Toronto General Hospital says partnerships helping with emergency department volume

Toronto General Hospital, part of University Health Network, says its emergency department (ED) is facing ever-increasing patient volumes, and the numbers continue to rise year over year.

Department Head Dr. Erin O’Connor says their ED also sees patients with very complex needs, which means the length of the stay is typically longer.

“This department was built for 20,000 and we’re seeing 60,000-70,000 patients per year,” she said, adding being located downtown comes with its own unique challenges related to mental health and homelessness.

“We’ve made a number of adjustments to try to ensure that people are not waiting a long time, but it sometimes does outstrip our resources.”

From using AI to find efficiencies to turning offices into medical spaces, hospitals across the GTA are turning to healthcare workers on the ground to help come up with solutions to address similar challenges. At Toronto General, staff say they’ve created partnerships with other hospitals and organizations to help alleviate some of the pressure and divert people from their ED when possible.

Follow up rather than overnight stays

O’Connor said rapid followup is also part of that process, which allows patients to have the care they need in the days following their visit.

“So they would leave here today, and we would say ‘you have an appointment tomorrow at 3:00 p.m. and further testing will be done at that time,'” she explained.

“They get to go home and sleep in their own bed. They don’t have to stay in a hospital and we can move patients through and see the next person.”

These partnerships, called care pathways, currently operate with Women’s College Hospital, a virtual ED and Princess Margaret Urgent Care Clinic, which can do imaging and bloodwork. A mental health and substance use care pathway with CAMH and the Ministry of Health is in development.

UHN says this involves management of withdrawal symptoms in the ED, starting patients on medications that will help them manage their addiction, and connecting them to the appropriate supports for followup care as an outpatient or inpatient. 

‘We try things, we say let’s fail fast’

Michael De Wit, nurse manager of the ED at Toronto General, says the emergency department he’s working in now is not the same place it was a few years ago.

“We have to work with the team to constantly innovate and work on new models of care delivery in order to meet the challenges,” he said.

De Wit said one of the ways they’re doing that is by working with staff to brainstorm solutions, and then taking those ideas from the frontline team and putting them into practice.

“We try things. We say, let’s fail fast,” he said.

“And if something works, then that’s great, we put that into practice. If something doesn’t work, then we can always try something else. But so many of those ideas, they do come from the team.”

Nurse practitioner Kathryn Grundy says it’s difficult to see the wait times go up, but the team is addressing the challenges head on everyday, finding ways to improve the flow and working their hardest.

“We’ve been hiring more advanced practice providers to help offload that volume,” she said, adding the virtual ED is helping.

“I just hope that we continue to support staffing in the emergency department, getting the resources that we need and utilizing people like us — nurse practitioners and physician assistants — to help where we can.”

O’Connor believes moving forward, continuing to build on the partnerships and relationships with other organizations is going to be a key part of meeting the demand and delivering good care.

“I think in the emergency department over the last decade or so, we’ve evolved to serve many unfilled needs in the community, whether it be primary care needs or social needs,” she said.

“I think moving forward, it’s going to be building up those partnerships and relationships so that patients are able to access care in the right place at the right time.”