Emergency Health Services

Having recently launched the Patient Care Models for Select 9-1-1 patients in 40 municipalities across the province, we’re pleased to share a few success stories that illustrate the positive impact these innovative patient care models have already had in our communities.

Adopting patient care models may help ensure paramedics have more options to provide safe and appropriate treatment for patients, while helping to protect hospital capacity as part of Ontario’s ongoing COVID-19 response.

If you are interested in submitting a proposal to the Ministry of Health, or for additional information on new or existing patient care model(s), please contact Danielle.Trigatti@ontario.ca.

Members of the public can contact their local municipalities for further details regarding program rollout and availability in their regions.

Patient Story 1
Implementing municipality: London

Project partners: the Canadian Mental Health Association (CMHA) Middlesex, Middlesex London Paramedic Service and London Health Sciences Centre.

Eligible patients: select 9-1-1 patients with care needs related to mental health and addictions.

Model of care: instead of visiting an Emergency Department (ED), eligible patients would have the option of going to a 24/7 Walk-in Crisis Centre operated by CMHA Middlesex or receiving care on scene provided by a mobile Crisis Response Team.

The Crisis Centre was launched in 2015 to provide crisis support and services within a non-institutional and welcoming environment.

Patient Impact:

“Having the option to come to the Crisis Centre was a huge relief - did not want to go to the ED.”

“He [the patient] was pleased at Crisis Centre. He was disappointed with the hospital system and felt the Crisis Centre-Paramedic route was "much more helpful" to him. He said he attended at hospital previously and was wanting a "psych evaluation" and said he had waited eight hours and did not receive a psych evaluation and received information to access a family doctor.”

“Paramedics explained it well. I didn't know going to Crisis Centre was an option before and was happy for it. It was ‘calmer"’ than going to the emergency department. I have referred Crisis Centre and Reach Out to other friends. It's awesome that you don't have to wait six hours! The person I talked to (at Crisis Centre) changed my entire mood!”

“Honestly, the service was so much help. Yes, I'm reading through the modules and self-reflection about emotions on a phone app. The staff helped and were open. I'm glad for this call too. Keep the program going!”

“Paramedics were very nice and helpful. Very nice people and very supportive, environment good (at Crisis Centre).”

Patient Story 2
Implementing municipality: York

Project partners: York Region Paramedic Services

Eligible patients: select 9-1-1 patients with care needs related to palliative care

Model of care: instead of visiting the Emergency Department (ED), eligible patients would have the option of receiving symptom management services on scene related to pain and dyspnea, hallucinations or agitation, nausea or vomiting and terminal congested.

This model of care allows for comfort-oriented care through relieving symptoms, reassuring families and honouring the wishes of patient and/or family in transport options: stay home or transport to hospital.

Patient Impact:

The Treat and Refer model for palliative care intends to provide comfort-oriented care at home where patients prefer to be. The project in York has demonstrated that patients and families prefer this model of care than going to ED. For example, since implementation, there have been cases where paramedics were called multiple times to provide symptom management services at a patient’s home. Some family expressed their appreciation to the services that “we are so grateful for the wonderful care all of these paramedics offered. They truly made the process more bearable for all of us.”

“I am on call this week and on Monday night 10pm I get a call from a family with a palliative patient where paramedics had been on scene for 2-3hrs. This patient declined quickly over a matter of days and the Symptom Relief Kit (SRK) had not yet been in place. The paramedics were able to give several different medications to comfortably settle the patient. I had ordered for urgent delivery of SRK but knew it wouldn't arrive until sometime the next morning. The paramedics had to go back at 7am the next morning to administer more meds. The patient died that next morning (before an SRK had even arrived). I feel like this patient would have likely ended up in the ER and died there if it had not been for the paramedics! I just wanted to thank the paramedics for their compassionate care and congratulate the team for making an impact on our patients and their families!”
-Palliative Care Physician (York Region)

Patient Story 3
Implementing municipality: Guelph-Wellington

Project partners: Guelph-Wellington Paramedic Service (GWPS) and Hospice Wellington (HW)

Eligible patients: select 9-1-1 patients with care needs related to palliative care and have registered for a hospice

Model of care: instead of visiting the Emergency Department (ED), eligible patients would have the option of being transported to a hospice.

Patient impact:

“I am happy to report the communication between our two organizations was excellent and this provided seamless transitions for those who accessed our services. When the GWPS is called to serve a patient in the community who is at end of life and a referral is in place, with a bed available at Hospice Wellington, (and both parties agree upon the alternate delivery) the emergency department at the hospital is averted. At HW we have 24 hour access to a palliative care physician whenever needed.” “When patients and families are introduced to our end-of-life care they are also given free access and immediate follow up to our bereavement programs at Hospice Wellington. The participation in these programs has proven to be a huge benefit to patients and families and their appreciation is noted regularly. The improved experience supports the continuum of integrated care. The impact of what could be a traumatic end of life event is changed many times by the implementation of this pilot project for Alternate Destination Model for Palliative Care Patients. I would ask your consideration in continuing this important work and assisting us in preventing patients from dying in emergency rooms. As mentioned, we have received positive feedback from family members in regard to the end-of-life experience of their loved one while at Hospice Wellington. We cannot change the outcome of death, but we can change the patient and family experience.”

Letter from Hospice Wellington to the ministry

We admitted the above resident overnight via direct 911 transfer route to Hospice Wellington and it worked out really well. Thank you to our on-call nurse for working with the night staff to guide a plan. The family called asking for admission, but we could not get transportation from non-emergency providers. Staff worked together to determine a call to 911 by the family and then a direct admit to us here. All the members of the team have been amazing. We are so appreciative of the efforts that were made to ensure his safe transfer and he is very much needing our care here. If we did not have this process in place this patient would have ended up in ER that is already swamped and not an appropriate setting for this client.
- Letter from HW to GWPS

To learn more about the impact introducing this model of care had on patients, visit the Guelph Today website.