Hostname: page-component-77c89778f8-m8s7h Total loading time: 0 Render date: 2024-07-19T03:07:44.342Z Has data issue: false hasContentIssue false
  • English
  • Français

Variations in monetary distribution among Ontario’s Alternative Funding Agreement workload model hospitals

Published online by Cambridge University Press:  21 May 2015

Mitchell Whyne ,
Garrett Whyne  and
Brian H. Rowe
Mitchell Whyne*
Affiliation:
Emergency AFA Group, Royal Victoria Hospital, Barrie, Ont.
Garrett Whyne
Affiliation:
Emergency AFA Group, Royal Victoria Hospital, Barrie, Ont.
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
*
Royal Victoria Hospital, 201 Georgian Dr., Barrie ON L4M 6M2

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Alternative Funding Agreements (AFAs) were in place in 41 hospital emergency departments (EDs) in Ontario at the time of this survey (May to August 2005). Each of these 41 hospitals works with its own internal administrative model. The primary objective of this paper was to document the administrative models used in these Ontario EDs. The secondary objective was to inform current and future AFA EDs of the potential models.

Methods:

Telephone surveys were conducted with a member of each of the 41 AFA workload model hospitals.

Results:

All hospitals provided at least 1 emergency physician to answer the questionnaire. Although most AFA hospitals divide the AFA fund pool on an hourly basis, there is impressive variation on premium values awarded for day, evening, weekend and night shifts. Other variations included holdback of funds for bonuses, distribution of non-OHIP (Ontario Health Insurance Plan) dollars, on-call allowances, and different pay scales for the general practitioners and locums working in some departments.

Conclusions:

Allowing flexibility in distribution of AFA dollars to physicians in each group has helped make this program more acceptable. Many issues unrelated to funding remain to be resolved in order to stabilize ED recruitment and retention as well as improve work satisfaction. Further research on these latter topics is required to develop a fair and equitable funding arrangement that supports and enhances physician coverage in EDs across Canada.

Keywords

AFAAlternative Funding Agreementspremiumsnon-OHIP dollarsfast-track
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 1 , January 2007 , pp. 21 - 25
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Jiménez, JG, Murray, MJ, Beveridge, R, et al. Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the Principality of Andorra: Can triage parameters serve as emergency department quality indicators? Can J Emerg Med 2003;5(5):315–22.Google ScholarPubMed
2.Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(3 suppl). Online version available at: www.caep.ca (accessed 20 Nov 2006).Google Scholar
3.Warren, D, Jarvis, A, Leblanc, L; and the National Triage Task Force members. Canadian Paediatric Triage and Acuity Scale: implementation guidelines for emergency departments. Can J Emerg Med 2001;3 (4 suppl):S1–27.Google Scholar
4.Wuerz, RC, Milne, LW, Eitel, DR, et al. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7:236–42.CrossRefGoogle ScholarPubMed
5.Murray, M, Bullard, M, Grafstein, E; for the CTAS and CEDIS National Working Groups. Revisions to the Canadian Emergency Department Triage and Acuity Scale Implementation Guidelines. Can J Emerg Med 2004;6(6):421–7.Google Scholar
6.Fernandes, CMB, Christenson, JM.Use of continuous quality improvement to facilitate patient flow through the triage and fast-track areas of an emergency department. J Emerg Med 1995;13: 847–55.Google Scholar
7.Fernandes, CMB, Christenson, JM, Price, A.Continuous quality improvement reduce length of stay for fast-track patients in an emergency department. Acad Emerg Med 1996;3:258–63.CrossRefGoogle ScholarPubMed
8.Murray, MJ, Levis, G.Does triage level (Canadian Triage and Acuity Scale) correlate with resource utilization for emergency department visits [abstract]. Can J Emerg Med 2004;6(3):180.Google Scholar
9.Trzeciak, S, Rivers, EP.Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402–5.Google Scholar
10.Baker, DW, Stevens, CD, Brook, RH.Patients who leave a public hospital emergency department without being seen by a physician. JAMA 1991;266:1085–90.CrossRefGoogle ScholarPubMed
11.Hobbs, D, Kunzman, SC, Tandberg, D, et al. Hospital factors associated with emergency center patients leaving without being seen. Am J Emerg Med 2000;18:767–72.CrossRefGoogle ScholarPubMed
12.Fernandes, CM, Daya, MR, Barry, S, et al. Emergency department patients who leave without seing a physician: the Toronto Hospital experience. Ann Emerg Med 1994;24:1092–6.CrossRefGoogle Scholar
13.Dunn, R.Reduced access block causes shorter emergency department waiting times: An historical control observational study. Emerg Med 2003;15:232–8.Google Scholar
14.Canadian Association of Emergency Physicians and National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding [policy]. Can J Emerg Med 2001;3(2):82–4.CrossRefGoogle Scholar
15.Canadian Association of Emergency Physicians and the National Emergency Nurses Affiliation. Access to acute care in the setting of emergency department overcrowding [policy]. Can J Emerg Med 2003;5(2):81–6.CrossRefGoogle Scholar
16.Derlet, R, Richards, J, Kravitz, R.Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8:151–5.Google Scholar
17.Espinosa, G, Miro, O, Sanchez, M.Effects of external and internal factors on emergency department overcrowding. Ann Emerg Med 2002;39:693–5.CrossRefGoogle ScholarPubMed
18.Thompson, JM, Dodd, G.Ruralizing the Canadian Triage and Acuity Scale. Can J Emerg Med 2000;2(4):267–9.CrossRefGoogle ScholarPubMed
19.Dryer, JF, Zaric, GS, McLeod, SL, et al. Emergency physician time by activity and hospital type [abstract]. Acad Emerg Med 2006;5(suppl 1):S92–3.Google Scholar
20.Schull, MJ, Vermeulen, M.Ontario’s alternate funding arrangements for emergency departments: the impact on the emergency physician workforce. Can J Emerg Med 2005;7(2):100–6.CrossRefGoogle ScholarPubMed
21.Innes, G.Eat what you kill [editorial]. Can J Emerg Med 2000;2(4):228.CrossRefGoogle Scholar
22.Campbell, SG, Watson, ML.Fee-for-service remuneration [letter]. Can J Emerg Med 2001;3(1):6–7.CrossRefGoogle Scholar