Abstract
Ontario has shown an increasing number of emergency department (ED) visits, particularly for mental health and addiction (MHA) complaints. Given the current opioid crises Canada is facing and the legalization of recreational cannabis in October 2018, the number of MHA visits to the ED is expected to grow even further. In face of these events, we examine capacity planning alternatives for the ED of an academic hospital in Toronto. We first quantify the volume of ED visits the hospital has received in recent years (from 2012 to 2016) and use forecasting techniques to predict future ED demand for the hospital. We then employ a discrete-event simulation model to analyze the impacts of the following scenarios: (a) increasing overall demand to the ED, (b) increasing or decreasing number of ED visits due to substance abuse, and (c) adjusting resource capacity to address the forecasted demand. Key performance indicators used in this analysis are the overall ED length of stay (LOS) and the total number of patients treated in the Psychiatric Emergency Services Unit (PESU) as a percentage of the total number of MHA visits. Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure.
Highlights
Ontario has shown an increasing number of emergency department (ED) visits, for mental health and addiction (MHA) complaints
Since the Psychiatric Emergency Services Unit (PESU) is operating close to its capacity, the number of MHA patients seen in the PESU as a percentage of the total number of MHA visits to ED only decreased from 37.9% at the baseline to 37.1% in 2017 and 35.0% in 2018. e numbers obtained in this scenario are intuitive, considering that if demand is expected to increase
No adjustments in capacity are made, the service level is likely to deteriorate. e reader should be mindful that, as depicted in Figure 1, whenever the PESU is operating at its capacity, the excess of MHA patients is treated in the regular ED
Summary
Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure. Several hospitals in the Greater Toronto Area have created separate MHA emergency units (usually within the ED) to provide streamlined care and safer environments for patients [12,13,14,15] Another Ontario program to reduce the number of MHA ED visits is the META : PHI (Mentoring, Education, and Clinical Tools for Addiction : Primary Care-Hospital Integration), which provides evidence-based and timely. They decreased by 27% in the following year (though it should be noted that this 27% only considers 9 months of comparable data, from Jan to Sept 2015) [28]
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