Emergency departments cut gridlock considerably


The Challenge: Reduce wait times and overcrowding in EDs

Overcrowding in emergency departments is a problem for many hospitals across Canada. But it is a particularly daunting challenge for officials of the former Calgary Health Region (now the Calgary Zone of Alberta Health). Patients at the healthcare authority’s emergency departments waited twice as long as patients in Ontario for initial assessments; and urgent cases were forced to wait four times longer than recommended by national guidelines. Dr. Ward Flemons believed that a solution lay not in addressing one stage of the process alone—input, throughput or output—but in examining and treating the system of emergency services as a whole.

The Improvement Project: Examine findings to create a system-wide approach

To uncover ways to speed patient flow, Dr. Flemons, Vice- President of health outcomes, Calgary Zone of Health, started his EXTRA program journey by undertaking an exhaustive review of existing research. While Dr. Flemons found that most research deals with throughput only (what happens to patients when they are at the hospital), he was able to use current findings to design a number of evidence-based improvement projects that cover the entire system—from input (why people come to emergency departments) to throughput to output (how they are moved out of emergency departments).

The Result: GRIDLOCC improvements designed to end Emergency Department gridlock

Together, these improvement projects are known as GRIDLOCC (Getting Rid of Inappropriate Delays that Limit Our Capacity to Care). While different projects are designed to tackle specific problems in each of the three zones, all improvement interventions are based on proven methods, such as LEAN and Six-sigma, and stress taking on immediately the most serious impediments to smooth patient flow.

The Impact: Designated zones accelerate patient flows dramatically

One particularly successful improvement involved redesigning throughput so that it enabled emergency physicians to remain in zones designated for different patient categories instead of having physicians travel between patients. The results were immediate and dramatic: the time physicians spent moving throughout the hospital dropped from 51 percent of their total time at work to just four percent. This improvement increased the amount of time physicians spent with patients from 14 percent of their total time to 59 percent and decreased the median wait time for patients’ initial assessments by emergency physicians by 21 percent.

Ward Flemons image


Dr. Ward Flemons
Vice-President of Health Outcomes
Calgary Zone of Health Calgary, Alberta


To learn more about this project or the EXTRA program, visit cfhi-fcass.ca/EXTRA or email us at info@cfhi-fcass.ca.