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The Report of the Hospital Emergency Department and Ambulance Effectiveness Working Group
Submitted to the Honourable George Smitherman, Minister of Health and Long-Term Care
Summer 2005

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September 16, 2005
The Honourable George Smitherman
Minister of Health and Long-Term Care
Government of Ontario
10th Floor, Hepburn Block
80 Grosvenor Street
Toronto, ON M7A 2C4

Dear Minister Smitherman:

It is with pleasure and anticipation that the Hospital Emergency Department and Ambulance Effectiveness (HED&AE) Working Group presents its report to you. As part of our mandate, the group has reviewed recommendations of other task forces and committees, best practices from Ontario, Canada and abroad, and available published research. We are confident that the submitted report reflects best evidence and if implemented in its entirety will result in significant and sustainable reduction in ambulance offload delays and emergency department overcrowding, as well as system transformation to improve patient care and experience in ambulances and hospitals.

While the body of the report and its 15 recommendations are organized according to the patient’s journey through the emergency health care system, the following three themes emerge:

1. System Commitment – Commitment from all stakeholders is the fundamental requirement for improvement in emergency department overcrowding and ambulance offload delays. Many previous initiatives have failed because they addressed only the emergency department component of the problem. Hospitals and communities must recognize that emergency department overcrowding is a symptom of systemic issues and must be a high priority for change. Moreover, integration with other initiatives in the transformation agenda such as Primary Care Reform and the Wait Time Strategy will help to ensure sustainability of the improvements.
2. Accountability – Stakeholders must be accountable to each other and to the citizens of Ontario for emergency patient care. The design and collection of key performance indicators will allow tracking of progress. Implementation, by the ministry, of incentives and disincentives for hospitals and ambulance services will guide the evolution of the system improvements contained herein.
3. Capacity – Resource requirements generated by admissions to the hospitals from emergency departments can be predicted daily, seasonally and regionally. Based on objective modelling methodologies, capacity should be defined and expanded through efficiencies, rescheduling of other services and innovative solutions; and finally, with addition of acute care beds only under circumstances in which all other means have been exhausted. Further, expanded capacity can be created in the community consistent with the government’s agenda to allow patients to stay in their community for care.

Emergency department overcrowding and resultant ambulance offload delay are national issues. The government of Ontario has recently provided national leadership in addressing wait times, improving the supply of physicians and nurses and improving community care. The establishment of the HED&AE Working Group demonstrates your understanding of the issues and commitment to finding solutions. Implementation of its recommendations will unequivocally and explicitly show ongoing leadership in Canadian health care reform and, most importantly, allow our patients to receive the right care in the right place at the right time.

We respectfully submit this report.

Sincerely,
Brian Schwartz
On behalf of the Hospital Emergency Department and Ambulance Effectiveness Working Group:]]> Wed, 04 Jun 2008 12:52:17 +0000 96 http://www.paramedicweb.info/ipb/index.php?/files/file/91-ontario-auxillary-directives-2007/ Ontario_Auxillary_Directives_2007.pdf ( 184.28K ) Wed, 16 Jan 2008 18:34:30 +0000 91 http://www.paramedicweb.info/ipb/index.php?/files/file/90-ontario-medical-directives-2007/ Ontario_Medical_Directives_2007.pdf ( 538.65K ) Wed, 16 Jan 2008 18:33:18 +0000 90 http://www.paramedicweb.info/ipb/index.php?/files/file/89-2007-auditor-general-of-ontario-report-air-ambulance/
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http://www.auditor.on.ca/en/reports_2007_en.htm]]> Fri, 11 Jan 2008 18:13:30 +0000 88 http://www.paramedicweb.info/ipb/index.php?/files/file/87-practice-exam-2-answers/ Corresponding answers for Practice Exam 2. Sun, 07 Oct 2007 22:07:30 +0000 87 http://www.paramedicweb.info/ipb/index.php?/files/file/86-practice-exam-2/ US Paramedic level national registry practice exam. Some items will be out of scope for the EMT-A however it is a good practice for ACoP. Sun, 07 Oct 2007 22:03:31 +0000 86 http://www.paramedicweb.info/ipb/index.php?/files/file/85-practice-exam-1-answers/ Corresponding answers for Practice Exam 1 Sun, 07 Oct 2007 22:01:49 +0000 85 http://www.paramedicweb.info/ipb/index.php?/files/file/84-practice-exam-1/ US Paramedic level national registry practice exam. Some items will be out of scope for the EMT-A however it is a good practice for ACoP. Sun, 07 Oct 2007 21:59:59 +0000 84 http://www.paramedicweb.info/ipb/index.php?/files/file/82-first-responders-fire-services-and-pre-hospital-emergency-care-in-british-columbia-a-report-to-the-emergency-health-services-commission/ First Responders, Fire Services and Pre-hospital Emergency Care in British Columbia A Report to the Emergency Health Services Commission

Accepted by The Emergency Health Services Commission
May 2007]]> Fri, 01 Jun 2007 18:23:25 +0000 82