Time Spent in Emergency Departments

Indicator Description

This indicator measures the percentage of patients whose emergency department (ED) visit was completed within Ontario's target time. The ED length of stay (LOS) is calculated as the average time interval between the earlier of triage or registration and when a patient is admitted to the hospital or discharged, transferred, or leaves the ED (non-admitted patients). Provincial targets have been set for the maximum amount of time patients should spend in the ED, waiting and being treated, before being discharged or admitted to the hospital, based on clinical evidence.

Interpretation (for example, directionality)

A higher percentage is better.

Definition and Source Information

Statistic and Unit of Measurement

Percentage

Numerator      

Number of patients whose emergency department visits were completed within the provincial target wait time.

Numerator Inclusion/Exclusion Criteria        

Inclusions:

ED visits with a valid and known registration date/time or triage date/time, and a valid and known date/time the patient left the ED or disposition date/time

Admitted Patients: unscheduled emergency visits with Disposition Codes 06 - 07

Non-admitted Patients: unscheduled emergency visits with Disposition Codes 01, 03-05, 08-15

Exclusions:

Scheduled visits to the emergency department

ED visits with Visit Disposition 02 (Left without being seen or triaged)

Visits with both unknown/invalid registration and triage date/time OR with unknown/invalid patient left ED date/time

Negative ER LOS (that is, the registration or triage date/time is after the date/time that the patient left ER)

Duplicate records within the same functional centre

Denominator

All patients whose ED visits met the criteria to be included 

Denominator Inclusion/Exclusion Criteria   

Inclusions:

ED visits with a valid and known registration date/time or triage date/time, and a valid and known date/time the patient left the ED or disposition date/time

Admitted Patients: unscheduled emergency visits with Disposition Codes 06 - 07

Non-admitted Patients: unscheduled emergency visits with Disposition Codes 01, 03-05, 08-15

Exclusions:

Scheduled visits to the emergency department

ED visits with Visit Disposition 02 (Left without being seen or triaged)

Visits with both unknown/invalid registration and triage date/time OR with unknown/invalid patient left ED date/time

Negative ER LOS (that is, the registration or triage date/time is after the date/time that the patient left ER)

Duplicate records within the same functional centre

Calculation Method   

Numerator divided by the denominator times 100

Indicator Reporting Level(s)/Stratification(s)

Patient group based on Canadian Triage and Acuity Scale (CTAS), hospital site, Ontario, reporting period          

Refresh Frequency

Monthly           

Data Asset Name(s)

National Ambulatory Care Reporting System (NACRS)           

Data Providers

Canadian Institute for Health Information (CIHI)        

Adjustment(s)

N/A

Limitations and Assumptions Notes

1. Scheduled visits to the ED are excluded from this analysis.
2. Patients who registered in the ED but left without being seen or triaged are not included in the analysis.
3. For non-admitted patients, patients who left without being seen or without treatment and who left after triage and initiation of treatment are included in the analysis.
4. Many factors can influence the indicator results, including triage level, patient population and hospital resources.
5. Depending on the acuity of the case or hospital procedures, triage may occur before registration or vice versa. Therefore, the earlier of these 2 events is used as the starting point for calculation of this indicator.

Total number of patients who had an emergency department visit

Indicator Description

This indicator measures the total number of patients that completed an emergency department (ED) visit. The ED visit begins with the earlier of triage or registration and ends when a patient is admitted to the hospital or discharged, transferred, or leaves the ED (non-admitted patients).

Interpretation (for example, directionality)   

No directionality

Definition and Source Information

Statistic and Unit of Measurement

Number of patients

Numerator      

Total number of patients who met inclusion criteria and had an emergency department visit

Numerator Inclusion/Exclusion Criteria

Inclusions:

ED visits with a valid and known registration date/time or triage date/time, and a valid and known date/time the patient left the ED or disposition date/time

Admitted Patients: unscheduled emergency visits with Disposition Codes 06 - 07

Non-admitted Patients: unscheduled emergency visits with Disposition Codes 01, 03-05, 08-15

Exclusions:

Scheduled visits to the emergency department

ED visits with Visit Disposition 02 (Left without being seen or triaged)

Visits with both unknown/invalid registration and triage date/time OR with unknown/invalid patient left ED date/time

Negative ER LOS (that is, the registration or triage date/time is after the date/time that the patient left ER)

Duplicate records within the same functional centre

Denominator

N/A      

Denominator Inclusion/Exclusion Criteria   

N/A

Calculation Method   

Total count of ED visits meeting the inclusion/exclusion criteria

Indicator Reporting Level(s)/Stratification(s)            

Patient group based on Canadian Triage and Acuity Scale (CTAS), hospital site, Ontario, reporting period

Refresh Frequency     

Monthly

Data Asset Name(s)   

National Ambulatory Care Reporting System (NACRS)

Data Providers             

Canadian Institute for Health Information (CIHI)

Adjustment(s)

N/A

Limitations and Assumptions Notes

1. Scheduled visits to the ED are excluded from this indicator.
2. This indicator reflects the number of ED visits, which does not necessarily equal the number of individuals.

