ICES | Emergency Department Services in Ontario 1993 - 2000 - page 3

Introduction
Emergency departments (EDs) offer an essential service to the general
population. They provide episodic care to patients with injuries or acute
and treat exacerbations of chronic diseases. They are often used as an
conditions, alternative to primary care when patients cannot see their family
physician or cannot find one. For disadvantaged populations, EDs may also
serve as a provider of last resort.
EDs are a critical component of the health care system. They are important
hubs that interact directly with primary care givers, the pre-hospital system,
in-hospital care, home care, and long-term care services. EDs often serve
as the portal of entry for patients admitted to hospital. As a result, EDs are
also an important indicator of how well a community’s health care system is
functioning. When resources are reduced in other parts of the system, or
demands increase from seasonal pressures, the impact is frequently felt in
the ED.
Recent reports of ED overcrowding, ambulance diversion, and a growing
perception of physician and nursing shortages have attracted significant
public scrutiny. Yet, these issues have also highlighted the lack of systematic
information on the use and provision of emergency services in Canada. The
purpose of this report is to enhance the present understanding of emergency
services in Ontario, and assist policy makers and planners in anticipating
future trends. In this ICES Atlas Report, the following questions are examined:
The Organization and Funding of EDs
1. How many EDs are there in Ontario and how has the organization of the
ED system changed over time?
2. How are ED services funded and how has this changed over time?
The Use of ED Services by Patients
3. How often do people visit the ED?
4. How has the use of EDs changed over time?
5. When do peaks and dips in ED volume occur?
6. How often do patients visit the ED in the middle of the night?
7. What types of medical conditions are managed in the ED?
8. How does ED use vary across the province?
The ED Physician Workforce
9. How many physicians work in the ED and how has this changed over time?
10. What type of training do ED physicians have?
11. How has the clinical workload of ED physicians changed over time?
12. What are the demographics of the ED physician workforce?
Methods
Data Sources
Data from the Ontario Health Insurance Plan (OHIP) were used. The time
frame for this study was from fiscal year 1993 to 2000. During this period,
most physicians working in EDs were paid on a fee-for-service basis,
whereby they submitted a claim to OHIP for each service provided. This
claim identified the physician and patient,
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the type of service provided, the
ED where the service took place, date and amount paid.
Physicians in some EDs were paid on an alternate funding plan (AFP) or a
sessional (hourly) fee. Some, but not all, of these physicians were required to
submit “shadow billings,” where they submitted claims to OHIP but attached
a zero dollar value to the bill. Data on ED use in AFPs with no shadow billing
were unavailable.
Information about the funding and organization of ED services was obtained
through consultations with the Emergency Health Services Branch of the
Ontario Ministry of Health and Long-Term Care (herein referred to as ‘the
Ministry’), surveys to each District Health Council and, where warranted,
telephone calls to individual hospitals identified as having unique funding
arrangements or organizational structures.
Defining an Emergency Department
Remarkably, there is no standard definition of an emergency department in
Ontario.
Walk-in clinics, urgent care centres and EDs mostly treat unscheduled
patients presenting with acute or episodic conditions. Yet, they differ greatly
in the level of service provided and the acuity of conditions managed. There
are no clear guidelines to differentiate which ones should and should not be
considered EDs.
Emergency Department Services in Ontario
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Institute for Clinical Evaluative Sciences
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All patient and physician identifiers were scrambled to protect the confidentiality of individuals.
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