Examining the waiting time in emergency unit in St .Thomas Elgin General Hospital

Executive summary

This paper is to examine the waiting time in emergency unit in St .Thomas Elgin General Hospital, Ontario Canadian hospital. The study is designed to understand the populations that use emergency services with respect to length of time a patient waits for and receives care once at the hospital. It will also explore issues that impact waiting time and in addition provide recommendations on how to make the Canadian Ontario based hospital meet the international standards. In this case the A&E Attendance &Emergency April 2016 data is used to understand how long patients spent in the emergency departments using three departments, the data will be presented using flowcharts, histograms to give clear mental description on the study.















Executive summary. 2

Introduction. 4


2.1Healthcare in Canada. 5

2.2.ST .Thomas Elgin General hospital (STEGH). 6

2.3 Quality of Health Care. 7



2.4 The Wait time of patients. 10

2.5 Users of emergency department 13

  1. Research method. 14

3.1 research methodology; 14


4.1 presentation. 14

CTAS I. 15



  1. DISCUSSION.. 1819
  3. CONCLUSION.. 21
  4. REFERENCE.. 22



The wait time to receive emergency service is defined as the duration which individuals take to be given chance or gain entry to and receive care and services from the healthcare system. The emergency departments have unique characteristic  in providing health  care service since their demand  are unexpected and unscheduled and involve immediate assessment and also the decision on the  mode of treatment ought to be made rapidly and action taken immediately. The potential wait time for a patient begins immediately the need of emergency care arise. However, before they reach the emergency department, patients can persist and wait to reach the facility and can leave or exit at several points before actual entry in the facility. The waiting time in Canadian hospitals are longer than the other countries. The long waiting time can be inconvenient and risky to patients since it can lead to adverse effects on patient’s outcome. Patients can suffer more pain hence may leave without receiving treatment while on the queue.


Emergency department is the symbol of good health care system in any country since the majority of services are offered to treat various illness, both for the young and old. They have different specialties that is some are directly involved in children and others are involved in adult illness (Williams, et al. 2016). The demand for emergency service varies also by age and household income. The severity of illness in the emergency department is in the Canadian triangle and Acuity scale.

The service quality in the emergency department are of different dimension such as reliability, assurance, empathy and responsiveness. Due to this quality concern, the quality of health care service is judged using statistics and statistical quality tolls because the main goal of the health provider is to meet customers’ fulfillment.

To improve quality in provision of the health services, proper understanding on the factors influencing the provision of emergency healthcare and the reason for that variation is needed to achieve the required standards (Benneyan et al.2003). The Attendance &Emergency April 2016 data is used to understand how long  Data the information and the statistical process control which involves a series of descriptive statistics for easier presentation of data (flowcharts, histograms, pareto charts and control charts) hence making easier understanding of the process being carried out. The main aim of this paper is to examine the waiting time in emergency unit in Ontario Canadian general hospital in the light of factors that influence the waiting and in addition to that provide recommendations on how to make the Canadian Ontario based hospital meet the international standards.


2.1 Healthcare in Canada.

Canadian emergency divisions are essential to the patients in various ways. The majority of healthcare facilities are government supported since government attention has increased over time on the access to care and specifically wait time which is also an area of major concern for different stake holders in the health sector majorly in the emergency department. Canadian healthcare system has the longest time wait compared to other countries, an international survey by commonwealth in 2004 about the seeking care in the emergency departments between 2001 and 2003,the study curried out in five countries(Australia ,Canada,Newzealand,UK and USA) the findings where that the Canadians had the highest use and wait for the emergency services.



The system is made to provide all-inclusive 24 hour in internal medication to families both young and old. It provides full service emergency department to meet the unscheduled and emergency needs of the patients. It receives more than 36700 emergency department visits per year, the hospital has improved waiting area, triage and specializes zones (STEGH portal).

