Better waits start with seeing where the time goes

Emergency departments in Ontario are under sustained pressure. The average time from triage to a physician was 118 minutes in 2022/23, up from 87 minutes a decade earlier, and the share of patients who left without being seen rose to 5.3%.^[1] Much of the pressure comes from access block: admitted patients waiting in the department for a bed upstairs.^[2][3]

Information does not create beds. But the research is consistent that how a wait is explained shapes how it is experienced: patients who were told about delays were 1.42 to 5.48 times less likely to give poor ratings.^[4] And people who feel informed are less likely to leave before being seen, or to return to the desk to ask again.

The overview shows today's census, the number of people waiting to see a physician, the median and 90th percentile time to physician against the provincial target, left-without-being-seen counts, boarding, open requests and active codes.

• Flow segments: arrival to triage, triage to physician, physician to first order, orders to results, results to reassessment and decision to departure, each as p50 and p90 against your benchmarks.
• Heatmaps of arrivals, time to physician, length of stay and left-without-being-seen by hour and day of the week.
• Test turnaround by test, day of the week and hour, with sample sizes and a flag when an estimate falls back to the catalogue default.
• Code events with their duration and the delay they caused to assessments and reassessments.
• Period comparisons and annotations, for example an HIS downtime or the start of the pilot.
• A table view for every chart, and a data definitions page with each metric's formula and source.

Ontario's Pay-for-Results priorities and hospital Quality Improvement Plans put the 90th percentile time to physician initial assessment at the centre: it was the most selected indicator in 2025/26 QIPs, chosen by about half of hospitals.^[5][6] The analytics use the QIP technical specifications, so the numbers mean the same thing in your board report and in the provincial data.^[7]

Time estimates shown to patients are computed from your department's own history for the same step, day of the week and hour: a usual range plus the time 9 in 10 people are done within. When there is not enough history for a step, the estimate falls back to a reviewed catalogue default and says so. A calibration report shows how often real visits finished within the stated range, so you can see that the numbers deserve trust.

Clinician-level metrics are private by default. Each clinician sees their own numbers; leaders see blinded ranges and case-mix context, never a league table.

1. Sandbox. A simulator and synthetic fixtures exercise every event; your privacy office receives the draft privacy impact and threat risk assessment inputs.
2. Manual-first (optional). The staff console drives stage-level updates in one department, with no EHR feed, so staff can run a shift with it.
3. Read-only EHR feed. Your integration engine sends admission, order and result-status events. A shadow run of at least two weeks must agree with the EHR on at least 98% of milestones, with updates arriving within 60 seconds at the 95th percentile.
4. Patient go-live. Patient and family access is switched on after the privacy and security sign-offs, a signed clinical safety case, simulations with real staff and training.

The pilot is measured on the instruments the department already uses: the Ontario ED patient experience survey items ("If you had a long wait, were you told why?"), left-without-being-seen and 72-hour return rates as balancing measures, and the 90th percentile time to physician.^[8][7]