The influx of patients with the flu, COVID-19, and other respiratory illnesses during winter months further strains the system and can overwhelm emergency departments by overtaxing hospital resources, increasing patient wait times, and causing overcrowding.
Recent international survey results from the Canadian Institute for Health Information (CIHI) indicate that Canada lags behind peer countries regarding primary healthcare access, though the US doesn’t fare much better, according to the survey.*
Below are two examples of how MEDITECH customers are addressing these real-life challenges, by improving access to the right care settings — as well as implementing ways to alleviate emergency room congestion.
Pioneering new pathways at Royal Victoria Regional Health Centre
Royal Victoria Regional Health Centre (Barrie, ON), part of the CARE4 partnership, runs one of the busiest emergency departments in the region. To prevent ED overcrowding at high volume times, RVH created an emergency department e-booking portal called the Emergency Department Minor Ailment Patient Pathway.
The hospital's pilot program initially allowed patients to book appointments online for minor injuries like sprains, strains, or possible simple fractures to an arm or leg. The program's rapid success led to expansion and now includes minor ailments like cuts, lacerations, urinary tract infections, and skin infections, as well as cold and flu symptoms.
When patients access the ED MAPP, they are directed to answer a set of questions online about the events surrounding their injury as well as any potential exclusion criteria such as bleeding, loss of consciousness, head, neck, or back injuries, ensuring the appropriate level of care needed.
The ED MAPP allocates time slots for eligible patients to book a same-day or a next-day arrival time at RVH. Once the patient arrives at the hospital, they are rerouted out of the ED and into a designated treatment area.
Patients can easily access the ED MAPP booking link from the RVH website. Since September 2023 and January 2025, 6,620 patients have been seen and treated through the ED MAPP, and for most patients, the average time between being seen by the doctor and leaving the health centre is approximately 1.5 hours.
RVH continues to look at ways to improve access to care within its community, creating efficiencies that further enhance patient care and experience.
Taking a multi-pronged approach to direct the right care at Fraser Health Authority
Fraser Health Authority (Surrey, BC) is the largest regional health authority in British Columbia. To direct non-emergent patients to more appropriate care settings outside of the emergency department, it is taking a multi-pronged approach under its digital transformation project called Fraser Health’s Digital Twin, a first-of-its-kind project for a health authority in BC.
The digital twin technology replicates the health authority’s key data and clinical information systems. Under the digital twin, when patients access the health authority online, they do so through its Digital Front Door, a self-service triage tool accessible by smartphone or computer. Within the Digital Front Door sits the health authority’s AI-based digital navigator, aptly named Fraser.
Fraser assists patients by helping them decide if they should seek emergency care, urgent care, virtual care, palliative care, or care for mental health and substance use concerns, and directs them to the appropriate care based on their location, symptoms, and availability of services. Fraser provides navigational recommendations but does not make independent clinical decisions. Since its introduction just over a year ago, Fraser has helped over 67,000 people find the closest, most appropriate care.
The health authority also ensures that a human connection is available if needed. For example, should a navigational error occur or if the patient is uncertain, the system automatically directs them to care providers through Fraser Health Virtual Care, which is a contact center staffed by registered nurses and dietitians who can assess patient concerns and direct them to the most appropriate health information or resource, including going to the ED if necessary. Fraser Health Virtual Care is open from 10am to 10pm, 7 days a week.
Early findings from the analysis of Fraser Health Virtual Care service showed a 30 percent relative reduction in low-acuity visits among those who connected with Fraser Health Virtual Care prior to attending the ED compared to those who did not.
The Canadian Triage and Acuity Scale (CTAS) is a five-level system used to prioritize patients based on the severity of their condition, with CTAS I indicating the need for immediate or life-threatening care, and CTAS V requiring non-urgent care. The recent data review also looked at 165,000 patients and noticed a relationship between the use of Fraser Health Virtual Care and the rate of low-acuity presentations (rated as CTAS 4 and 5) in EDs. The results are indicative of the positive impact of providing virtual health options.
Interestingly enough, results also indicated that the majority of virtual care callers are between 50 and 89 years old, and yet younger age groups also make up a high portion of CTAS 4 and 5 in ED visits. Fraser Health is looking at ways to reach younger patient populations through different means, including social media.
While there are other factors that could influence the difference in low-acuity visit rates in general, based upon the analysis, there is great potential to divert such visits when people of all ages use the virtual care option before heading directly to the ED.
We look forward to sharing more in the year ahead on how Fraser Health is building upon its system to meet the evolving needs of its patients and staff (medical and non-medical) through its virtual care program and advanced AI initiatives.
Improving access and building awareness are key to improving patient care
These examples demonstrate how digital tools can transform care by improving access and more efficiently direct people to the right care where and when they need it. When we provide options to patients upfront that perhaps they weren’t otherwise aware of, and that are better suited for their needs, they gain a better understanding of the importance of triage before immediately turning to the ED, which benefits everyone.
Reducing the number of non-emergent patients in the ED alleviates the strain on hospital system resources and reduces wait times, as well as helps patients avoid prolonged periods of exposure to others who are sick, which is especially important during the respiratory season.
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