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Emergency Department Wait Time Benchmarks: Why the Delay?

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An Alberta emergency physician who raised public concern two years ago over the sad state of affairs in Alberta’s emergency departments has again gone public with his concerns with a delay in achieving target wait times for ER care.

Desirable target times for ER waits have been suggested and promoted by Canada’s emergency physicians since 2009. The aim of the targets is, in part, to guarantee timely access to emergency care depending on their level of illness or injury at the time of prersentation. There is a recognized morbidity and mortality associated with delays in access to care and by establishing targets, the hope is that such unnecessary complications will be avoided.

The article noted that “while patients are spending much less time in the ER now than two years ago, the province hasn’t met the targets, which are intended to improve the flow of the entire health-care system, says Dr. Paul Parks, past president of the Alberta Medical Association section of emergency medicine.

“How is it possible that we’re two years later and they’ve missed every single one of those (emergency department) benchmarks and no one’s really upset about it?,” he said.

The 2010 benchmarks aim to have patients wait no longer than four hours from when they get to emergency to the time they’re treated and discharged. Patients who need to be admitted, meanwhile, are meant to wait no longer than eight hours for a hospital bed.

According to Alberta Health Services data, Calgary’s adult hospitals met the eight-hour target less than 35 per cent of the time in early December.

Edmonton’s adult hospitals fared little better, with one facility meeting the benchmark just 19 per cent of the time.”

For the record, this the current position paper of Canada’s emergency physicians and nurses with respect to wait times in the emergency department.

1. That emergency department (ED) length of stay 1 benchmarks be established nationally as
follows:
i) ED length of stay not to exceed six hours in 95% of cases for CTAS 2 Level I, II and III
patients
ii) ED length of stay not to exceed four hours in 95% of cases for CTAS 2 Level IV and V
patients
2. That all admitted patients must be transferred out of the emergency department to an inpatient
area within two hours of decision to admit.
3. That overcapacity protocols be rapidly implemented to allow Canadian hospitals to meet the
national emergency department length of stay benchmarks until functional acute care capacity
is sufficient.
4. That achievement of these benchmarks must be continually measured and ED length of stay
should be documented on a daily basis by hospitals for all patients, and reviewed monthly.
Hospital and Regional administrators should be held accountable if the throughput standards
are not met.
5. That hospitals optimize bed management strategies to ensure the appropriate use of existing
and future acute care beds
6. That governments sufficiently increase the number of functional acute care beds to achieve
regular hospital occupancy rates that do not exceed 85%

Currently there remains no common definition of wait times and different provinces have different targets and different ways of measuring perfromance.

In a country that purports to want data and science to drive health care decisions, it seems wise to call for a national consensus on the definition of achievable and reasonable (from a patient’s perspective) wait time targets for emergency care and a national strategy to achieve these goals. What ,just exactly, are we waiting for?

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