The hospital emergency rooms in St. Thomas and London are only 30 km apart.

But for patients, the first is a virtual speedway; the other, gridlock.

ER wait times in St. Thomas have been among Ontario’s shortest, even the best by some measures, while those in London have been among the longest — dead last in November, for less complex cases at University Hospital.

That gap grew wider last week as waits in London for simpler cases soared to about 10 hours. The London wait grew so long, the London Health Sciences Centre (LHSC) asked residents to stay away unless absolutely needed.

In contrast, all patients were welcomed in St. Thomas, where officials at the smaller hospital were confident they’d tame wait times with tools not used at all, or only in part, by its big-city neighbour.

Asked about the gap, London’s head of emergency medicine, Dr. Gary Joubert, said Monday the comparison isn’t fair — that community hospitals like St. Thomas have fewer complex cases and less trouble finding open hospital beds.

But as recently as the holidays, officials in St. Thomas say, their hospital beds were more overloaded with patients than London’s — and still, wait times were kept down.

At St. Thomas Elgin General Hospital, anytime a doctor decides to move a patient from the ER to a hospital bed, a clock starts ticking. After 60 minutes without a bed a manager intervenes. After 90 minutes, an executive steps in — even the chief executive.

“It’s unsafe for the patient (to wait),” hospital CEO Paul Collins said Monday.

But in London, there’s no comparable oversight — LHSC’s hospitals don’t even track how long it takes to be moved from the ER to a bed.

Instead, London hospitals track the total time to a hospital bed from the moment patients register in the ER and officials have created a target that might surprise some: 28 hours.

Still, Joubert defends London’s record, saying its waits are comparable to those in other large teaching hospitals in Ottawa and Hamilton.

Teaching hospitals draw more complex emergency cases and that affects wait times, he said. Such hospitals also tend to be at or over full capacity, creating a bottleneck that keeps patients in the ER waiting for a bed.

“St. Thomas is not a good model for us,” Joubert said. “We’re not as terrible as the provincial numbers indicate.”

But Collins believe his hospital can be a model for bigger institutions. While teaching hospitals attract complex cases that lead to longer waits, they can learn from smaller hospitals.

“I think (what we do) is 100% transferable,” he said.

Over the holidays, up to 20% more patients were in St. Thomas hospital wards than what’s considered full capacity, but staff still moved patients swiftly through the ER and, when needed, to beds, Collins said.

St. Thomas has done so well, it was asked by regional bureaucrats to help hospitals in Stratford and Tillsonburg, Collins said. Among its strategies:

Instead of only seeing the most acutely ill quickly, the ER has a special room for people with very low needs. Doctors quickly address their needs and have them out the door so they don’t clog main treatment areas.

Nurses and staff huddle daily to track the flow of patients and plan discharges so there are spaces for ER patients to be admitted.

Hospital brass borrowed the philosophy and practices of business in always trying more to streamline patient flow.

Joubert says London hospitals also want to improve and already have staff huddle daily and segregate patients who can be discharged quickly during peak hours.

But backlogs occur and that reached a tipping point last week. Among the aggravating factors named by London officials:

A spike in patients seeking mental health care.

Roads closed north of London because of snow prevented the hospital from discharging some patients.

jonathan.sher@sunmedia.ca

Twitter.com/JSHERatLFPress

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NOVEMBER ER NUMBERS

Complex cases:

St. Thomas: Half treated within 2.7 hours; 90% within 5.7 hours

University Hospital: Half treated within 4.9 hours; 90% within 14.7 hours

Victoria Hospital: Half treated within 4.4 hours; 90% within 13 hours

Less Complex cases:

St. Thomas: Half treated within 1.3 hours; 90% within 3 hours

University Hospital: Half treated within 3.2 hours; 90% within 6.5 hours

Victoria Hospital: Half treated within 2.2 hours; 90% within 5.8 hours

*Source: Ontario Health Ministry