Evaluation of emergency department (ED) visits by oncology patients: A running comparison to admissions and ED visits under the CMS OP-35 ruling.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18683-e18683
Author(s):  
Nada Alsuhebany ◽  
Jamie Brown ◽  
Jacquelyne Echave ◽  
Emad Elquza ◽  
Hani M. Babiker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Supportive Care ◽  
Solid Tumor ◽  
Cancer Center ◽  
Oncology Patients ◽  
Quality Reporting ◽  
Outpatient Chemotherapy ◽  
Prophylactic Measures ◽  
Number Of Patients ◽  
Ed Visits

e18683 Background: The incidence of emergency department (ED) visits by oncology patients has grown in recent years. Some visits are medically unnecessary or could be prevented with improved prophylactic measures. Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Outpatient Quality Reporting (OQR) Program, to which hospitals must report data on quality measures of care furnished in the outpatient setting. One of the proposed measures, OP-35, evaluates admissions and ED visits by patients receiving outpatient chemotherapy, assessing for ten potentially preventable visits. These ten visit reasons included are: anemia, nausea, vomiting, dehydration, neutropenia, diarrhea, pain, pneumonia, fever, and sepsis. This study evaluated the incidence and reasons for ED visits by patients receiving outpatient chemotherapy, as well as outcomes following these visits in order to assess appropriate prophylactic treatment related to outpatient chemotherapy at our institution. Methods: This single-center, retrospective chart review was conducted at The University of Arizona Cancer Center. We collected data using an electronic medical record and included oncology patients with active cancer who had ED visits from January 1, 2018, to December 31, 2018. Data points included baseline demographics; malignancy; ED visit reason; clinic visit history; past ED visits; treatment and supportive care data; and outcome of the ED visit. Results: Study authors included 205 of the 1,659 screened encounters. Approximately 70% of the encounters involved patients with solid tumors and 30% with hematologic malignancies. Nearly 50% of hematologic malignancy patients presented to the ED for potentially preventable reasons, while 32.8% of solid tumor patients had potentially preventable visits. The most common preventable ED visit reasons in both groups were pain, fever, nausea, vomiting, and dehydration. In our analysis, over 90% of patients presenting for neutropenia and fever had received appropriate growth factor prophylaxis when indicated based on their chemotherapy regimen. Of the patients presenting for nausea or vomiting, it was determined 95.3% had received appropriate antiemetic prophylaxis. Conclusions: This study showed that the incidence of potentially preventable visits was numerically higher in the hematologic cancer group compared with the solid tumor group. In addition, this study showed that a number of patients who were admitted to the ED with nausea/vomiting or neutropenia/fever received appropriate guideline-recommended prophylactic or supportive care therapy, regardless of the OP-35 proposed CMS core measure determination that these visit reasons should be considered preventable. These findings highlight the need for CMS to further review OP-35 to include information addressing the use of appropriate supportive care in the future.

Evaluating the utility of rule OP-35 to define preventability of ED visits for oncology patients at an academic cancer center.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 272-272
Author(s):  
Steven Manobianco ◽  
Zachary L. Quinn ◽  
Valerie Pracilio Csik ◽  
Adam F Binder ◽  
Nathan Handley
Keyword(s):  
Emergency Department ◽  
New York ◽  
Outpatient Setting ◽  
Cancer Center ◽  
New York University ◽  
Timely Manner ◽  
Oncology Patients ◽  
Outpatient Chemotherapy ◽  
Treatment Models ◽  
Ed Visits

