www.oakvillebeaver.com The Oakville Beaver Weekend, Saturday February 7, 2009 - 15 Emergency wait times to be reported publicly By Angela Blackburn OAKVILLE BEAVER STAFF P "The whole Emergency Department wait time issue is a very complex problem and I'm very encouraged that ublic reporting of the Province is taking a lot of time and resources to Emergency wait times now address each component of a systemic problem." Dr. Eric Letovsky, Emergency lead Mississauga Halton Local Health Integration Network -- by hospital -- and a program to find a doctor for thousands of local seniors without a family physician -- will make February busy for the Ministry of Health and Long-term Care. So busy that ministry communications staff and Mississauga Halton Local Health Integration Network (LHIN) officials met Wednesday with local media, to provide background about the major news to be officially rolled out later this month on Ontario's Plan to Improve Access to Care. "The whole Emergency Department wait time issue is a very complex problem and I'm very encouraged that the Province is taking a lot of time and resources to now address each component of a systemic problem," said Dr. Eric Letovsky, the Mississauga Halton LHIN Emergency Room (ER) lead and head of Credit Valley Hospital's Emergency department. Later this month, the Ministry will announce that it will, via a website -- ontariowaittimes.com site -- be reporting the wait times at Emergency Rooms, including Oakville-Trafalgar Memorial Hospital (OTMH), Milton District Hospital and Georgetown Hospital. The three local hospitals are in Halton Healthcare Services (HHS), which falls under the Mississauga Halton LHIN. The times reported won't just be how long it will take to be seen, but how long it will take before you will be on your way again. Since the news may not be good when the public eyes the numbers -- even "shocking," according to a ministry spokesperson, the ministry also has a host of programs that either already do, or will, work in tandem to improve the situation. "If it's not great now, fine, we'll set targets to improve," said Mississauga Halton LHIN CEO Bill MacLeod. The Mississauga Halton LHIN reaches into Etobicoke, but doesn't include Burlington. It encompasses three municipalities and approximately 1.1 million people -- and it's growing. LHINs were created by the provincial government nearly two years ago and charged with the funding, planning and coordination of health care within specific communities. The reporting of wait times is not exactly designed for people to log on and gauge where they may get the quickest service. Rather, it is about making hospitals accountable for the provincial funding they get to improve, said MacLeod. While a baseline comparison model has been developed to gauge ER wait times, it still wouldn't be fair to compare a small, rural hospital to a large metropolis hospital. As well, not all ER experiences are the same. ERs use what's called Canadian Triage and Acuity Score to prioritize ER visits over five levels -- the first priority level being the visit that requires intensive intervention and the fifth being the least serious visit -- and each would result in a different experience on wait times. Letovsky admitted hospitals, for the first time will set targets on what ER wait times should be -- in Mississauga Halton eight hours for treatment and discharge of top level emergencies and three to four hours for low-level emergencies. "For the first time in history, we'll be setting targets for what's acceptable and optimal for patient care," said Letovsky, noting that even further, the Ministry will be demanding a 10 per cent improvement over the first year. "This is really the first time we've seen government make Emergency wait times a political priority," said Letovsky, an ER doctor for 29 years. "I hope that we're going to use it as a measure of accountability and not for patients to decide where to go if they need Emergency care," said Letovsky, noting the wait time reporting won't be in real time, but done quarterly, so all statistics will be three to four months out of date. As well, other programs that may offer alternatives to an ER visit are not meant to steer real emergencies elsewhere. Letovsky warned that could prove dangerous and if someone has chest pain, they should go to the nearest Emergency regardless of what a specific hospital recorded as a wait time four months ago. The focus on ER wait times has been widely reported in the media and is problematic across North America, noted Ted Haugen, Ministry spokesperson. The local LHIN includes HHS as well as Mississauga's Trillium and Credit Valley hospitals, which Letovsky said, are among the busiest in Ontario and in Canada. While Haugen said the expected "warts" to be revealed when ER wait times are reported publicly, is not a ploy to discourage people from going to Emergency. However, other programs will work in conjunction with the aim of deferring patients, who may not really need to be at Emergency, to a better point in the health care system. MacLeod said LHINs have been tasked to "stratify" the flow of people from the community to ERs, to hospital or back into follow-up care in the community. Thus, the ministry is not just tackling ER wait times by publicly reporting them. It is also augmenting or creating other programs to assist in the job. MacLeod said the local LHIN is looking at ways of getting primary care to people in the community, for example in long-term care homes, rather than having them access Emergency. Another program, not yet in place, would be for ambulance paramedics, now honour bound once called, to take a person to the hospital, with "proper medical backup" to assess whether someone needs to go to Emergency and, if not, to deliver them to the appropriate care or have them attend follow-up care in the community. In Halton and Mississauga, approximately 13 to 14 per cent of ER visits get admitted to hospital. If those cases experience delays in getting admitted to the hospital, they require significant investment of ER resources. Again, in hospital, 14 to 20 per cent of the beds are occupied by persons finished their acute care needs and waiting to move on to community care -- for example, rehabilitation, long-term care or complex and continuing care. MacLeod said funding is aimed at increasing the number of hours the local Community Care Access Centres (CCACs) can provide to people in the community. Also, funding will aim to support alternative care providers the ability to offer 24/7 coverage. "Because of the complexity of the system, Emergencies and hospitals alone cannot solve the problem. It needs someone looking at it from a total system point of view," said MacLeod, noting that's the LHIN's role. Provision of good primary care, like family doctors, can be one way of removing the necessity to visit the ER and the government has been funding the ability of family doctor teams being able to provide round-the-clock coverage, even nurse-led family health teams. On the family doctor front, MacLeod said a survey of local seniors has revealed that three to four per cent of residents over age 65 don't have access to a family physician. That leaves them going to Emergency. While it may sound like a small number, it represents upwards of 4,000 seniors locally. In all of Ontario, seven per cent of the population (891,000 people) has no family doctor. To reduce this number, a new program will be announced later this month, Health Care Connect, which will see a designated person within the LHIN linking people, who need one, with a family doctor. "If people have access to a family physician, they're less likely to go into Emergency to get treatment," said Haugen, noting priority will be given to those in the greatest need. While the program will be web based, it will begin with a 1-800 number linked to Telehealth Ontario. Aging at Home and Alternate Levels of Care are programs that aim to get senior patients the improved care they need in order to remain at home. That will be key to maximizing hospital and ER capacity. A Geriatric System Navigation (GSN) program will address the fact that annually, more than 30,000 ER visits are made by people aged 75 or more. While just over half the visits are "treat and release," they are from the same people or those at risk of further health issues. 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