2.3 Quality of Health Care.

The major aim of all medical providers is to provide quality and patients safety. The STEGH hospital in the Ontario has improved its standards for efficiency in the provision of health care services. The Ontario association ensures that the quality standards and measurements in all hospitals within the 8 municipalities are met and well distributed. The emergency medical services have put in place quality management measures that spans across all activities of the institution (Gupta & Rokade, 2016).


The emergency department treatment needs a rapid and immediate treatment, patient can arrive using an ambulance or on their own, the once who arrive on their own register during this first point the patients are triaged by qualified medical practitioners and are assigned severity score  depending on the urgency of the medical condition. On the other hand if the patient arrives in an ambulance the registration may differ in a slight way but the severity of the patients is still examined.

The emergency process is presented in the chart below.


When a patient arrives at the hospital by different mode of transport he/she is taken to the triage where the priority and urgency of the treatment is determined after that the patient is then taken for treatment examination and observation on the patients’ medical condition later the patient is either admitted, transferred or discharged depending on the patients relief or the doctor’s prescription.


The Canadian severity system is grouped into five groups. CTAS 1 that includes conditions that may need aggressive intercession to the patients in the emergency unit. Unlike CTAS 1, CTAS 2 require developing care that may demand patience and consistent observation and guidance. CTAS 4 unlike CTAS 3 does not demand speedy care less urgent care. These stages and categorization helps to determine which emergency response methods should be used on a particular patient and what methods to use in diagnosing their illness.

Table 3

2.4 The Wait time of patients.

The factor that lead to the long wait in the emerged department are determined by a number of factors such as how serious the patient’s condition is, the extent to which the medical intervention is required and Whether a patient should be admitted in the hospital and possible activity that could be carried out in the in the emergency care unit at that time (Moskop, et al, (2009).


2.5 Health care and control

Congestion is to a great extent inferable from the results of systemic change. Clinical rebuilding, healing center terminations, informal lodging of long haul mind (LTC) offices, group and home care assets play a role here. The nursing deficiency over all human services segments worsens the issue by successfully closing beds that can’t be appropriately staffed in the health facilities. Delays in surgical and symptomatic testing and poor access to elective doctor’s facility add to the over-burdening of crisis divisions.


In this setting, doctor’s facility crisis divisions have developed past their conventional intense care part to wind up key players such as regulators in deciding how patients travel through the social insurance framework. The extent of this new part incorporates a few or the greater part of the accompanying, contingent upon the doctor’s facility estimate, area, populace served, clinical projects offered, and so on.


Deficiencies of intense care old-fashioned little inns staff combined with the move far from organization based care now require that each ED patient being considered for confirmation, right now constituting 12-20% of all ED visits, be precisely screened and surveyed by ED staff, as well as by other wellbeing experts who are presently associated with the ED such as social laborers, release organizers, LTC organizers etc. with a view to dealing with the patient in the home or group as opposed to conceding them to an intense care bed.


Patients who ARE at last considered contender for affirmation frequently sit tight in the ED for a long time or days for an intense care bed to end up accessible. These patients require inpatient mind in the ED.


Patients who could possibly go home, yet require advance adjustment of the intense period of their ailment such as with asthma, are presently kept in perception beds or perception units in the ED for up to 24 hours of treatment preceding release. In the later recent years, the greater part of these patients would have been admitted to clinic. A few healing facilities have set up particular sorts of perception units, for example, Chest Pain Clinical Decision Units, to decrease the requirement for admission to a high power Coronary Care Unit bed.


Patients who require emergency position in LTC beds are regularly admitted to such beds specifically from the ED or must be admitted to in-house intense care beds, again requiring multi-disciplinary ED group appraisal. Those who are released from intense inpatient quaint little inns holding up to be exchanged to another office for confirmation might be sent to the ED. Numerous EDs have built up staffed release or holding units for such patients (Kelly, et al. 2012).