272 Background: Rule OP-35, which characterizes treatment-related complications of patients receiving outpatient chemotherapy that result in a potentially avoidable emergency department (ED) visit or hospitalization, was developed to encourage practices to build treatment models that reduce such events. However, defining visits as potentially avoidable based on symptoms may not capture the complexity of caring for oncology patients. We aim to evaluate the effectiveness of OP-35 in identifying preventable ED visits by real world standards at an academic institution. Methods: A retrospective analysis was performed reviewing ED visits at the Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University for oncology patients from 10/1/2020 to 1/31/2021. Each patient received care at SKCC had received intravenous or oral chemotherapy in the preceding 30 days, and each encounter was classified as potentially avoidable by OP-35 criteria. Two investigators independently conducted chart reviews to determine whether these visits were potentially avoidable, recording whether the patient attempted to contact their care team prior to the ED encounter and assessing if the concern could have been managed in a timely manner in an outpatient setting. The two records were then compared, and the principal investigator served as an arbiter for determining if a visit was potentially avoidable in instances where the investigators disagreed. Results: We reviewed 144 total encounters and excluded events from patients with either acute leukemia or breast cancer on hormone therapy only, leaving 107 encounters for analysis. After evaluating the clinical circumstances, we determined that 29% of these ED encounters were potentially avoidable. Applying New York University Emergency Department Algorithm (NYU-EDA) criteria, 69% of encounters were considered potentially avoidable. Patients called for advice before seeking ED care in 53% of unavoidable encounters compared to 26% of potentially avoidable encounters. An additional 14% of visits deemed unavoidable were from patients sent directly from clinic. For potentially avoidable encounters, 60% of patients were discharged directly from the ED. In comparison, 8% of unavoidable encounters led to discharge from the ED. Pain was the most common reason for encounters and 53% of these visits were considered potentially avoidable. Conclusions: We found that approximately 30% of ED encounters deemed avoidable by OP-35 criteria were considered potentially avoidable following clinician review. In the majority of cases patients were referred to the ED following initial outpatient attempts at management. NYU-EDA criteria for preventability did not correlate with OP-35 nor clinician consensus regarding potentially avoidable encounters. More work remains in refining tools to identify potentially avoidable ED visits for oncology patients.

Emergency department visits among patients with advanced solid tumors at a cancer center in Mexico City.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 52-52
Author(s):  
Miguel Araujo ◽  
Mirza Alcalde Castro ◽  
Enrique Soto Perez De Celis ◽  
Andrea De la O ◽  
Rafael Reyes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Solid Tumors ◽  
Mexico City ◽  
Advanced Cancer ◽  
Palliative Chemotherapy ◽  
Emergency Department Visits ◽  
Cancer Center ◽  
Advanced Solid Tumors ◽  
Newly Diagnosed ◽  
Ed Visits

52 Background: Emergency department (ED) visits are a distressing event for patients with advanced cancer, and identifying planned, unplanned and avoidable ED visits is important for providing better cancer care. We studied the causes for ED visits, as well as potentially avoidable ED visits during palliative chemotherapy, among patients with advanced cancer treated at a public cancer center in Mexico City. Methods: Consecutive patients with newly diagnosed advanced solid tumors treated at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán from 10/2015 to 03/2016 were screened. Patients who visited the ED during that period were included, and their demographic and clinical characteristics recorded. Number and reasons for ED visits were obtained from medical records. Among patients who received chemotherapy within the previous 30 days, the following reasons for ED visits were classified as avoidable: anemia, nausea, dehydration, neutropenia, diarrhea, pain, emesis, pneumonia, fever or sepsis (according to Centers for Medicare and Medicare Services Hospital Outpatient Quality Reporting Program). Results: 77 patients were diagnosed with advanced solid tumors during the study period, of which 53 (69%) had at least one ED visit. Median age was 63 years (range, 19-88), and 47% were men (n = 25). 51% had gastrointestinal, 21% genitourinary and 28% other tumors. Median follow-up was 360 days. 95 ED visits were identified; with a median number of ED visits per patient of 1 (range 1-5). The most common causes of ED visits were: infections (n = 20; 21%), gastrointestinal disorders (n = 18; 19%), pain (n = 15; 16%), ascites (n = 14; 15%), anemia (n = 4; 4%), catheter dysfunction (n = 4; 4%), and other causes (n = 20; 21%). 57% of ED visits among patients who received chemotherapy within the previous 30 days were classified as potentially avoidable. Conclusions: Over two thirds of patients with newly diagnosed metastatic cancer had ED visits in the first year after diagnosis. Furthermore, more than a half of ED visits among patients receiving palliative chemotherapy were potentially avoidable. Strategies aimed at reducing ED visits are needed to improve quality of care for patients with advanced cancer.

Incidence and characteristics of emergency department presentations during immune checkpoint inhibitor therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14164-e14164
Author(s):  
Daniel Arnold Smith ◽  
Kai Laukamp ◽  
Melanie Campbell ◽  
Robert Devita ◽  
Ariel Ann Nelson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Overall Survival ◽  
Anticancer Agents ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Demographic Data ◽  
Cancer Type ◽  
Primary Cancer ◽  
Oncology Patients ◽  
Ed Visits

