Emergency and Urgent Care | Niagara Health System

By: Niagara Health  09-12-2011
Keywords: Mental Health, Memorial Site

Call 911 if you have severe chest pain, stroke symptoms or a serious emergency.

Emergency Departments (24/7)

  • Greater Niagara General Site
    Portage Rd., Niagara Falls
  • St. Catharines General Site
    Queenston St., St. Catharines
  • Welland Site
    Third St., Welland

Urgent Care Centres

  • Douglas Memorial Site (24/7)
    Bertie St., Fort Erie
  • Ontario Street Site (8 a.m. to 10 p.m.)
    Ontario St., St. Catharines
  • Port Colborne Site (24/7)
    Sugarloaf St., Port Colborne

What’s the Difference?

A full-service Emergency Department takes every level of patient, from those suffering a life-threatening heart attack or car accident, to those with a minor ear infection or sprained ankle. Ambulances take patients to Emergency Departments and ER physicians admit patients to acute care (medical/surgical) beds or mental health beds.

Urgent Care Centres are for those patients who have bumps and bruises, mild infections or injuries. Ambulances do not usually take patients to Urgent Care Centres, but a unique agreement between the NHS and Niagara EMS means ambulances in southern Niagara will take non-emergency patients to Urgent Care Centres at Douglas Memorial Site and Port Colborne Site.

Urgent Care physicians do not admit patients to an inpatient unit, although they may keep a patient for several hours for observation. Patients who come to an Urgent Care Centre but require more detailed diagnostic tests or treatment are transferred to a full-service Emergency Department.

ER Departments Treat … Urgent Care Centres Treat …
  • Chest pain and/or shortness of breath
  • Broken bones
  • Severe abdominal pain
  • Dizziness
  • Stroke symptoms – Sudden, severe headaches, vision problems, sudden weakness, numbness and/or tingling in the face, arm or leg, trouble speaking, or dizziness
  • Major injuries
  • Mental health issues

Call 911 if you have severe chest pain, stroke symptoms or a serious emergency.

Ambulances bring patients to Emergency Departments.

  • Sprains, strains, sports injuries
  • Cuts that may need stitches
  • Minor burns
  • Minor abdominal pain (nausea,vomiting, flu)
  • Ear, nose, throat an eye problems
  • Coughs and colds
  • Minor mental health issues
  • Chronic migraines
  • Minor asthma attacks or allergic reactions

Urgent Care Centres have access to services such as x-rays, lab tests and pharmacy.

Ambulances bring non-emergency cases to Douglas and Pt. Colborne Urgent Care Centres.

How are Patients Assessed?

The Triage Nurse is the first person a patient will see in an Urgent Care Centre or ER Department. Triage is a head-to-toe assessment done to determine who needs to be seen immediately and who can safely wait, based on each patient’s medical need.

Use These Services Levels of Assessment/Triage
Call 911 or go to full-service
ER Department
  • Level 1 – Resuscitation (Critical), e.g. cardiac arrest, shock, major trauma
  • Level 2 – Emergent, e.g. asthma, altered mental state
Go to Urgent Care Centre.
Level 4 and 5 patients can also be treated at a Walk-in Clinic
  • Level 3 – Urgent, e.g. abdominal pain, mild dehydration
  • Level 4 – Less-urgent, eg. vomiting and diarrhea with no dehydration, earache
  • Level 5 – Non-urgent, eg. vomiting, sore throat

Not sure where to go?

If you need advice on the right place to receive the care you need, consult…

  • your family physician or
  • call Telehealth Ontario at 1-866-797-0000

Reducing ER wait times our No. 1 priority

Most patients begin their hospital journey in the Emergency Room, whether they arrive by ambulance, walk in or are transferred from another healthcare facility.

“Reducing wait times in the Niagara Health System’s three ERs is our No. 1 priority,” says Anne Atkinson, Vice President Patient Services. “Our ultimate goal is to provide patients with the quality care they deserve while at the same time reduce the length of time they have to wait to receive their care. We have made some improvements, but there are still challenges and opportunities for further improvement.”

Doctors and nurses in the ERs assess patients, stabilize them, and get them where they need to go in a timely and safe manner. In many cases, they can diagnose, treat and send the patient home, but in other cases, the patient requires extensive intervention.

