In late 2023, Lakeridge Health's Emergency Departments (EDs) were under immense pressure. Some patients were waiting up to 73 hours for an inpatient bed, while ambulance offload delays regularly exceeded provincial targets, at times stretching beyond two hours. EDs were increasingly functioning as inpatient units, placing significant strain on staff, limiting access to timely emergency care, and creating challenges across the broader health system. It was clear that change was urgently needed. 

Less than two years later, the results tell a very different story. Despite rising ED volumes across all sites, patients are being seen by an emergency provider 48% faster, treated and discharged 30% faster, and ambulance offload times have improved by 81%, consistently meeting provincial targets. Work across programs to help patients transition home sooner and strengthen a home-first approach has saved approximately 50,000 patient days, freeing up capacity for patients who need acute care.  

Behind these statistics is a story of culture change, courageous leadership, and the power of partnership across an entire health system.  

And for organizations across Ontario and Canada facing similar pressures, it offers a practical roadmap. 

A System Under Pressure 

In April 2024, ED volumes were already high. The issue was long-standing, and the pressure was mounting.  

Nurses were exhausted.  

Patient satisfaction was low.  

Staffing shortages were chronic.  

Provincial partners were questioning performance alignment. 

“It was a hot mess,” Brian Pollard, Health System Executive, Clinical, at Lakeridge Health reflected candidly. 

The challenge was not simply about emergency care. It was about flow. It was about how patients moved through the entire system. A critical inflection point emerged within the ED itself, particularly at Lakeridge Health’s Oshawa Hospital, where physical space constraints, high volumes, and poor patient experience converged. As a result of rooms being blocked by admitted patients, the ambulatory care area was operating with patients being assessed in hallway chairs without privacy, creating both clinical and dignity concerns.  

People who no longer required assessment or acute care were remaining in hospital beds because there were few alternatives. Others were being admitted for what were categorized as “social admissions”: situations where a hospital felt like the only safe option because community supports were unreliable or unavailable. 

Tabitha Carroll, Health System Executive, Clinical at Lakeridge Health, whose portfolio includes the EDs, described the early days as all hands-on deck and a turning point. The Board was directly engaged in setting the priority for change to improve ED performance.  

Staffing consistency became a top priority.  

The organization moved away from heavy reliance on agency nurses and invested in recruitment through job fairs and Human Resources partnerships. A new Chief and Director of the ED were brought in, and schedules were redesigned to reduce overreliance on casual staff.  

For the first time in years, there were no vacancies. 

But staffing alone would not solve the flow problem. 

In summer 2024, ED leaders launched a comprehensive redesign of how patients moved through the department, with a clear goal: eliminate hallway and chair-based care. Under the new model, patients were assessed in dedicated rooms and then moved to designated treatment areas based on their care needs. This helped reduce bottlenecks, improve privacy, and ensure assessment spaces remained available for incoming patients. 

Lighting a Fire for Change 

Brian believed that meaningful change required clarity and urgency.  

He initiated an external peer review to conduct a deep dive into Lakeridge Health’s data.  

“We didn’t have a clear line of sight into what was really happening,” Brian said. “We needed a play-by-play.” 

The review examined patient journeys, chart trends, and provincial benchmarks. It revealed significant gaps, including high rates of social admissions and extended lengths of stay for patients who no longer required acute care but had nowhere else to go. 

Lesson #1: You cannot fix what you cannot see. Get external validation of your flow data. 

There was also cultural resistance. Many clinical teams felt the hospital was the only safe option. Families expressed distrust in home care services, reporting that promised services sometimes failed to materialize.  

The result was predictable: people stayed in hospital far longer than necessary. 

At the same time, Ontario Health introduced a “Hospital to Home” program. Lakeridge Health saw opportunity not just to participate, but to innovate.  

With $1.7 million in strategic funding, leaders asked a simple question: What if we created a bridge? 

The Bridge That Changed Everything 

In late summer 2024, Lakeridge launched a bridging model.  

If a patient required home care services but could not immediately access Ontario Health at Home supports, the hospital funded a temporary bundle of services through a partner agency.  

The expectation was clear: Ontario Health at Home would assume ongoing care once available.  

In September 2024, the model was launched across Lakeridge Health’s EDs at the Ajax-Pickering, Bowmanville, and Oshawa Hospitals. Community care partners stepped in early to provide temporary supports and services, helping patients remain safely at home and reducing unnecessary hospital admissions.  

Social admissions were reduced by nearly 75%. 

The impact was dramatic. 

In January 2025, the program expanded to include patients requiring more complex supports, such as two-person lifts and intensive assistance. A specialized agency partnered in a bridge-in model.  

The result: a significant reduction in Alternate Level of Care (ALC) patients occupying ED and inpatient beds.  

About 50,000 patient days were saved.  

One patient who had been hospitalized for nearly a year was finally able to return home safely.  

For staff, this was transformative. They saw patients discharged safely and not returning in crisis.  

Not weekly. Daily. 

Lesson #3: Meet every day. Flow cannot be managed retrospectively. 

One critical change focused on ALC processes. Previously, patients waiting for long-term care (LTC) beds could remain designated for extended periods – for years – contributing to ED backlogs.  

The OFC established clear parameters: any patient requiring LTC approval required group discussion. This tightened accountability and significantly reduced LTC-waiting designations. 

Winter surge planning was also redesigned as well. Rather than reacting to overcrowding, Lakeridge Health pre-approved surge beds based on predictive modeling and coordinated planning with Ontario Health.  

The Ajax Pickering and Oshawa Hospitals prepared staffing, stretchers, and inpatient capacity in advance.  

The result: Less confusion. More proactive management. Improved ED flow.  

“It’s been powerful to see directors, managers, and health system leaders committed,” said Jennifer. “There’s a visible shift. 

Admission Avoidance - “Home is Best” Culture Shift in the ED 

Andreea Anton, Director of Emergency Services, emphasized that sustainable change required a culture shift.  

“Recognizing that 25% of our patients visiting the ED are over 65 years of age, we know the longer elderly patients remain in the ED leads to rapid deconditioning and therefore a key strategy was strengthening geriatric emergency medicine support in the ED,” Andreea shared.  

Several Lakeridge Health sites, for example, introduced a ‘super track’ for lower-acuity patients, aligning staffing hours with peak demand and creating a separate, fast-moving care zone.  

By summer 2025, Lakeridge Health continued refining its model.  

A 43-bed Transition Care Unit in a retirement residence was converted into an activation unit focused on rehabilitation and reconditioning.  

A short-stay unit at the Oshawa Hospital that opened in January 2024 continued to differentiate patients needing brief stabilization from those requiring longer internal medicine admissions.  

When new long-term care beds opened in fall 2025, the system was ready.  

Volumes were already bending downward.  

Leaders remain clear: This work is not finished.  

Continuous data monitoring remains central to the model. Teams meet regularly to review performance and make iterative adjustments, with current work focused on improving diagnostic imaging turnaround times to further reduce length of stay. 

The organization has moved from misalignment with government targets to measurable improvement.  

“This success truly shows that it takes a village,” said Dr. Jaclyn Herman, Chief and Medical Director for Emergency Medicine, Lakeridge Health. “Our frontline teams, leaders, community and government partners all played an essential role. It was a collaborative effort with combined initiatives that delivered these results. It was the collective commitment of people across the health system and community working toward a shared goal of improving care and access for patients.”