North York General Hospital (NYGH) is home to the Charlotte & Lewis Steinberg Emergency—one of the busiest Emergency Departments (ED) in the Greater Toronto Area and for the second year running the top ranked in Ontario out of 74 hospitals for the ED Pay-For-Results (P4R) program.
The ED P4R Program is run by the Ontario government and provides financial incentives to hospitals for improved performance on ED length-of-stay targets. NYGH's recognition under the program reflects improved wait time performance with consistent high volumes. It is the result of an organization-wide effort over many years to help reduce the time patients spend in the ED waiting to be assessed, receive care and be admitted, if needed.
“We are sharing our approach and learnings with other hospitals through providing advice, coaching and tours of our ED," says Andrea Ennis, Interim Director of the Emergency Services Program. “Being recognized as a top performer under the ED P4R program validates the good work the NYGH team is doing to reduce wait times and improve patients' access to care throughout the hospital."
Based on January 2023 data, NYGH has achieved a 46.3% improvement in ED Length of Stay, a 54.1% improvement in time to inpatient bed, and a 17.1% improvement in ambulance offload wait times.
One of the initiatives behind NYGH's successful approach involves how patients flow through the ED.
“If a patient arrives by ambulance but is low acuity, they will go to the waiting room and receive ambulatory care," says Karen Allentoff, Interim Clinical Team Manager for the ED. “If a patient arrives on their own but is higher acuity they will go into a bed. This approach lets us ensure our stretchers and beds are being used for patients most in need while keeping our ambulance offload times down so paramedics can return to the community and respond to others needing care."
NYGH has also assigned a dedicated flow coordinator in the ED's yellow zone where patients with moderate conditions like abdominal pain, first trimester complications, headaches or mild breathing difficulties are treated.
The coordinator greets and processes incoming patients triaged to the zone and directs the medical team to attend to patients in an organized and seamless way without interrupting care to existing patients.
NYGH has also looked at process improvements for how patients are placed into hospital beds. This includes using mixed gender rooms during periods of high occupancy and standardizing the patient assessment process to contain and control infections when admitted.
“Our IPAC team will frequently review the files of those patients admitted with infectious conditions so we don't need to keep them in isolation for longer than necessary," says Marwan Asalya, Manager of Care Transitions and the lead for patient placement processes at NYGH. “We also look at the potential to safely cohort those patients with others recovering from similar conditions to help ensure private rooms can be available for those who really need them."
In the community, NYGH has also opened its new Reactivation Care Centre (RCC) at the NYGH Finch Site.
The RCC is a 120-bed facility that provides a much-needed option for seniors who require additional restorative care between a hospital stay and safely transitioning to long-term care, back home or to another appropriate setting for ongoing care.
“At NYGH, improving our performance on ED length-of-stay targets has been about streamlining our processes to ensure the right patient is in the right bed at the right time," adds Susan Woollard, Vice President, Clinical Services, Quality and Long-Term Care, Chief Nursing Executive. “This is truly a whole-of-hospital achievement that is making a positive difference to patients and to the health system."