|P4P Program Reduces Emergency Room Congestion In British Columbia
Patients visiting the emergency departments of the
busiest hospitals in British Columbia will benefit from shorter waits
through $20 million in program funding aimed at providing financial
incentives for delivering more timely care.
"Innovation can help unclog bottlenecks in our public
health system and is critical to improving patient access and care,"
said Health Services Minister George Abbott. "In some hospitals in
Vancouver, 25 percent of patients waited less as a result of the
P4P funding to ease emergency department congestion was
first piloted in 2007 by Vancouver Coastal Health (VCH). It rewarded
hospitals that met predetermined targets for moving patients through
the emergency department, either into a hospital bed or back to the
community. In the first half of 2008, compared to the first half of
2007, VCH saw:
- Twenty-two percent more patients with lower medical
concerns being treated and discharged from emergency within the
- Thirteen percent more patients with higher medical concerns getting care within the four-hour target; and
- Twenty-four percent more patients who needed to be admitted getting a hospital bed within the 10-hour target.
"The results of our emergency decongestion pilot and the
pay-for-performance funding model have been outstanding," said Dr. Eric
Grafstein, an emergency physician and regional emergency services
council chair for VCH. "Overall, 30,000 more patients were seen within
the target time for discharge from the emergency department or
admission to a ward. The success is due not just to the innovation and
commitment of physicians and emergency department staff, but to
everyone in the hospitals with a role in helping patients get care more
Following the successful emergency decongestion pilot in
four hospitals in VCH, the program will continue as a Lower Mainland
Innovation and Integration Fund (LMIIF) funded project at Vancouver
General, St. Paul’s, Richmond and Lions Gate as well as expanding
to Abbotsford Regional Hospital, Burnaby Hospital, Royal Columbian
Hospital and Surrey Memorial Hospital in Fraser Health.
"Pay-for-performance is an innovative model to help
ensure patients receive the care they need in a timely manner," said
Dr. Nigel Murray, Fraser Health CEO. "Fraser Health welcomes the
opportunity to reduce congestion by rewarding hospitals for their
ability to meet patient-focused targets."
Fraser Health is focusing tailored resources for
site-specific projects with the best chance of producing the desired
results. This includes an emergency triage physician at Surrey Memorial
Hospital, rapid assessment zones at Burnaby and Abbotsford and an
emergency rehabilitation team at Royal Columbian.
"We physicians appreciate the funding that is targeted
directly at reducing emergency department congestion," said Dr. Neil
Barclay, an emergency physician at Royal Columbian Hospital. "We hope
this will have a significant impact on wait times for patients who come
to the emergency department."
Each emergency department has a current baseline of the
time from arrival to treatment and discharge, or admission, for each
category of patient. Reducing wait times from those baselines earns
dollars to be reinvested by the facilities for further improvements.
With $20-million worth of resources available through
the LMIIF, each hospital will now have the opportunity to fund unique
projects anywhere in the healthcare system that may help it to meet
targets for transit times for patients admitted and discharged through
the emergency department.
For every low acuity patient treated and discharged in
less than two hours, the hospital receives $100. For more serious
patients treated and discharged in less than four hours, the payment
will also be $100. For admitted patients who move to a bed in less than
10 hours, the hospital receives $600. The money will then be reinvested
in improvements to hospital care.
Fraser Health and VCH have collaborated on a series of
pilot programs as part of a two-year $75-million LMIIF to encourage new
patient-focused funding models that will support patient access
–a government initiative announced in the 2008 throne speech.
VCH received $14 million in its first year piloting this
model. That money has been reinvested in the projects that delivered
the results. Fraser Health has the opportunity to earn up to $12
million with $8 million available to VCH.
Address: British Columbia Ministry of Health Services,
P.O. Box 9050, STN PROV GOVT, Victoria, BC V8W9E2 Canada; (950)