ICES | Emergency Department Services in Ontario 1993 - 2000 - page 10

The facility has equipment and staff to manage high acuity emergencies
(e.g. cardiac arrest, trauma, other resuscitations);
The facility accepts ambulances;
The facility operates on a 24 hour basis;
The facility is adjacent to and affiliated with a hospital.
Predicting Future Demand for ED Services
Predicting future demand for ED care, and the number of ED physicians
required to meet the demand, it is a major challenge for planners. Yet,
growing perceptions of difficult or diminished access to emergency care
19,20
make this task all the more important.
The HSRC attempted to do this, by assuming that the ratio of ED visits to
acute care beds observed in 1995 was appropriate, and then projected
future ED visits according estimated growth in the number of hospital beds
needed. Based on this method, a 20 per cent increase in ED capacity over
1995 levels was projected for 2003.
21
Yet, the HSRC, by its own admission,
felt that the “insufficient precision in the data reported by hospitals respecting
ER visits and ambulatory care” limited the usefulness of this formula.
22
After
a decade of restructuring, it may be time for a comprehensive, province-wide
review of emergency department services, given the significant changes that
have taken place in the system. Data from NACRS might be used to establish
benchmarks for emergency department services and to evaluate access
across different regions of Ontario.
Efforts to predict future demand should carefully consider the finding that ED
use is declining in the pediatric and young adult population and rising among
the elderly. This trend, also documented in studies of EDs in the U.S.,
8;10
needs to be monitored closely, as the aging of the population, combined with
rising ED use per capita in the elderly, may lead to greater strains on the ED
system.
Predictions of future demand should also consider the following:
Are there other opportunities to shift non-urgent cases to other settings?
What will the impact of primary care reform be on ED visit volume, if, as
planned, primary care groups provide 24 hour coverage for their patients?
What impact will changes in other parts of the health care system have on
ED demand? Will investments or cutbacks in the acute care, home care
or long-term care sectors result in decreases or increases in ED visits for
complications of illnesses?
Will recently introduced telephone triage systems decrease or increase
demand on EDs?
Conclusions
This study identifies a number of trends in how ED services are used in Ontario
and how these services are provided by the health care system (Exhibit 14).
Policy makers need to anticipate the impact of these trends, if they continue.
First, strategies for dealing with predictable peaks in ED system demand need
to be developed. Such strategies should consider options such as expanded
primary care coverage during weekends and holidays, or greater flexibility in
the availability of staff and resources in the ED and in the settings to which ED
patients are discharged (inpatient wards, long-term care and home care).
Second, the ED physician workforce requires careful planning. Increased
training may improve the quality of care, but careful attention needs to be paid
to the total number of physicians available to work in the ED. Planners and
physician groups should also consider the future role of the GP/FPs without
emergency medicine certification in the staffing of EDs, since they will continue
to be needed in this capacity in the foreseeable future.
Third, the aging of the ED patient population is outpacing that of the general
population, which has the potential to increase demand for emergency
services. Strategies to address this trend include reducing the demand for
ED services through community-based alternatives to ED care, coupled with
strategies to better manage chronic diseases, or increasing ED capacity.
However, ED capacity depends as much on resources in other parts of the
health care system, such as inpatient or long-term care beds, as it does on
the size and staffing of EDs. Therefore, successfully managing these trends
will require careful planning of health care resources both inside and outside
of Ontario's EDs.
Acknowledgements
We would like to express our appreciation to Dr. Brian Rowe, Dr. Ian Stiell,
Mr. James Whaley and Dr. Andreas Laupacis for providing helpful comments on
an earlier draft of this report.
We also wish the acknowledge the excellent work of the ICES Research
Transfer Unit, including Paula McColgan, Laura Benben and Donna
Hoppenheim, in the editing, design and publication of this Report.
Any errors or omissions in this report remain solely the responsibility of the
authors.
9
Institute for Clinical Evaluative Sciences
Emergency Department Services in Ontario
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