province can take care of growing, changing populations in the right place by the right providers at the right time.

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

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Presentations from Connected Care launch now available
Thursday, Oct 19, 2017

Presentations from Connected Care launch now available

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

External Partners

Kyla Avis

Initiative Consultant

Saskatoon

Dr. Jenny Basran

Physician Consultant

Saskatoon

Alan Buckley

Initiative Consultant

Saskatoon

Deb Chobotuk

Initiative Consultant

Saskatoon

Dr. Rashaad Hansia

Physician Consultant

Regina

Barb Jirika

Initiative Consultant

Saskatoon

Dr. Kish Lyster

Physician Consultant

Regina

Diane McDougall

Initiative Consultant

Saskatoon

Dr. Nate Osgood

Initiative Consultant

Saskatoon

Dr. Janet Reynolds

Physician Consultant

Saskatoon

Nazmi Sari

Initiative Consultant

Saskatoon

Dr. James Stempien

Physician Consultant

Saskatoon

Dr. Ron Taylor

Physician Consultant

Regina