e14164 Background: Immune checkpoint inhibitors (ICIs) have emerged as a novel class of anticancer agents with unique response and toxicity profiles. Oncology patients undergoing ICI therapy can present acutely with cancer- or treatment-related complications, but knowledge of these acute clinical presentations is limited. The objective of this study was to investigate the features of emergency department (ED) presentations of patients undergoing ICI therapy. Methods: A retrospective chart review was performed of 1044 adult oncology patients at a single institution from 2010-2018 who underwent treatment with one or more ICI. The number of patient visits to the ED during and up to one month following ICI treatment was recorded, in addition to various clinical and demographic data. These data were compared based on stratification by number of ED visits (0 visits, 1 visit, or ≥2 visits) using Likelihood Ratio Chi-Square and Mann–Whitney U tests. Results: Mean age for the 1044 patients receiving ICI therapy was 64±13 years, with 57% males and 43% females. Primary cancer distribution included 42.0% lung, 24.2% melanoma, 6.9% head & neck, 5.1% kidney, 4.0% bladder, and 17.8% other malignancy. 83.4% of patients were treated with a single ICI, 14.9% with 2 ICIs, and 1.2% with 3-4 ICIs. 56.0% of patients had no ED visits during their treatment duration, 27.0% had 1 ED visit, and 17.0% had ≥2 ED visits. Patients with lung, kidney, and bladder cancer were more likely to present to the ED (p = < 0.001). Black ethnicity was the only demographic feature associated with more ED visits (p = 0.017). Patients receiving ≥2 ICIs or monotherapy with nivolumab, pembrolizumab, or atezolizumab more frequently presented to the ED compared to other ICIs (p = < 0.001). Patients with 1 or ≥2 ED visits had longer durations of ICI therapy (136±12 days and 216±15 days, respectively) compared to patients with no ED visits (127±8 days) (p = < 0.001). Patients with no ED visits also demonstrated better overall survival (p = < 0.001). Conclusions: More frequent ED visits during ICI therapy is statistically associated with several key clinical factors, including primary cancer type, ethnicity, specific ICI agent, ICI therapy duration, and overall survival.

ED utilization trends for medical oncology patients at Thomas Jefferson University during COVID-19.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 238-238
Author(s):  
Zachary L. Quinn ◽  
Adam Binder ◽  
Valerie Pracilio Csik ◽  
Helen Evers-Hunt ◽  
Nathan Handley
Keyword(s):  
Acute Care ◽  
Active Treatment ◽  
Medical Oncology ◽  
Healthcare Delivery ◽  
Thomas Jefferson ◽  
Care Utilization ◽  
Oncology Patients ◽  
Oncology Patient ◽  
Number Of Patients ◽  
Ed Visits

238 Background: For patients receiving cancer care, utilization of acute care resources can be frequent and, in many instances, is avoidable. At Thomas Jefferson University (TJU), up to 50% of emergency department (ED) visits for medical oncology patients on active treatment (receiving intravenous or oral chemotherapy within 30 days) may be preventable based on OP-35 criteria. The COVID-19 pandemic drastically altered healthcare delivery, prompting providers and patients to re-evaluate the safety and necessity of acute care. We aimed to evaluate the effect of the COVID-19 pandemic on ED utilization for medical oncology patients at TJU. Methods: We reviewed the total number of visits to the TJU ED for all patients and for medical oncology patients from January 1, to May 31, 2020. We defined the months of January and February as “Pre-COVID” and the months of April and May as “COVID”. We excluded data from March in our analysis. For medical oncology patients, we tallied both the number of patients with an ED visit and total ED visits for each month. We stratified patients by whether or not they were on active treatment. We reviewed the outcome of each ED visit and categorized results as admission (inpatient admission or observation) or discharge. We classified each ED visit as avoidable or unavoidable using OP-35 criteria. Results: In the Pre-COVID months there were 489 total visits by 432 oncology patients; 41% (179) of these patients were on active treatment. During COVID months there were 313 visits by 284 oncology patients; 48% (137) were on active treatment at the time of visit. During COVID, total ED visits decreased by 37%. Visits by medical oncology patients decreased by 35%. For medical oncology patients on active treatment, we observed a 21% reduction in ED visits. In the Pre-COVID months, 38% of oncology patient visits were considerable potentially avoidable and 41% of visits ended with a discharge to home. In comparison, during COVID, 31% of visits were considered potentially avoidable and 35% of visits ended with a discharge to home. Conclusions: We observed a decrease in ED utilization by oncology patients that mirrored decrease in total ED utilization following the COVID-19 outbreak. The decrease was less prominent for patients on active treatment. The percent of visits that were potentially avoidable and the percentage of patients discharged to home from the ED decreased slightly during the COVID period. Further analysis is ongoing to understand factors driving reduction in ED utilization observed immediately following the COVID-19 outbreak.

