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evaluate the impact of the curriculum changes. Conclusion: A collaborative, modular, longitudinal QIPS curriculum for UT FRCP emergency medicine residents that met CanMEDS requirements was created using multiple educational methods. The first resident cohort that completed the curriculum demonstrated an absolute increase in QI knowledge and its applicability (as measured by the QIKAT-R) by 19.6%. Two PDSA cycles were completed to improve the curriculum with the change ideas generated from resident feedback. Ongoing challenges include limited staff availability to teach and supervise resident QI projects. Future directions include incentivising staff participation and providing mentorship for residents with a career interest in QI beyond what is offered by the curriculum. Keywords: quality improvement and patient safety, residency training, CanMEDS Introduction: The administration of "to-go" medications in the Kelowna General Hospital Emergency Department was identified as an issue. Frequently, multiple administrations of "to-go" medication prepacks were administered to individual patients on a frequent basis. In addition, the variability in "to-go" medication was substantial between providers. Recognizing the patient issues (addiction, dependency and diversion) and system issues (costs, risk) a team-based quality improvement initiative was instituted, utilizing a variety of quality improvement techniques. The aim was to reduce the number of "to-go" medications by half, within a year. Methods: The project began January 2015, and is ongoing. Multiple stakeholders were engaged within the emergency department; these included leaders of the physician, nursing and pharmacy teams, including an executive sponsor. Using change theory, and traditional Plan-Do-Study-Act (PDSA) cycles, an iterative methodology was proposed. The outcome measure proposed was number of "to-go" medications administered; secondary measures included number of opioid "to-go" and benzodiazepine "to-go"prescriptions. Balancing measures were the number of narcotic prescriptions written. Physician prescribing practice and nursing practice were reviewed at meetings and huddles. Individualized reports were provided to physicians for self-review. Data was collated at baseline then reviewed quarterly at meetings and huddles. Run charts were utilized along with raw data and individualized reports. Results: At baseline (January 2015), the number of "to-go" medications was 708. Over the next year, this value reduced to 459, showing a 35% reduction in "to-go". Two years later (June 2017), this had reduced to 142, resulting in an overall reduction of 80% "to-go" medications. Secondary measures are currently under analysis. Further, no increase in prescribing of narcotics was seen during this time period. Conclusion: The administration of "to-go" medications from the emergency department has significant individual and societal impact. Frequently, these medications are diverted; meaning, sold for profit on the black market. Further, opioid prescribing is under i...

which 3440 were transferred to the EP (67.4%), 2958 of EP assessed callers (86.0%) had a family doctor, but only one-quarter of such patients could contact their family doctor. Overall, 2301/3440 "red" callers did not attend an ED (67.0%) compared to 2508/4770 in the control period (52.6%), for an absolute reduction of 14.4% (95% CI 12.2 to 16.4%, p < 0.0001). In callers for those <17 years old there was a 20.3% (95% CI 16.5 to 24.1%) reduction in ED visits compared to the control group: 771/1520 (50.7%) vs 364/1067 (30.4%). 40% of callers attending an ED (458/1139) were advised to try non-ED follow up by the MD and 108 (9.5%) were admitted, with no difference in 30-day mortality between groups. Age and CTAS distribution were similar between the two groups and the non MD-transferred cohort. Mean caller satisfaction was excellent (4.7/5.0). Conclusion: EP supplementation of a RN advice service has the potential to reduce ED visits by almost 15% while providing excellent safety and satisfaction. Keywords: input mitigation, telemedicine, emergency department crowding Introduction: Over 700 different input, throughput and output metrics have been used to quantify ED crowding. Of these, only ED length-of-stay (ED LOS) has been shown to be associated with mortality. No comparative evaluation of ED crowding metrics has been performed to determine which ones have the strongest association with patient mortality. The objective of this study was to compare the strength of association of common ED input, throughput and output metrics to patient mortality. Methods: Administrative data from five years of ED visits (2011)(2012)(2013)(2014) at three urban EDs were linked to develop a database of over 900,000 ED visits with patient demographics, electronic time stamps for care processes, dispositions and outcomes. The data were randomly divided into three partitions of equal size. Here we report the findings from one partition of 253,938 ED visits. The remaining two data partitions will be used to validate these findings. Commonly-used crowding metrics were quantified and aggregated by day or by shift (0800-1600, 1600-2400, 2400-0800), and the shift-specific metrics assigned to each patient. The primary outcome was 7-day all-cause mortality. Multilevel logistic regression models were developed for 7-day mortality, with selected ED crowding metrics and a common set of confounders as predictors. The strength of association between the crowding metrics and mortality was compared using Akaike's Information Criterion (AIC) and the Bayesian Information Criterion (BIC): ED crowding metrics with lower AIC and BIC have stronger associations with 7-day mortality. Results: Of 909,000 ED encounters, 124,679 (16.5%) arrived by EMS, 149,233(19.7%) were admitted, and 3,808 patients (0.5%) died within 7 days of ED arrival. Of input metrics, the model with ED wait-time was better (i.e. had a smaller AIC and BIC) than models for daily census, ED occupancy or LWBS proportion for predicting 7-day mortality. Of throughput metrics, the model with me...