Increasing number of patients with serious conditions

“Our ERs are seeing an increasing number of patients with more serious conditions who require extensive assessment from our healthcare team,” says Dr. John McAuley, Regional Chief of Emergency Medicine. “These patients require more time with the doctors and nursing staff and more resources, such as diagnostic imaging and laboratory work, increasing the amount of time they are in the ERs.”

A key reason ER patients are sicker may be the lack of access to primary care in Niagara; many patients do not go to their family doctor or other healthcare providers for care and instead wait until their condition is serious before seeking help at the ERs.

The more involved assessment required for sicker patients unfortunately creates delays for others and has a direct impact on the length of time it takes patients who arrive by ambulance to be transferred from the care of paramedics to the care of ER doctors and nurses. This time is known as an off-load delay.

“In 2009, we made significant headway in decreasing off-load delays, but in 2010 they started creeping back up,” says Anne. “This is due to the increasing amount of time and resources involved in caring for our sicker patients who come to us with chest pain, head injuries, abdominal pain and other serious conditions.”

Every patient who comes through our Emergency Room or Urgent Care Centre doors, whether they walk in or come by ambulance, is assessed or “triaged” according to their level of illness or injury.

Patients who arrive at hospital by ambulance are not seen first by the physicians because they arrive by ambulance. They are seen in the order of priority of condition – life and limb threatening conditions are seen first whether they drive in, walk in or come by ambulance.

No connection with conversion of ERs in Port Colborne and Fort Erie

Niagara Health statistics do not show a connection between the increase in the off-load time at the three large ERs and the conversion of the ERs at Port Colborne and Douglas Memorial (Fort Erie) sites to Urgent Care Centres.

“Overall, we are seeing a two per cent increase in the number of patients coming to the three ERs,” says Anne. “At the same time, the Urgent Care Centres in Fort Erie and Port Colborne are seeing more patients than they did when they were ERs.”

“We encourage patients to continue to use the Urgent Care Centres for treatment for less serious conditions. Wait times in our Urgent Care Centres are significantly lower than in our ERs. This includes our Ontario Street Site Urgent Care Centre in St. Catharines.”

Delays: a ripple effect

Another key impact on wait times in the ERs is the number of patients elsewhere in the hospital who occupy beds but no longer require hospital care. These patients cannot be discharged until the care they require is available elsewhere in the community, creating a ripple effect throughout the hospital. Delays occur in in the ERs as patients continue to be admitted but have to wait for patients elsewhere in the hospital to be discharged. This, in turn, creates a backlog of new patients arriving in the ER by ambulance, car or otherwise.

New initiatives underway

Niagara Health is working closely with ambulance officials and other healthcare partners to decrease wait times and off-load delays in the ERs. These are some of the initiatives underway:

  • A dedicated off-load delay nurse was recently added at each of our three ERs through new provincial funding. This nurse attends to the needs of less urgent patients who arrive by ambulance. The role of this nurse is vital to helping us work hand-in-hand with ambulance officials to meet patient needs in a more timely manner and allow paramedics to get back on the road in the community.
  • Nurse practitioners stationed in the ERs in Niagara Falls and Welland help doctors care for patients, enabling the overall flow of patients through the ERs.
  • Additional physicians have been added to the ER shifts during peak times; more doctors working at the same times means patients can be seen faster.
  • Fast track areas in the ERs opened to meet the needs of patients with non-urgent conditions and reduce congestion for patients waiting to be seen in the ER.
  • New medical directives give nurses the authority to conduct certain tests in advance of the doctor’s assessment. This way, when the doctor sees the patient, they already have test results and information that can lead to a more rapid diagnosis and course of treatment. As a result, patients spend less time in the ER.
  • Enhanced support services (porters/housekeeping) are improving response times for transporting of patients throughout the hospital and cleaning of patient areas.
  • Greater focus on working with community partners ensures patients can access care in the community so they can be discharged from hospital on a timely basis.
  • Re-evaluating a protocol agreed upon a year ago by hospital and ambulance officials to continue bringing certain patients by ambulance to the Urgent Care Centres in Port Colborne and Fort Erie, depending on the seriousness of their condition. There may be opportunities to revise the guidelines so more patients can be safely taken to the Urgent Care Centres.

Committed to improving wait times

“There are always peaks and valleys with Emergency Department care, in terms of the number of patients coming to the ER on any day as well as the seriousness of their conditions,” says Anne. “We are committed to improving wait times, and we will continue to closely monitor the ERs and introduce new initiatives to enhance care for patients and their loved ones.”

