1. Transformation of the Emergency Health Services System
Health and Long-Term Care
Transformation of the Emergency Health Services System
Presentation to NOSDA 2017 Annual General Meeting
Tanzeel Merchant, Director, Emergency Health Regulatory and Accountability Branch
Direct Services Division
June 8, 2017

2. Presentation Overview1
Context 2
Integration of Emergency Health Services
Transformational Agenda 3 4
System Improvements Underway 5
Q & A

3. Context – Patients First
The Government is committed to providing Ontarians with high- quality health care.
Patients First: Action Plan for Health Care is about providing patients with the right care, at the right time, in the right place, that is fiscally responsible and sustainable.
Emergency health services (EHS) is a key gateway to the broader health care system.
Connect
Inform
Protect
Access
Our commitment to integrated care across the patient’s journey requires more system inter-operability to make and communicate decisions about patient care needs.
Putting patients first means empowering patients and caregivers with tools to make informed decisions about accessing a broad range of health care resources.
To ensure a fiscally sustainable public health system, we need to make the best use of our infrastructure, funding and health human resources.
To provide equitable access to care, we’ll need to better match patient needs with health care facilities/resources that can provide the most appropriate care at the right time.

4. Integration of Emergency Health Services
Patients First: Action Plan For Health Care Providing patients with the right care, at the right time, in the right place, that is fiscally responsible and sustainable
Enhancing Emergency Services Ontario (EESO): Enterprise wide multi-year transformation initiative to improve coordinated care throughout the patient’s journey
Emergency Health Program Management & Delivery Branch (EHPMDB): Provides strategic direction and program support on the operations of emergency ambulance services
People
Processes
Technology
Emergency Health Regulatory & Accountability Branch (EHRAB):
Sets standards, measures performance and oversees the seamless functioning of emergency ambulance services
Patient Care
Enhancing Ministry Oversight
Driving System Performance

5. Patients First
Through the Patients First: Action Plan for Health Care, the government is collaborating with health care partners to develop opportunities such as:
ED diversion strategies
diversion at dispatch
community paramedicine
Health Links
improving dispatch triage
provincial bypass protocols
virtual waiting room
treat & refer
Alternative destinations
Improving ambulance offload
Patient destination software
Improving inter-facility transfers
These opportunities seek to build capacity and improve patient outcomes in the health care system that is sustainable for generations to come. 5

6. Patient’s Journey: 911/Medical Emergencies
Phase 2
Phase 1
Legend
Immediate Response
Prompt Response
Scheduled Response
Diverted Response
No Transport
Will be informed by consultations

7. Patient’s Journey: Critical Care Inter-Facility

8. Patient’s Journey: Non-Urgent Inter-Facility
Issues related to non- urgent inter-facility (NUIF) patient transfers persist at both regional and systematic level.
From a system perspective, there are opportunities to:
develop alternatives to improve the patient’s journey. Initially, efforts will be focussed on priority populations in northern and rural communities where the largest gaps in equitable access exist.
Identify more effective service delivery and system oversight opportunities by developing a sustainable, system-level solution.
Improve integration with other health care reforms.

9. Improving Ambulance Offload Times (AOT)
 Implemented enhanced DONP performance measures and reporting.
 Continue to engage OAPC to identify opportunities to improve AOT.
 AOT was added to the Pay-for-Results (P4R) metric.
 Worked with OAPC to develop enhanced DONP performance measures & reporting.
 Expanded distribution of monthly AOT data to every paramedic service.
 Monthly AOT data distributed to P4R hospitals.
 Partnered with the OAPC to reconcile data sources (ADRS, NACRS and ePCR), identify data gaps and implement solutions.
 Capture of transfer of care time (CAD).
 The ministry engaged Deloitte to conduct a subsequent review on DONP.
2017/18
2016/17
2015/16
2014/15
2013/14

10. Improving Dispatch Technologies
Dispatch Medical Triage Algorithm
Efficient use of existing resources
Technology Infrastructure
Improved mapping and improved call handling and dispatch functionality.
Foundational to implementation of a new dispatch medical triage algorithm
Inter-connectivity Projects
Investing in interconnectivity to improve data sharing, flexibility and interconnectivity
Strengthen real-time data sharing
Enhance situational awareness for municipal land ambulance stakeholders, enables trend analysis

11. Investing in People and Process Improvements
Supporting First Nations Communities
Provided 16 First Nations with new response vehicles
Identify opportunities to strengthen emergency medical service in Northern communities.
Dispatch Process review  
Create a comprehensive picture of the ambulance dispatch landscape, both in Ontario and in other jurisdictions
Contracted a consultant
Consultant findings will be taken into consideration as part approach to improving and reforming quality coordinated care across the patient’s journey
Engaging partners in the process is essential
Stakeholder input will inform this process

12. Paramedic Practice Standards Engagements at a Glace
Internal Ministry Staff
December 2, 2016/December 5, 2016
Information session on the BLS PCS / ALS PCS / Equipment Standards, including impacts to program areas.
Audience: 30+ (Operations, Investigations, Inspections, AAOU, EESO 2.0)
Critical Care Services Ontario
December 21, 2016
Briefing on changes to trauma care standards for paramedics, with a focus on spinal motion restriction provisions.
Audience: Dr. Bernard Lawless, Provincial Lead, CCSO
Faculty of Paramedic Training Programs
January 10, 2017
Information session on the BLS PCS / ALS PCS / Equipment Standards, including impacts to provincial certification examinations.
Audience: 70+ (Faculty from public and private colleges, and other paramedic training programs, e.g. Toronto Paramedic Services and Ornge)
Ontario Association of Paramedic Chiefs
February 6, 2017/February 8, 2017
Information session on the BLS PCS / ALS PCS / Equipment Standards, including implementation considerations.
Audience : 200+ (Chiefs, Deputy Chiefs, Commanders Superintendents)
Ontario Base Hospital Group
March 2, 2017
Panel discussion on the BLS PCS, with members from the BLS PCS Working Group.
Audience : 100+ (Base Hospital Directors/Managers/Staff, paramedics)
Emergency Services Advisory Committee (formerly ED LHIN Leads)
March 31, 2017
Briefing on changes to trauma and medical care standards for paramedics, with a focus on spinal motion restriction provisions.
Audience: 20+ (Physicians, administrators)
Paramedic Practice Standards – Engagements 2016/17

13. Questions?