scholarly journals COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

2021 ◽  
pp. 471-483
Author(s):  
Maram Mohammed Jaboua ◽  
Warif Jameel Abdulhaq ◽  
Nada Saeed Almuntashiri ◽  
Sarah Saud Almohammdi ◽  
Asayel Qeblan Aldajani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Critical Conditions ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Ed Visits

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied. Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED. Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively. Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

Protecting high-risk oncology patients during the pandemic of COVID-19 by creating an outpatient cancer clinic for febrile neutropenia (California clinic).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 191-191
Author(s):  
Manidhar Reddy Lekkala ◽  
Mohammad Abedi ◽  
Tammy Clarke ◽  
Bahar Moftakhar ◽  
Arpan Patel
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Case Fatality ◽  
Cancer Center ◽  
High Risk Population ◽  
Oncology Patients ◽  
Number Of Patients ◽  
The Social ◽  
Rule Out

191 Background: Delivering care for vulnerable cancer patients during a pandemic is challenging given the competing risks of death from cancer versus the high case fatality rates from SARS-COV-2 (CV-19). Data currently available suggests a total fatality rate close to 30%-50% with CV-19 in active malignancy patients. In addition to adapting guidelines from national organizations to reduce the social footprint of patients in order to minimize risk of exposure of CV-19, our cancer center implemented an isolated clinic with personal protective equipment (PPE) and direct access to a CV-19 rule out floor (if admission warranted) in order to manage those with febrile neutropenia (FN) who otherwise would have been triaged to the emergency room (ED). Methods: We implemented an outpatient isolated extended hour clinic with access to PPE, blood work, intravenous antibiotics and fluids for FN patients as a pilot project from mid-April with expected duration during the pandemic with the aim to decrease the ED admissions for FN by 50%. We used the Multinational Association of Support Care in Cancer (MASCC) validated tool to assist with outpatient versus inpatient management of these patients. All patients were screened via polymerase chain reaction nasal swab for CV-19 to identify CV-19 in a high-risk population. Our PDSA (Plan Do Study Act) cycles have been in 2-week sessions with constant re-education to multiple providers. Results: Prior to CV-19, our databases show an approximate 15 to 20 FN hematology and oncology patients per month who are triaged to ED during the business hours. Since the implementation of our clinic in the last 45 days, we have screened 8 patients, of which 2 were discharged home with oral antibiotics on isolation until CV-19 testing returned, 6 were directly admitted to CV-19 rule out floor avoiding ED. Our overall patient numbers were low during the peak of the pandemic and we expect to see increasing number of patients utilizing the clinic over the next few months. Conclusions: Implementing the California clinic has thus far successfully decreased the social footprint of our highest-risk cancer patients, those with FN, in hopes of decreasing their possible exposure to CV-19 as well as the unnecessary exposure of the clinical personnel. [Table: see text]

scholarly journals Supportive Care and Unmet Needs in Upper Gastrointestinal Cancer Patients: Screening and Related Factors

2021 ◽  
Vol 18 (15) ◽  
pp. 8124
Author(s):  
Ya-Ting Tseng ◽  
Chia-Hsun Hsieh ◽  
Chien-Wei Hung ◽  
Chia-Chia Chen ◽  
Shu-Hui Lee ◽  
...  
Keyword(s):  
Social Support ◽  
Supportive Care ◽  
Cancer Patients ◽  
Unmet Needs ◽  
Symptom Distress ◽  
Supportive Care Needs ◽  
Cancer Center ◽  
Care Needs ◽  
Outpatient Chemotherapy ◽  
Upper Gastrointestinal

Upper gastrointestinal (UGI) cancer treatment can cause physical and psychological distress and may result in unmet needs. The purposes of this study were to (1) examine the levels of gastrointestinal (GI) symptom distress, social support, and supportive care needs; (2) screen the priorities of unmet supportive care needs; and (3) identify the factors associated with supportive care needs among UGI cancer patients receiving chemotherapy. This cross-sectional study examined UGI cancer patients who received treatment from the outpatient chemotherapy department of a single cancer center in northern Taiwan. Questionnaires were used to collect data regarding GI symptom distress, social support, unmet needs, and supportive care needs. The top three unmet needs were “fears about the cancer spreading”, “uncertainty about the future”, and “being informed about things you can do to help yourself to get well”. Descriptive statistics examined the levels of GI symptom distress, social support, supportive care needs, and priorities of unmet supportive care needs. Stepwise regression was conducted to determine significant factors related to supportive care needs. Greater supportive care needs were found to be associated with higher levels of disease-related worries, increased treatment-related symptoms, and a lower level of physical performance. These factors explained 48.0% of the variance in supportive care needs. Disease-related worries and treatment-related symptoms strongly influence overall supportive care needs and each domain of supportive care needs. Symptom management and psychological support for patients receiving outpatient chemotherapy may help patients meet needs.

