PIA & ED LENGTH OF STAY
William Osler Health System (Etobicoke General Hospital)
Length of Stay (EDLOS) are major quality indicators in emergency medicine. In March 2015, Etobicoke General Hospital’s (EGH) performance on these indicators was 90th percentile Time to PIA = 2.6 hours (P4R rank = 20/74 hospitals), and 90th percentile EDLOS CTAS 4-5 = 3.9 hours (P4R rank = 32/74 hospitals). Meanwhile, EGH’s Patient Satisfaction score remained at 68.9%.
For the year 2015-2016, Osler sought to achieve 3 goals at its EGH site:
- Decrease the 90th percentile Time to PIA
- Decrease the 90th percentile EDLOS CTAS 4-5
- Increase the Patient Satisfaction Scores.
To achieve these goals, Osler implemented the following initiatives:
- Mandatory use of Pulsecheck - a real-time dashboard for tracking patients in the ED, their Time to PIA and EDLOS
- Redesigned principles of flow of patients in the Ambulatory Treatment Centre (ATC) and Fast Track areas of the ED
- the Physician in Triage Collaborative Process (with Nurse Practitioners)
- ED Physician Navigators
- Numerous no cost intangible cultural changes.
Combined, these initiatives have transformed the EGH ED into a top-performing ED in Ontario. Despite a 20% increase in patient volumes, 90th percentile Time to PIA = 1.1 hrs - a 58% decrease (1st in the province); 90th percentile EDLOS CTAS 4-5 = 3.0 hrs - a 23% decrease (3rd in the province); and, EGH’s patient satisfaction score has increased by 12% to 77%.