Details
Emergency services indicators in the access and flow theme
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Measuring emergency department (ED) length of stay provides information about not only care within hospitals, but also how well other parts of the health system are working. Some patients may spend a long time in the ED because inpatient beds are not available. The lack of available inpatient beds is often a result of other factors in the health system, such as patients not being able to leave the hospital for care in other places.
Indicator: Percentage of patients who visited the emergency department (ED) and left without being seen (LWBS) by a physician
This indicator measures the percentage of visits to the ED that result in the patient leaving before being assessed or treated by a physician.
Indicator: 90th percentile emergency department (ED) length of stay (LOS)
This indicator measures the total time elapsed between the time of triage or registrations (whichever occurs first) and the time the patient leaves the emergency department. This indicator will use the 90th percentile ED LOS as its evaluation metric.
Indicator: 90th percentile ambulance offload time (AOT)
This indicator measures the total time elapsed between the time of ambulance arrival at the ED and the time of the ambulance transfer of care process. This indicator will use the 90th percentile AOT as its evaluation metric.
Indicator: 90th percentile emergency department (ED) wait time to inpatient bed
This indicator measures the time interval between the disposition date/time and the date/time the patient left the ED for admission to an inpatient bed (or operating room).
This indicator will use the 90th percentile time to physician initial assessment (PIA) as its evaluation metric.
Key Resources
- Ontario Provincial Data on Time Spent in Emergency Departments
- ALC Leading Practices Guide: Preventing Hospitalization and Extended Stays for Older Adults (2021 V1); and self-assessment tool
- Transitions between hospital and home quality standard
- Emergency Services Leading Practices Toolkit – Ontario Health
- Emergency Services Leading Practices Self-Assessment Guide – Ontario Health
- Emergency Services Community of Practice – Ontario Health
Change Ideas
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Improve ED flow
- Implement bedside registration to reduce wait time between registration and physician initial assessment if beds are readily available on patient arrival
Improving Service Quality by Understanding Emergency Department Flow: A White Paper and Position Statement Prepared For the American Academy of Emergency Medicine
Strategies for Dealing With Emergency Department Overcrowding: A One-Year Study on How Bedside Registration Affects Patient Throughput Times - Leverage technology to reduce wait times through pre-registration or pre-triage kiosks
Osler enhances the patient experience in their Emergency Departments
The use of a self-check-in kiosk for early patient identification and queuing in the emergency department
Predicting Hospital Admission among High Acuity Triaged Patients Transported to the Emergency Department in Ontario, Canada: A Population-Based Cohort Study using Machine Learning - Dedicated fast-track areas for less acute patients
A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department
Improving emergency department flow through Rapid Medical Evaluation unit
Fit2Sit - Update medical directives to decrease unnecessary laboratory testing
Choosing Wisely Canada’s Give the Test a Rest Toolkit, to reduce unnecessary emergency department lab testing
Medical Directives for diagnostic Imaging - Health Quality Ontario
Example of ED medical directive – Lakeridge Health
Improve overall hospital flow
- Improve hospital-wide patient flow
Achieving Hospital-wide Patient Flow
ALC Leading Practices Guide: Preventing Hospitalization and Extended Stays for Older Adults (2021 V1); and self-assessment tool - Reduce unnecessary tests and treatments (e.g., decrease routine lab testing, diagnostic imaging, and use of urine dipsticks)
Implement Choosing Wisely Canada’s evidence-based recommendations to ensure patients receive care that is appropriate and necessary - Streamline discharge process to create more readily available beds
Blaylock Discharge Planning Risk Assessment Screen
Patient Oriented Discharge Summary (PODS) Tool
Transitions between hospital and home quality standard
CIHI – Assessment Urgency Algorithm - Transition patients requiring support to age in place back to the community
RCA ED Post Falls Pathway
Avoid unnecessary ED visits
- Early identification and assessment
The Identification of Seniors at Risk (ISAR)
Blaylock Discharge Planning Risk Assessment Screen
Clinical Frailty Scale - Care plan development and ongoing assessment
Interprofessional Comprehensive Geriatric Assessment - Develop and implement a Geriatric Emergency Management Program
Geriatric Emergency Management Network (GEM) - Provincial Geriatrics Leadership Ontario (geriatricsontario.ca)
Developing & Implementing a Geriatric Emergency Management Program - Provincial Geriatrics Leadership Ontario (geriatricsontario.ca) - Implement a collaborative model for service delivery in the ED for frail seniors
Collaborative Model of Emergency Departments Services | Regional Geriatric Program of Toronto (rgptoronto.ca)
- Implement bedside registration to reduce wait time between registration and physician initial assessment if beds are readily available on patient arrival
Last Updated: August 26, 2026