Know Your Options

When You’re Sick

GO TO: Your family physician

Ask your doctor’s office what back-up coverage they offer or recommend when they are closed (i.e. after-hours clinics or on-call service).

Telehealth Ontario provides free access to a registered nurse, 24 hours a day, 7 days a week for general health questions. The nurse will assess your symptoms and help you decide whether to care for yourself, make an appointment with your doctor, go to an urgent care or walk-in clinic, contact a community service or go to a hospital emergency department.

A call to Telehealth Ontario will give you confidential advice about any health-related concerns such as:

  • symptoms that could require medical attention
  • illness or injury
  • chronic illnesses
  • teen health and lifestyle issues

GO TO: A Walk-in Clinic

A walk-in clinic is available to anyone requiring non life-threatening medical care. It is a primary care clinic, but not an urgent care facility or emergency department, providing same-day care by a physician without an appointment.

Walk-in clinics provide care for non life-threatening illness such as:

  • fever
  • sore throat
  • cough
  • earaches
  • muscle/joint pain
  • skin lesions

Niagara Health Location

Niagara-on-the-Lake – Walk-in Clinic, NOTL Site, 176 Wellington St., Open Monday to Friday, 9:30 a.m. to Noon and 2 to 4:30 p.m., Thursdays 12:30 to 8 p.m.

When You’re Sicker

GO TO: An Urgent Care Centre

Urgent Care Centres are similar to Emergency Departments in that they are staffed by physicians and nurses trained in emergency medicine. These professionals treat illnesses or injuries that cannot wait for a scheduled appointment with a primary care physician. Urgent Care Centres do not admit patients. They are equipped to do diagnostic tests such as x-rays and ultrasounds as well as blood tests.

They treat adults and children who have non-life-threatening illnesses or injuries such as:

  • lacerations (deep cuts or wounds that may require stitches)
  • sprains, strains or deep bruises
  • mild to moderate asthma attacks
  • ear infections
  • urinary tract infections
  • coughs, congestion, sore throats
  • diarrhea
  • insect bites and rashes, abrasions, fever, simple fractures

Niagara Health Urgent Care Centres:

St. Catharines – Urgent Care Centre, Ontario Street Site, 155 Ontario St., Open 7 days a week, 8 a.m. to 10 p.m.

Port Colborne – Urgent Care Centre, Port Colborne Site, 260 Sugarloaf St., Open 7 days a week, 24 hours a day

Fort Erie – Urgent Care Centre, Douglas Memorial Site, 230 Bertie St., Open 7 days a week, 24 hours a day

When You’re Sickest

CALL: 911 for a life-threatening emergency.

You will be taken to an emergency department. If you are uncertain, always call 911 with the following emergency medical situations.

  • severe bleeding
  • difficulty breathing
  • chest pain or pressure
  • broken bones
  • partial or total amputation of a limb, finger or toe
  • trauma or injury to the head
  • sudden dizziness or vision problems
  • severe abdominal pain

GO TO: A Hospital Emergency Department

ER Departments accept ambulances and are staffed by physicians and nurses trained in emergency medicine treating the sickest patients who have severe illnesses or injuries. ERs experience high volumes of patients, especially during the winter and holiday season. Patients are seen in order of urgency not by arrival time, please be patient. The ER is designed to handle the above emergency medical situations.

What to expect when you call 911

  • Stay calm and be prepared to tell the operator where you live – your street address, city, apartment #, building access code, phone number, your medical problem and a brief medical history.
  • Several vehicles may arrive at your home, including the fire department and/or police depending on the emergency. Do not be alarmed. They are there to help you.

Niagara Health Emergency Departments:

Niagara Falls: Greater Niagara General Site, 5546 Portage Road., Open 24 hours a day, 7 days a week

St. Catharines: St. Catharines General Site, 142 Queenston St., Open 24 hours a day, 7 days a week

Welland: Welland Site, 65 Third Street, Open 24 hours a day, 7 days a week

Keywords: Memorial Site, Mental Health,

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Feedback in the form of compliments and/or concerns will assist us to reinforce our efforts to provide quality care. Tell a member of your healthcare team if you have ever had an allergic or bad reaction to any medicine or food. It ensures that areas of improvement are identified and quality assurance initiatives are acted upon. Make sure you know what to do when you go home from the hospital or from your medical appointment.