Created by
Deb Harris
2002
1. First critical step is to acknowledge that patients who require hospital admission do not receive adequate care in ED stretchers
2. Patients who present to ED with acute medical, surgical or psychiatric conditions deserve appropriate access to ED care
3. The community and the government must identify ED overcrowding as a high priority health concern and acknowledge that prolonged ED waits for admitted patients are totally unacceptable.
4. Secondly they need to recognize that the cause of ED overcrowding generally lies outside the ED.
5. ED overcrowding is a symptom of system failure, and solutions will require more community care options for the elderly and chronically ill, better access to diagnostic, surgical and acute care services, and improved efficiency in the hospital setting.
These solutions will require philosophical and financial support at a government, regional health board, and a community level.
Strategies recommend by CAEP/NENA The primary solution:
1. Provincial Ministries of Health should link hospital funding to prompt admission of Emergency patients to hospital
2. Provincial waiting time standards for admitted patients in the ED would need to be developed and enforced
3. Open "Swing beds"or expand their permanent bed complement to meet waiting time standards.
4. None of the proposed secondary solutions will have any significant impact unless effective measures are imposed to move patients who require admission, testing or observation out of the ED once their initial evaluation and treatment have been completed.
Secondary solutions:
1. Implementation of Canadian Triage and Acuity Scale [CTAS] in all Canadian ED.
2. Computer databases so that ED managers can analyze visit volumes, acuity profiles, admission rates, waiting times and lengths of stay. Implement real time ED information Systems [EDIS] in all Emergency Departments so that nurses and physicians can use computerized data to help patients through their ED stay more efficiently.
3. Link current efforts in Primary Care Reform to Ed overcrowding.
4. Development of pilot projects in innovative ED care including: rapid diagnostic units, use of nurse practitioner, bedside registration, point of care testing, and linkage to community health centers.
5. Increase access to immediate diagnostic testing
6. Expansion of long term care facilities to reduce the number of patients in hospital awaiting placement
7. Development of innovative home care models to safely discharge patients from the ED and hospital
8. Expand available training and education programs for emergency physicians and nurses
9. Create research funding opportunities for emergency physicians and nurses to study the issue of overcrowding in a scientifically valid and timely fashion.
10. Develop programs by which the public can be informed about current health care system issues, so they can understand which services can be reasonably expected from an ED
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Canadian Association of Emergency Physicians