Emergency department (ED) wait times at three Wellington County hospitals have increased over the past five years, according to a recent report.
Yet wait times at hospitals across the Waterloo Wellington Local Health Integration Network (LHIN) have declined.
A recent Canadian Institute for Health Information study measured wait times for initial physician assessment in EDs throughout the country using a 90th percentile threshold, meaning 90 per cent of patients saw a physician within the stated wait time and 10% had to wait longer.
At Groves Memorial Community Hospital in Fergus the ED wait time was 3.5 hours in 2015-16, compared to 2.8 hours in 2013-14 and 3.2 hours in 2011-12.
“I don’t have any evidence that would tell me what drove [the dip in 2013-14], but … that could have been the time that Walmart opened up a clinic and may have redirected some of our patients there,” said Groves and North Wellington Health Care (NWHC) president and CEO Stephen Street.
“The volume would have started creeping up again as our population grows or as acuity of the patient visits come in, or if you have a bad flu year it would increase the number of visits to your (ED).
“It’s not an exact science and we don’t really do a lot of demand management.”
Compared to other hospital departments, Street said it’s difficult to predict when high volumes will pass through the ED.
“No one has an appointment so we may see seven people come in in one hour and then 16 people the next hour and then two people the hour after that,” Street said.
“We have no control over the demand and that’s really what drives wait times.”
Stephanie Pearsall, VP of patient services and chief nursing executive for Groves and NWHC, said hospitals use historical data to make predictions about the busiest times.
“We will try to schedule our staff according to that, so historically supper time to the evening are our higher volumes in the emergency department, which is pretty standard across the province,” she explained.
“So we will have more staff on at that time, our nurse practitioner works a later hour, she works a 10 to 6 to help facilitate patient flow through the emerg.”
Pearsall said the situation would be similar at Palmerston and District Hospital and Louise Marshall Hospital in Mount Forest, but volumes are lower so wait times are shorter.
Street said Groves sees twice the number of ED patients as each of the NWHC hospitals, where the wait time was 1.9 hours in 2015-16, 1.6 hours in 2013-14 and 1.7 hours in 2011-12.
In comparison, the ED wait times for hospitals within the LHIN have been on the decline, reaching 3.7 in 2015-16, down from 4.7 in 2011-12.
“The funding models for a large urban emerg are different than our community hospitals,” Street said. “They have separate funding incentives and pay for performance and many of the larger centres will actually hire hospitalists who are physicians just dedicated to manage emerg.”
Pearsall explained family physicians throughout the county are also the doctors who take care of patients at the hospital.
“Our family physicians staff the emergency department, as well as deliver our babies, as well as first assist in the operating room,” she said. “They really are a specialty of their own so it does look very different for us than it does at our Guelph Generals or Cambridge or Grand River or St. Mary’s.”
The hospitals have rosters to staff the ED but there are also procedures in place to call more doctors if demand exceeds expectations.
Mental health patients may also be adding to increased ED wait times.
“Acute mental health beds are very limited in supply and sometimes that will back up emerg volumes across the LHIN, in fact across the province and we’re no different as a facility,” Street said.
“From time to time we’ll have longer waits as patients are waiting to be transferred to an acute facility for a psychiatric assessment.”
Pearsall explained emergency departments are always open and to help shorten wait times and increase patient flow, she asks that patients bring their health card and medication.
“That’s always helpful for us to provide the best care that we can,” she said.
“Know that you are always seen by acuity; how sick you are. If you require care we will give it to you quickly.”
