North York General smooths ED flow using AI

TORONTO – As EDs across Ontario face record demand, North York General has become the first hospital in the province to introduce SmartER Zones — an AI-driven approach that’s designed to help address prolonged emergency department waits and support earlier access to care during peak demand periods.

SmartER Zones uses an AI algorithm developed by Toronto-based Signal 1, a Canadian health technology organization with roots in applied research at the University of Toronto, to help improve flow and ultimately reduce risks associated with long waits in the emergency department.

“Emergency medicine is constant decision-making under pressure,” said Dr. Kevin Wasko (pictured), chief of emergency medicine and program medical director at North York General.

“SmartER Zones gives our teams better visibility during the busiest moments, helping us identify patients who may be at risk from long waits and respond sooner, while keeping all care decisions with clinicians.”

During busy periods, some areas of an emergency department can become overwhelmed while others still have space. The algorithm generates recommendations for any patient who has waited longer than a hospital-defined threshold.

When space opens in another care area, the hospital’s electronic medical record notifies nurses, reducing wait times and enabling earlier treatment.

This tool was designed with North York General frontline nurses and physicians and tested extensively before launch, using real emergency department scenarios to ensure it works safely and effectively in day-to-day practice. Early implementation will focus on improving patient flow and safety during peak demand periods, with ongoing evaluation to measure outcomes such as shorter wait times, earlier clinical assessment, and fewer patients leaving without being seen.

“We are excited to partner with Signal 1 to create SmartER Zones to help patients and care teams,” said Duska Kennedy, vice president of Strategy and Digital Health and Chief Digital Officer at North York General. “Our goal is to apply it thoughtfully, in real clinical settings and help people get the right care when they need it most.”

North York General is a provincial leader in emergency medicine, home to one of the highest-volume emergency departments in Ontario at our Charlotte & Lewis Steinberg Emergency, with more than 121,000 emergency visits last year, including over 11,000 visits in December alone during peak respiratory illness season.

Long waits in emergency departments are linked to delayed diagnoses and a higher likelihood that patients leave before being seen — a growing safety concern across the health system. Patients waiting more than 6 hours have a 95% higher hospital admission risk.

“Emergency departments are dynamic, fast-moving environments, and North York General’s ED is one of the busiest and best performing in the province,” said Mara Lederman, co-founder, and?Chief Operating Officer at Signal 1. “We worked in partnership to co-create a tool that can have a real impact on the patient experience and help the front-line staff deliver exceptional care.”

This work is part of a broader effort at North York General to use data and technology in practical ways that support care delivery. All recommendations are reviewed by experienced clinicians, with clinical judgment guiding every patient care decision.

Recent initiatives include 24/7 CT imaging, robot-assisted surgery, and other digital tools that help clinicians work more efficiently and support North York General’s World-Class Care, 24/7 strategy.

“SmartER Zones represents the kind of responsible innovation we strive for,” said Dr. Phil Shin, chief medical information officer and chair of the Medical Advisory Committee at North York General. “This is a tool built to strengthen clinical practice, offering additional insight during high-pressure moments while ensuring that medical decision-making remains in the hands of clinicians.”

In recent years, North York General has optimized a zonal model to manage the large volume of patients presenting to its ED. Patients are assessed by a triage nurse and assigned to an area or zone of the ED that is equipped to manage specific types of cases.

For example, staff and physicians working in the Green Zone typically care for patients with minor injuries, such as cuts or fractures. Ideally, seeing patients with similar issues in a common space optimizes patient flow through the department.

However, an unintended consequence of this approach is that some zones may experience periods of high volume, causing them to become overloaded, while others still have capacity.

The SmartER Zones initiative uses an AI algorithm to provide a recommendation of zones in which a patient may receive care sooner. To generate its recommendation, the model analyzes the patient’s wait time along with a range of clinical and operational factors, including zone capacity and detailed triage information such as patient vitals, presenting concern and initial assessments.

This zone recommendation is then refined based on inclusion or exclusion criteria for each zone and wait-time thresholds. The output is a recommendation list with ED zones ranked from most to least suitable for the patient.

The algorithm generates recommendations for any patient who has waited longer than a hospital-defined threshold. When space opens up in one of the zones on the list, the hospital’s electronic medical record then notifies the nurses.

The algorithm does not provide diagnosis nor recommendations for clinical care; the final decision about where a patient will be allocated is made solely by the healthcare team based on clinical information and their own professional clinical judgment.

North York General
North York General is one of Canada’s leading community academic hospitals with a vision to deliver World-Class Care, 24/7. Affiliated with the University of Toronto, our multi-site campus supports our diverse community through every stage and life-defining moment by providing a wide range of acute care, ambulatory and long-term care services. North York General is a member of the North York Toronto Health Partners Ontario Health Team, which integrates local care with patients, primary care, and community partners.

Signal 1
Signal 1 helps health systems accelerate AI adoption with a category defining technology platform. Signal 1’s AI Management System (AIMS) gives health system leaders visibility and control across their growing AI portfolios. AIMS offers comprehensive oversight of predictive, generative, and agentic AI applications and introduces guardrails to mitigate downside risks. It sets the standard for Responsible AI in healthcare. Purpose-built for healthcare and informed by years of experience managing AI at scale in other industries, Signal 1 empowers healthcare organizations to translate innovation into real clinical, operational, and financial outcomes.