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Home / News & IndustryManaged Care Insight and Analysis
Updated: Oct. 28, 2008
P4P Leads To Faster Emergency Department Care In Vancouver

Over 18,000 Emergency Department patients received faster access to care during the past year due to a new incentive-based pilot project in Vancouver Coastal Health (VCH) and Providence Health Care (PHC).

The Emergency Decongestion Pilot (EDP) was launched in late 2007 as a pay-for-performance experiment to see if funding incentives would encourage better patient flow and faster access to hospital care, the two organizations said.

While similar to other pay-for-performance initiatives in the United States and Britain, this is the first such EDP in Canada.

"When the British Columbia Government supported this VCH-PHC pilot through the Health Innovation Fund in 2007, we believed that this new approach would result in better access to quality patient care," said George Abbott, British Columbia Minister of Health Services. "The results of this pilot will help us understand how to better improve patient access."

Under the EDP, VCH and PHC receives additional funding for every admitted and non-admitted patient at Lions Gate, Richmond, Vancouver General and St. Paul’s hospitals who are seen within a specific target time. While it is expected a percentage of patients should always be seen and discharged in less than two to four hours based on their level of sickness, and patients requiring a hospital bed receive one within 10 hours from time of arrival, the EDP has pushed to increase the percentage beyond those levels, the organizations said.

"The results of our Emergency Decongestion Pilot have been tremendous," said Ida Goodreau, president and CEO of VCH. "In some cases we are seeing over 25 percent more patients experiencing shorter wait times in the emergency department, resulting in less time spent in hospital and more positive patient experiences."

In more specific terms, the number of patients requiring a lower level of care within the national standard of two hours has risen from 54 percent a year ago to 66 percent now. The number of urgent patients requiring care within the national standard of four hours has risen from 45 percent to 59 percent, while the number of patients receiving a hospital bed within the 10-hour standard jumped from 46 percent to 66 percent over the same period – a 20 percent increase, the groups said.

The funding incentives received through the pay-for-performance do not go to individual physicians or others, but to the hospitals involved for reinvestment into programs that will further improve patient flow throughout the health region.

Examples include:

  • The Rapid Assessment Zone (RAZ) at Richmond Hospital to assess and treat mid-acuity patients;
  • Upgrades to Vancouver General Hospital’s laboratory information system that has improved turnaround times for lab results by as much as 28 percent for some tests;
  • A Fast Track Unit at St Paul’s Hospital for patients with urgent conditions that can be treated relatively quickly; and
  • A "progress chaser" to closely manage each patient’s journey through the emergency department at Lions Gate Hospital and expedite patient flow.

The success of the pilot has enabled VCH and PHC to keep patients flowing through the hospital system at a time when demand continues to grow. VCH and PHC emergency departments see an average of 600 people per day, with the number of patients admitted through those emergency departments already around six percent higher than this time last year, the organization said.

"That we can help people receive the care they need more rapidly without negatively impacting their care and outcomes is testimony to how well the entire health system can work together with the right creativity and the right incentives," said Dr. Jeff Coleman, VCH chief operating officer for Richmond Hospital and an emergency department physician. "The success of the EDP is due not just to theinnovation and commitment of physicians and ED staff, but everyone in the hospitals who realized they have a role to play in helping patients get care more quickly."

The results – which compare rates in the first half of 2008 with the same period in 2007 – have been most striking in community hospitals such as Lions Gate and Richmond.

At Lions Gate Hospital the number of patients requiring admission who are placed in a bed within the 10-hour target has increased to 57 percent from 39 percent. The number of urgent cases treated and discharged in less than two hours has jumped to 51 percent, up from 29 percent. Fifty-eight percent of less urgent patients are now seen in less than four hours, up from 47 percent, the groups reported.

At Richmond Hospital the number of patients requiring admission who are placed in a bed within the 10-hour target has increased to 67 percent, up from 39 percent. Seventy-one percent of less urgent cases are now treated and discharged in less than four hours, up from 61 percent. Sixty percent of urgent cases are now being treated and discharged in less than two hours, up from 56 percent, the organizations said.

Addresses: Vancouver Coastal Health, 601 West Broadway, 11 Flr., Vancouver, BC V5Z-4C2 Canada; (604) 736-2033, Providence Health Care, 1081 Burrard St., Vancouver, BC V5Z-4C2 Canada; (604) 806-9090,

  This article was taken from:
Pay-For-Performance Reporter

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