Pay for Results (P4R)

Pay for Results (P4R) is an initiative supported under Ontario’s Wait Time Strategy to reduce emergency room wait times by improving processes within the emergency room and/or flow between the emergency room and other hospital departments. In 2011-12, P4R expanded from 46 to 70 participating emergency rooms province-wide, this includes all of the hospitals across Erie St. Clair.


P4R provides hospitals with base funding to meet Emergency Department (ED) wait time reduction targets and variable funding if they exceed targets. If hospitals are unable to meet the targets and lack performance results, the funding may be retracted. Methods for reducing wait times include:

  • Human resources review
  • LEAN process improvement (PIP)
  • ED remodeling
  • System integration and health service provider partnerships

P4R Successes

  • Clinical Decisions Units
  • Fast Track/Rapid Asssessment Zones
  • Doctors directly included in the triage process
  • Increased multidisciplinary ED staff including
    • Nurse Practitioners
    • Physician Assistants
    • Pharmacists
    • Geriatric Emergency Medicine (GEM) nurses
    • Admission teams
  • LEAN PIP training has been implemented at all ESC LHIN urban ED’s
Moving forward, there is ongoing P4R work being done by all ESC LHIN hospitals to improve wait times. Even with challenges such as high Alternate Level of Care (ALC) rates impacting patient flow in our hospitals, P4R continues to see successes in maintaining or improving ED wait times.



Laurie Zimmer,
ED/ALC Manager


P4R Success

Thanks to Emergency Department (ED) Pay-for-Results funding, Hospitals have been able to create ED Performance Improvement Plans.

These plans have helped create ED fast track areas where nurse practitioners and flow nurses can effectively manage low acuity non-admitted patients.