Numerous healing centers have set up quick track zones inside their ED or critical care focuses off-site to handle the less earnest and non-dire caseload, who keep on presenting to the ED in light of the fact that twilight essential care administrations, or time and work weights are best met by the unscheduled accommodation of the ED. In this line, road kids and the destitute are expanding in numbers every day. This population depends vigorously on healing center EDs though of their essential and crisis couldn’t care less needs, to the degree in a few cases, that the doctor’s facility has set up exceptional regions inside or neighboring the ED to explicitly manage this patient populace.


With the conclusion of numerous psychiatric doctor’s facilities and the move to oversee emotional sickness in the group (in spite of absence of group framework and deficiencies of psychiatric wellbeing experts), the need to give ED emergency administration benefits and mastermind follow-up for day programs and other group psychiatric projects has risen significantly.


2.5 Users of emergency department


The users or the services differ regarding to the urgency of the medical care but the use of this facility also vary due to the patient’s gender, income and age. The largest population that visits the facility are the poor populace as compared to the higher income group by about (18% and 13%) respectively while the research curried out in Australia (2003-2004), Public hospital showed that males made more visits to the facilities. The age of the patient is also another factor that determines the provision of health care




3.1 research methodology;

The study is based in the secondary data obtained from the Attendances &Emergency admission monthly statistics. NHS and Independent organization in England in April 2016 shall take 3 different department as area of concern and the official Canadian website related to health care provision, the analysis from the finding will be used generally to analyze the St. Thomas Elgin General Hospital, Ontario Canadian hospital wait time and the factors that influence the provision of the emergency services. Presentation will be by use of descriptive statistic tools (Benneyan, Lloyd & Plsek, 2003).


4.1 presentation


The length of time that patients normally take in the emergency departments  can be and largely be partitioned between time spent holding up to see a doctor and time spent after that experiencing diagnostics and getting treatment. Patients evaluated to be extreme such as CTAS I, for instance, stun, significant injury, heart capture, invested the most limited extent of energy in EDs holding up to be evaluated by a doctor. Then again, those evaluated as non-pressing such as CTAS V like sore throat, ceaseless back agony invested the biggest extent of energy sitting tight for a doctor.


Waiting time to see a doctor



From the graph the number of patients spending >12 hour tend to be increasing







More itemized demographic


Data about who is utilizing EDs is additionally accessible from CIHIís National


Though scope could be restricted, the information incorporate visits in any case of age from all over the regions, and incorporate insights with respect to the reasons for care and patients encounters. As indicated by these information, guys and females went by EDs to practically the same degree in 2003ñ2004 (49.6% versus 50.4%, separately). By and large, the quantity of visits dropped as age expanded. In any case, newborn children, below one year in particular accounts for a larger percentage of visits to the emergency departments.


As per these information, guys and females went to EDs to practically the same degree in 2003 to 2004 (49.6% versus 50.4%, individually). Generally, the quantity of visits dropped as age expanded. Be that as it may, newborn children (especially those under 1 year old) accounted for the most visits to EDs in while just 12% of those going to EDs arrived by emergency vehicle, patients with the most extreme wellbeing concerns (78%, versus 2.8% with the slightest extreme conditions) and elderly ladies 85 years old and more established will probably arrive by emergency vehicle.









The study Is aimed in finding the length of time one takes to wait for and receiving care once in the emergency department. The emergency department is a critical area in all medical department hence it should be of high quality standards and care (Knapman& Bonner 2010). The (Benneyan et al. 2003) suggested that the statistical process control tool is the key tool to identify, monitor and control the continuous improvements hence it’s used has given a better understanding of the waiting time in the emergency department. Most of the hospital follow different but similar stages immediately the patient gets to a point he/she has to leave. Most of the long wait are due to some random and non-random factors. The non-random factors are the availability of beds, the level of activities in the Emergency department. The severity of the process the random factors are the patient’s conditions.

Increased waiting time makes a patients decide to leave the emergency department before being attended, which can be a threat to both the patient and the external environment if the patient is suffering from disease that can be a threat to the immediate healthy person, to the patient not receiving attention at the right time can make him suffer more or at some extended my lead to death



To reduce the wait time and increase the quality of health provision in the emergency department should be as follows.

