Operational Direction: Priorities for Spring/Summer 2025

We are deeply appreciative of the dedication, skill and teamwork of all health service providers in addressing the seasonal surge in respiratory illnesses earlier this year. Your collective efforts continue to make a difference supporting communities across Ontario.

The health system performed with few service reductions over the respiratory season. This was a significant achievement in a challenging environment where we faced sustained pressures driven by one of the most severe flu seasons in the past decade, alongside high hospitalizations for RSV among seniors residing in the community.

We have maintained progress on surgical performance, and emergency department (ED) data shows that we have successfully diverted low-acuity visits, demonstrating that efforts to provide this care in the community are working. We also remain on track on primary care expansion.

In the coming months, our goal is to continue to advance quality, access and capacity measures to support patients and overall system optimization, as well as to lay the groundwork for the 2025/26 fall/winter respiratory surge. This operational direction outlines priority actions and targets to guide you in working toward this goal with your Ontario Health region. Priorities include:

• Improving primary care access and attachment as outlined in Ontario's Primary Care Action Plan
• Ensuring people receive the right care in the right place, focusing on keeping people in their homes and communities while also reducing the number of patients designated alternate level of care (ALC)
• Ongoing health human resource (HHR) efforts across the system
• Access to mental health and addictions care
• Performance and flow in EDs
• Timely access to surgical care

We ask that you work with your Ontario Health region and local partners to implement these actions. As always, please reach out to your Ontario Health region for questions and support.

Operational Direction

All sectors:

• Participate in regional and local surge planning processes to prepare for the fall/winter, including tabletop exercises and developing surge plans.
• Monitor and address potential health human resource shortages through clear communications protocols and mitigation strategies, including leveraging regional/provincial supports (e.g., incentives/training funding) and innovations such as regional collaboration and alternative models of care.
• Promote Health811 for non-urgent health inquiries and questions, including links to virtual urgent care clinics.
  • Use the communications materials on the Health811 Resource Hub, including key messages, social media imagery, digital screen content, and posters.
• Utilize supports and resources provided by the Ontario Caregiver Organization (e.g., Supporting Caregivers in Home and Community Care, the Essential Care Partner Support Hub) to ensure that caregivers are identified, included, and supported as essential care partners.

ALC reduction

• Prioritize ALC reduction with a target to maintain ALC throughput >1 (i.e., more patients designated ALC are discharged than newly added).
• Continue to implement the Home First Operational Direction and ALC Leading Practices, working with your Ontario Health region for specific focus areas in alignment with local and regional plans.
• Work with your Ontario Health region, Ontario Health atHome, and local providers to ensure there is a clear understanding of local capacity and barriers to discharge, and a clear process for early identification and integrated discharge planning.
• Do not ramp down funded ALC initiatives over the spring/summer months without discussion with your Ontario Health region. Regional teams will continue to work with health service providers to ensure initiatives are having the greatest impact. This may require a re-allocation of investments. Your regional team will discuss this with you as appropriate.
• Ensure that ALC reporting, coding, and data collection is reflective of clinical reality and application of ALC guidance for clinical scenarios.
• Actively monitor key ALC metrics such as ALC volumes and ALC length of stay, and process measures such as percentage of patients designated ALC waiting for home care or long-term care who do not yet have an Ontario Health atHome referral within CHRIS.
• Focus on collaborative discharge planning that follows patient-centered approaches and aligns with standardized assessment practices (i.e., discussions across the interprofessional care team to determine the full breadth of discharge destination options).
  • In particular, ensure home care services are explored with Ontario Health atHome and the patient/family before considering a long-term care referral, in alignment with the Home First Operational Direction.

Primary care:

• Support the priorities outlined in the Primary Care Action Plan, with the ultimate goal to connect every person in Ontario to primary care. Specifically:
  • Work with your Ontario Health Team (OHT) and primary care network (PCN) to coordinate attachment of patients from the Health Care Connect waitlist to primary care (including through new and expanded IPCTs), in partnership with local clinicians and Ontario Health atHome Care Connectors.
  • For practices/clinicians in postal codes with the highest rates of people not connected to a primary care provider/team, work with your OHT and PCN to bring forward proposals to create and expand primary care teams, per available funding opportunities.
• Continue to prioritize measles prevention and management, including via immunization and testing, and encourage regular immunizations across the lifespan as per Ontario's routine immunization schedule.
  • Review measles resources from Public Health Ontario and the Ontario College of Family Physicians for the latest information and tools for primary care providers.

Home care and community support service providers:

• To support ED diversion:
  • Service provider organizations (SPOs): Provide timely escalation to Ontario Health atHome on changes to patient status and be available for joint home visits and care planning.
  • SPOs: Be prepared to offset vacationing staff during summer months to support summer surge response, including the ability to support increased referrals in nursing clinics.
  • Ontario Health atHome: Prioritize case load review and DIVERT score monitoring.
  • All providers: Continue to adhere to infection prevention and control standards.
• Ontario Health atHome: Ensure staff adhere to rigorous crisis designation practices.
• Ontario Health atHome: Collaborate with Ontario Health, public health, and SPOs on fall vaccine preparedness, coordination and prioritization.
• All community partners: Work with your Ontario Health region and Ontario Health atHome to establish home and community care surge plans in time for September.
• All community partners: Work with your Ontario Health region to develop regional and local plans to increase discharge from hospital to home care and reduce open volume of patients designated as ALC waiting for home and community care services.
• All community partners: Ensure local partners, including hospitals and Ontario Health atHome, are aware of existing capacity (beds, bundles).