Indicator Description

This indicator measures the total number of patients who waited to see a doctor, nurse practitioner or dentist in the emergency department.

Interpretation (for example, directionality)

No directionality

Definition and Source Information

Statistic and Unit of Measurement

Number of patients

Numerator      

Total count of patients who waited to see a doctor, nurse practitioner or dentist in the emergency department

Numerator Inclusion/Exclusion Criteria        

Inclusions:

Unscheduled emergency visits with a valid and known registration time or triage time and a valid and known initial assessment time.

Exclusions:

1. Cases where Registration date/time and Triage date/time are both blank/unknown
2. Cases where the MIS functional centre is under Emergency Trauma, Observation, or Mental Health Services (as of January 2015 data)
3. Duplicate cases within the same functional centre where all ED data elements have the same values except for Abstract ID number
4. Cases where ED visit indicator is = "0" (i.e., scheduled ED visit)
5. When ONLY PIA date/time are completed:
   Cases where PIA date/time are blank/unknown
   Cases where time to PIA is greater than or equal to 100,000 minutes (1,666 hours)
   Cases where PIA date/time is AFTER Disposition date/time or Patient left ED date/time
6. When ONLY NPIA date/time and service are completed:
   Cases where NPIA date/time are blank/unknown
   Cases where NPIA service are blank/unknown
   Cases where NPIA service is NOT nurse practitioner, physician assistant, or dentist
   Cases where NPIA is AFTER Disposition date/time or Patient left ED date/time
   Cases where Time to PIA is great than or equal to 100,000 minutes (1,666 hours)
7. When PIA date/time and NPIA date/time and service are completed:
   Cases where both PIA and NPIA date/time are blank/unknown
   Cases where NPIA service is NOT nurse practitioner, physician assistant, or dentist
   Cases where Time to PIA is greater than or equal to 100,000 minutes (1,666 hours)

Denominator

N/A      

Denominator Inclusion/Exclusion Criteria   

N/A

Calculation Method   

Total count of patients seen in the emergency department meeting the inclusion/exclusion criteria

Inclusions:

Unscheduled emergency visits with a valid and known registration time or triage time and a valid and known initial assessment time

Exclusions:

1. Cases where Registration date/time and Triage date/time are both blank/unknown
2. Cases where the MIS functional centre is under Emergency Trauma, Observation, or Mental Health Services (as of January 2015 data)
3. Duplicate cases within the same functional centre where all ED data elements have the same values except for Abstract ID number
4. Cases where ED visit indicator is = "0" (i.e., scheduled ED visit)
5. When ONLY PIA date/time is completed:
   Cases where PIA date/time is blank/unknown
   Cases where time to PIA is greater than or equal to 100,000 minutes (1,666 hours)
   Cases where PIA date/time is AFTER Disposition date/time or Patient left ED date/time
6. When ONLY NPIA date/time and service are completed:
   Cases where NPIA date/time is blank/unknown
   Cases where NPIA service is blank/unknown
   Cases where NPIA service is NOT nurse practitioner, physician assistant, or dentist
   Cases where NPIA is AFTER Disposition date/time or Patient left ED date/time
   Cases where Time to PIA is greater than or equal to 100,000 minutes (1,666 hours)
7. When PIA date/time and NPIA date/time and service are completed:
   Cases where both PIA and NPIA date/time are blank/unknown
   Cases where NPIA service is NOT nurse practitioner, physician assistant, or dentist
   Cases where Time to PIA is greater than or equal to 100,000 minutes (1,666 hours)

Indicator Reporting Level(s)/Stratification(s)

Patient group based on Canadian Triage and Acuity Scale (CTAS), hospital site, Ontario, reporting period

Refresh Frequency     

Monthly

Data Asset Name(s)   

National Ambulatory Care Reporting System (NACRS)

Data Providers

Canadian Institute for Health Information (CIHI)        

Adjustment(s)

N/A

Limitations and Assumptions Notes

1. Scheduled visits to the ED are excluded from this indicator.
2. Patients who registered in the ED but left before being seen are not included