Niagara Health


Type of Practice


Hospital capacity pressure and admitted patient flow is a persistent challenge across Canada, with every province experiencing an increase in Emergency Department length-of-stay (EDLOS) for admitted patients in 2016/17.

In June 2018, Niagara Health (NH) utilized a patient flow simulation technique, using real-time data, to test the efficacy of a proposed St. Catharines Hospital site surge plan and alleviate ED overcrowding. The simulation was conducted using a high-fidelity table-top approach to decide when and where to offload ambulance arrivals and transfer admit-no-bed (ANB) patients. The simulation involved interdisciplinary collaboration between 13 patient care units (inpatient and outpatient) and 3 support services departments (Quality, Decision Support, and Environmental Services).

During the simulation, we were able to reduce ED admitted patient volume by 39% (31 to 19 patients) based on real-time data, and site surge plan actions. While this impact has been difficult to replicate in practice, we are starting to see decreases in EDLOS 3-months post-launch. We expect to see additional improvements as we continue to refine and embed surge plan actions into daily standard work at all levels of the organization based on lessons learned.

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