Mental health and addictions service providers:

• Develop referral pathways and refer clients with depression and anxiety-related disorders to the Ontario Structured Psychotherapy Program.
• Work with your Ontario Health region and the provincial coordinated access partner/lead health service provider to ensure that your services are included in the development and implementation of mental health and addictions coordinated access.
• Submit the Mental Health and Addictions Provincial Data Set to enable improved understanding of need and access within the community mental health and addictions sector.
  • Review the Operational Direction on Data Submission Requirements for the Mental Health and Addictions Sector and contact MHADDI@ontariohealth.ca for more information.

OHTs:

• Support collaboration and mobilization of OHT partners to address provincial priorities, as communicated in the memo from the Ministry of Health, Primary Care Action Team, and Ontario Health (April 15, 2025) and further explained in the follow-up memo from Ontario Health (May 1, 2025). Priorities include:
  • Strengthening PCNs.
  • Working through PCNs with local clinicians to coordinate and support the submission of proposals for new and expanded IPCTs.
  • Coordinating the attachment of patients from the Health Care Connect waitlist to primary care, in partnership with Ontario Health atHome Care Connectors.
  • Continuing to support Integrated Clinical Pathways, Chronic Disease Prevention and Management models, and Home Care Leading Projects (for OHTs already implementing these initiatives).

All hospitals:

Surgery

• Accelerate run rates over the spring/summer months where possible to help offset potential slowdowns in the fall/winter. Do not ramp down funded surgical or medical imaging volumes without discussion with your Ontario Health region.
• Ensure the number of patients waiting beyond clinical access targets for surgeries and procedures (“long waiters”) is declining, with a focus on percent of surgeries completed within recommended access targets, aiming for >85% of patients receiving their procedures within their target wait times.
• Continue to work with your Ontario Health region to establish and/or enhance local or sub-regional surgical networks, which will help optimize capacity for surgical performance.

Medical imaging

• Ensure that medical imaging capacity (including CT and MRI) is optimized to help facilitate access and flow into, through, out of and between hospitals. This includes ensuring patients receive timely assessments including all appropriate diagnostic workups at the hospital where they first present before transfers to other centres are initiated.
• Expedite imaging for patients in the ED to reduce length of stay, and enhance access for semi-urgent patients (e.g., priority level 3) to enable timely treatment decisions for cancer diagnosis and staging.

Admission process and patient transfers

• Continue to follow a person-centred admission process aligned with organizational consent policy that includes early conversations about potential transfer to another hospital as appropriate.

Hospitals with EDs:

• Improve throughput in the ED to enhance patient outcomes, reduce wait times, and maintain the overall efficiency and sustainability of care services. Key performance metrics targeted through P4R program are essential indicators of system flow. Focus for 25/26 should include:
  • 90th Percentile Time to Physician Initial Assessment - target of 3.4 hours or less
  • 90th Percentile ED Length of Stay for Non-Admitted Patients - target of 6 hours or less
  • Ambulance Offload Time - target of 30 minutes or less
  • No-Bed Admits - target a 25% reduction from March 31, 2025, baseline
• Work to improve patient flow through the ED, leveraging the ED Leading Practices Toolkit and accompanying Self-Assessment Guide.
• Continue to plan ahead to ensure adequate staffing over the summer season, leveraging supports from Ontario Health where appropriate (locum programs, education opportunities) and working with your Ontario Health region on stability planning and averting closure risks.
  • Follow the Emergency Department Mitigation and Closure Protocol for reporting potential and confirmed closures.
• Utilize the training opportunities and grants available through the ED Nursing Education, Retention and Workforce Program to support nurses working in EDs.
• Continue to ensure robust surge plans are in place for triage, registration and coordination of flow within the ED and hospital, including a plan to assess patients promptly at peak hours.
• Participate in the Provincial Emergency Services Community of Practice.

Pediatric specialty hospitals and community hospitals with pediatric programs:

• Ensure that the number of patients waiting beyond clinical access targets for surgeries and procedures (“long waiters”) is declining and that surgical throughput is >1 (i.e., more surgeries are performed than are added to the wait list).
• Continue to develop and enhance hub and spoke models to allow more patients to receive surgical care closer to home.

Rehabilitation and complex continuing care:

• Continue to implement the Operational Direction on Rehabilitation and Complex Continuing Care Capacity and Flow (released July 12, 2023), including maintaining a target occupancy rate of 95% and implementing a 7-day-a-week discharge and admissions process.
• For acute sites with rehabilitation and complex continuing care capacity, reduce off servicing medicine patients in post-acute capacity to enable access to these specialty services and ensure patient flow across the system.
• Be ready to accept referrals direct from community via Ontario Health atHome to prevent complex patients needing to be admitted to hospital to access complex continuing care beds.

Long-term care homes:

• Maintain 97% long-stay occupancy (minimum), leveraging business continuity and staffing plans to ensure appropriate staffing resources are in place throughout high vacation time periods. Ensure optimal utilization of short-stay licensed beds within your Home, working with Ontario Health and Ontario Health atHome where appropriate.
• Maintain best-practice on-site clinical care and leverage community partners, including nurse practitioner-led outreach teams, to provide care to residents within your Home and prevent unnecessary transfers to the ED.
• Work closely with hospital partners to bring residents home as quickly as possible following an ED visit or hospital admission.
• Inform Ontario Health atHome of any vacancies as they occur and review and respond to applications within five business days of receiving application, as outlined in O. Reg. 246/22, to support applicants in better understanding the status of their long-term care applications.
• Ensure organizational emergency preparedness for events including, but not limited, to flooding, extreme heat and weather, with up-to-date Emergency Response and Business Continuity plans.
• Continue to support administration of all recommended vaccinations, including RSV for highrisk older adults.
• Wherever possible, be prepared to accept new admissions on weekends.