In Toronto, one ER makes progress on overcrowding

Five times a day, senior managers at Toronto’s North York General get alerts on the ever-rising tide of patients arriving at the hospital’s emergency department.

The updates are colour-coded — and too many “red status” alerts prompt immediate action, with managers huddling with nurses and doctors to find space on medical units.

It’s just one tactic used to make inroads against overcrowding in one of Canada’s busiest emergency rooms.

From a “bed traffic control room” to a special outpatient clinic that strives to keep patients out of hospital, chief executive Dr. Tim Rutledge, a veteran ER doctor himself, cautions there’s no single way to drop wait times for the 107,000 patients arriving each year.

“It’s hundred and hundreds of small projects getting to the root causes,” he said during an interview.

Across Canada, stories of patients languishing in emergency departments peaked this winter — including a case of woman with internal bleeding who spent five days in the hallways of the Brampton Civic Hospital and a Halifax man dying from pancreatic cancer who was left on a gurney for seven hours before being seen by a physician.

The stories about patient indignities are prompting rising interest in what’s gone right at North York General, situated between the Don River and a busy Ikea near Highway 401.

Five years ago, statistics at the mid-sized community hospital showed 90 per cent of emergency patients admitted to hospital were moved to an inpatient bed within 25 hours — meaning some waited all day and a night for a spot in a ward.

As of late last year, the key measurement has fallen by a third to at about 19 hours — a drop that occurred despite a 22 per cent hike in the number of patients.

When adjusted for volume, North York General’s rank is now first among the 74 hospitals in ER performance, says Rutledge.

Medical departments that once saw a patient languishing in ER as another doctor’s problem began to volunteer to bring them upstairs to a bed.

There was also training that built understanding among the ghettoized specialities in a facility with almost 3,000 health care workers attached to it.

Meanwhile, the hospital became a poster child for the North America-wide Choosing Wisely medical movement, where medical staff make recommendations on ways to eliminate wasted time and money.