  1. Financial incentives to ease in shortage in the medical system .this can be by government funding the purchase of more hospital emergency equipment making them available when the need arises.
  2. Human resource policies that is collaborative initiative between the patient staff and the management to improve the quality of medical provision hence shorter waiting time
  • Technology management of patient flow. This can help in the long registration process that a patient has to follow .and also advanced equipment making the services faster and of quality (Schoen, et al. 2012.).
  1. The government ought to attempt the improvement of national principles for doctor’s facility crisis benefits as a rapid need for enhancing the Canadian human services framework. Such an attempt would at long last guarantee the arrangement of crisis administrations in reaching, general, compact, and available standards of the Canada Health Act.
  2. This activity ought to be led under the protection of CAEP and suitably resourced by the government. The benchmarks ought to be confirmation or best-rehearse based and deliver every day and additionally phenomenal and squeezing crisis administrations issues.
  3. The central government ought to require commonplace and local wellbeing powers to execute the norms through ordered common approach or potentially enactment and to screen and assess consistence through near companion assemble execution pointer reporting.
  • The central government ought to focus on supporting consistent audit and upgrading of the national gauges. Government exchange installments for medicinal services administrations ought to be fixing to common consistence with these and other national human services principles.
  • The advancement and execution of national gauges for healing facility crisis administrations, if upheld by the government, could speak to a noteworthy stride toward the formation of an exhaustive, consistent crisis administrations framework in Canada.



This section portrayed time consumed in Canada’s crisis divisions. In the recent past, emergency department visits are finished within eight hours. Patients who are conceded and of higher sharpness had the longest general length of remain

Even in the wake of altering for reality of their condition, most patients held up longer to see a doctor than recommended by CAEP’s optimal reaction times Include review of information demonstrates that ED hold up times in Canada are for quite some time contrasted and those in different nations.

Moving forward, as container Canadian information gathering builds, the quality and comprehension of that information will probably enhance, offering ascend to an expansion in number what’s more, nature of jurisdictional correlations Ambulatory mind touchy conditions and substitute level of care, of the frequently referred to elements identified with long holds up in E.Ds.’ Nonetheless, current examinations have recognized that most emergency visits where patients were looking for watch over ACSCs were likely fitting. It gives the idea that elements, for example, the volume of emergency cases and share of high sharpness patients were better indicators of emergency department hold up times than were any of the analyzed measures of the effect of ALC remains

The next part will dig advance into ALC and different holds up experienced in the intense care situation.



Benneyan, J.C., Lloyd, R.C. and Plsek, P.E., 2003. Statistical process control as a tool for             research and healthcare improvement. Quality and Safety in Health Care, 12(6), pp.458- 464.  https://secure.cihi.ca/free_products/HCIC2012-FullReport-ENweb.pdf,

Kelly, K.R., Espitia, C.M., Mahalingam, D., Oyajobi, B.O., Coffey, M., Giles, F.J., Carew, J.S.    and Nawrocki, S.T., 2012. Reovirus therapy stimulates endoplasmic reticular stress,            NOXA induction, and augments bortezomib-mediated apoptosis in multiple myeloma.           Oncogene, 31(25), pp.3023-3038.

Schoen, C., Osborn, R., Squires, D., Doty, M., Rasmussen, P., Pierson, R. and Applebaum, S.,     2012. A survey of primary care doctors in ten countries shows progress in use of health           information technology, less in other areas. Health affairs, 31(12), pp.2805-2816.

Urbach, D.R., Govindarajan, A., Saskin, R., Wilton, A.S. and Baxter, N.N., 2014. Introduction of           surgical safety checklists in Ontario, Canada. New England Journal of Medicine,     370(11), pp.1029-1038.

Williams, A.P., Lum, J., Morton-Chang, F., Kuluski, K., Peckham, A., Warrick, N. and Ying, A.,             2016. Integrating Long-Term Care into a Community-Based Continuum. Institute for      Research on Public Policy.

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