A solution to reducing avoidable emergency department visits: Implementation of an outpatient oncology acute care clinic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13517-e13517
Author(s):  
Sadaf Charania ◽  
Judy Devlin ◽  
Edie Brucker ◽  
Shayna Simon ◽  
Christine Hong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Treatment ◽  
Acute Care ◽  
The United States ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Outpatient Basis ◽  
Oncology Patients ◽  
Care Clinic ◽  
Ed Visits

e13517 Background: Emergency Department (ED) utilization by oncology patients accounts for more than 4.5 million visits in the United States annually, leading to hospitalization four times the rate of the general population.1,2 Many ED visits are the result of symptoms related to cancer or cancer treatment that can be managed on an outpatient basis. Unnecessary admissions lead to possible delays in cancer treatment and increased burden on healthcare resources.3 Simmons Acute Care (SAC), an advanced practice provider (APP)-led clinic, was established in August 2020 to provide an alternative model of oncology care to address these issues. Methods: A multidisciplinary team of key stakeholders was formed to develop an action plan. Institutional data was reviewed to identify the timing and volume of ED visits by oncology patients. Clinic hours were set Monday through Friday, 7:00am – 7:00pm, and referrals were made from primary oncology providers. Evidence-based clinical pathways were developed to standardize patient management, and a data collection plan was implemented to measure outcomes. Internal communications to patients and presentations at staff and faculty meetings occurred to inform patients and clinical staff/providers. Results: From August to December 2020, 165 patient visits were completed in SAC, 141 patients discharged home, 14 patients directly admitted to the hospital, and 10 patients transferred to the ED for a higher level of care. Based on data from 2020, the average cost of an ED visit for an oncology patient was $5,500 and increased to $28,500 if the patient is admitted. Patients with hematologic and gastrointestinal malignancies represented approximately 30% of all visits. Gastrointestinal symptoms were the most frequent presenting chief complaint. Conclusions: Supporting oncology patients in the ambulatory setting provided a reduction in admissions and unnecessary ED visits, leading to cost savings/avoidance to the patient and health system. Based on internal cost analyses, there are potential savings of over $2 million to the organization during this 5-month period. Additional studies are underway to assess patient satisfaction, as well as the economic impact for patients. 1. Rui PKK. National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf 2. Hong AS, Froehlich T, Clayton Hobbs S, Lee SJC, Halm EA. Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits. J Oncol Pract. 2019;15(6):e501-e509. doi:10.1200/JOP.18.00743 3. Roy M, Halbert B, Devlin S, Chiu D, Graue R, Zerillo JA. From metrics to practice: identifying preventable emergency department visits for patients with cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. Published online November 7, 2020. doi:10.1007/s00520-020-05874-3

scholarly journals Planning Capacity for Mental Health and Addiction Services in the Emergency Department: A Discrete-Event Simulation Approach

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Deyvison T. Baia Medeiros ◽  
Shoshana Hahn-Goldberg ◽  
Dionne M. Aleman ◽  
Erin O’Connor
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Discrete Event Simulation ◽  
Capacity Planning ◽  
Discrete Event ◽  
Minimal Impact ◽  
Event Simulation ◽  
Number Of Patients ◽  
Ed Visits ◽  
Resource Capacity

Ontario has shown an increasing number of emergency department (ED) visits, particularly for mental health and addiction (MHA) complaints. Given the current opioid crises Canada is facing and the legalization of recreational cannabis in October 2018, the number of MHA visits to the ED is expected to grow even further. In face of these events, we examine capacity planning alternatives for the ED of an academic hospital in Toronto. We first quantify the volume of ED visits the hospital has received in recent years (from 2012 to 2016) and use forecasting techniques to predict future ED demand for the hospital. We then employ a discrete-event simulation model to analyze the impacts of the following scenarios: (a) increasing overall demand to the ED, (b) increasing or decreasing number of ED visits due to substance abuse, and (c) adjusting resource capacity to address the forecasted demand. Key performance indicators used in this analysis are the overall ED length of stay (LOS) and the total number of patients treated in the Psychiatric Emergency Services Unit (PESU) as a percentage of the total number of MHA visits. Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure.

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