How Osler’s EDs are “humming like a sewing machine”

This week’s guest blogger is Dr. Naveed Mohammad, VP Medical Affairs

It’s no secret that Osler is home to one of the busiest emergency departments (ED) in Canada. Last year, more than 214,000 people visited the EDs at Brampton Civic and Etobicoke General for care, which accounts for an additional 3,400 patients over the previous year. With this kind of volume increase, our teams in the ED need to be at the top of their game.

On any given day, we strive to meet specific targets in the ED – length of stay, time to physician assessment and time to inpatient bed among others to help deliver a better patient experience. We recently reached a new milestone in the ED at Etobicoke General as our 30-day 90th Percentile Time to Physician Initial Assessment (PIA) was reduced to just 1.5 hours for the first time. This means that patients were seen by a physician within 90 minutes, ranking Osler second in the province for this metric.

Two days later, the same team beat its own record and reduced the 30-day 90th Percentile Time to PIA to just one hour. As one physician put it, “we’re humming like a sewing machine.”

These incredible results show that our ED teams are performing at an incredibly high level. In addition to the talent of Osler staff, physicians and volunteers in the ED, a number of measures have recently been put in place to help move patients through the ED more quickly and efficiently.

Some of the changes that are making a difference in Etobicoke General’s ED include:

  • Designated “see and treat” zones in the Ambulatory Treatment Centre (ATC) and Fast Track zones that help to expedite care
  • Demonstrations of exceptional teamwork where physicians arrive early to help move patients and relay information between members of the care team

We’re also making positive changes to the ED at Brampton Civic to help see and treat patients faster:

  • Our ED Patient Experience Team is helping to keep patients comfortable and informed while they wait for treatment
  • Increased physician hours and “flex shifts” are enabling physicians to support busy areas of the ED at any time during the day
  • A new Mental Health Patient Flow Initiative is helping to move mental health patients out of the waiting area and into care quicker

While all of these initiatives help to increase the efficiency of the ED care team, these changes serve a double purpose to enhance the patient experience. A trip to the ED can be a stressful experience but shorter wait times, more frequent contact with patients and better information sharing helps make patients feel more comfortable throughout their journey.

Congratulations to the multi-disciplinary teams who are truly coming together in the ED to provide patient-inspired health care without boundaries!

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Facing off against ‘dragons’ in the ED

We recently celebrated a number of professional practice days at Osler but there is one special shout out I need to make. May 19 was Personal Support Worker (PSW) day and it was a remarkable one for Osler PSW Carolynne Haynes. She received the inaugural PSW of the Year award by the Ontario Council of Hospital Unions/CUPE (OCHU). As a person who is a “passionate and loving care provider with an infectious and warm personality [who] goes that extra mile on a daily basis” she is a deserving honouree. Congratulations on this incredible achievement!

Recently, Osler’s Emergency Department (ED) came up with a new name for their unit: the Dragon’s Den.

Based on the popular television show, the ED team created a “Dragon’s Den” and invited frontline staff from Brampton Civic’s ED to pitch their ideas on how to improve and enhance their department. They invited me to join two clinical leaders, Kim Maas-O’Hearn, Clinical Services Manager of Emergency Medicine and Dr. Tamara Wallington, Corporate Medical Director of Quality and Safety, to channel our inner dragons on the judging panel.

The teams with the top five pitches – as voted on by ED staff and physicians – will each receive $5,000 to implement their ideas from the physicians in the BCH ED.

Sixteen teams presented their ideas before an encouraging and vocal crowd of ED nurses, physicians and support staff – some coming off night shifts and others coming in on their days off – in Brampton Civic’s Auditorium. The pitches covered all aspects of the department – from improving the experience of the ED’s hallway patients to streamlining processes in different areas of the ED, and from new methods of combatting burnout to innovative team training and simulation sessions.

After each presentation, the dragons fired questions at the teams to learn more about how they will spend the money, how feasible it is to maintain the idea once implemented, and what other organizations have successfully used similar ideas.

The voice of Osler’s staff is powerful. They are the people who work in these environments every day and know the challenges of their departments better than anyone else. Our Dragon’s Den was a fun, innovative and simple way of challenging staff to think outside the box and really engage them in shaping the future of ED operations.

Sonam Bhojani, an RN in the ED, agrees: “I think we’re probably the best resource [we] have, being frontline staff. It’s great that [we] are asked to bring forward our thoughts about how we feel the department can function better.”

In the coming weeks, we’ll turn it back to the ED staff and physicians and ask them to vote for their favourite pitches. Winning ideas will be announced later this month.

While this event was exclusive to Brampton Civic, improvements are also happening at Etobicoke General. The Ambulatory Treatment Centre (ATC) has been redesigned into “see and treat” zones to create a more orderly process for patient flow and two new treatment rooms have been added to the Fast Track zone to expedite care. Osler will also be piloting ED Wait Time Cards in the coming months among patients requiring non-urgent care.

Keeping it 100 with our ABP and QIP

I’ve been hearing the phrase “Keep it 100” a lot lately. It’s an expression that embodies what is means to stay true to your values. We use two important tools to help keep Osler 100: our Annual Business Plan (ABP) and Quality Improvement Plan (QIP).

This year we created our first-ever joint ABP with our partners at the Central West Community Care Access Centre (CCAC) and Headwaters Health Care Centre (Headwaters). Over the past two years we’ve been working together to improve the delivery of health care across the Central West region and collaborating on our ABP is the next natural step in our journey.

Our ABP allows us to reflect on our achievements of the past 12 months and outlines where we will focus our energy in the coming year. We’ve aligned our ABP to a set of five common pillars – People, Service Quality, Clinical Quality, Efficiency and Growth – that will guide our work so each organization can achieve their individual strategic and clinical objectives to bring positive change to health care in our region.

The list of our achievements is extensive, so here’s a snapshot of highlights from the past year:

  • We’re better supporting the needs of patients and families through our new Emergency Department Patient Experience Program.
  • We’re part of a new regional Hospital to Home program that provides better support to patients as they return home after discharge.
  • We reached construction milestones by “topping off” at Peel Memorial, bringing us closer to opening our doors in 2017, and naming the team that will build Etobicoke General’s new wing.
  • We brought world-class care closer to home by performing our first-ever endovascular aneurysm repair (EVAR) surgery as part Osler’s innovative Vascular and Endovascular Program.
  • We lead our first successful mission to India in search of clinical partnerships as part of our Global Health Program.

For the second year in a row, we created a joint QIP with our partners at the Central West CCAC and Headwaters. This plan harmonizes our efforts to improve the quality of care across local and provincial health care systems. Osler staff and physicians have worked incredibly hard over the past year to achieve some excellent results:

  • We exceeded our individual Alternate Level of Care (ALC) targets, which helped the Central West LHIN achieve the lowest ALC rate in Ontario – 5.6 per cent compared to the provincial rate of 14.75 per cent.
  • We reduced our readmission rates to less than 30 days and maintain a C. Difficile rate of 0.16 per 1000 patients, which is below the target of 0.30 set by the Ministry of Health and Long-Term Care.
  • We worked closely with patients and families to shape the care experience through advisory councils, satisfaction surveys throughout the health care journey and thousands of post-discharge phone calls through our regional call centre.

I’m extremely proud of all that we have achieved over the past year and am looking forward to putting the wheels in motion on our new ABP and QIP. I know that at this time next year we’ll have even more great news to share.

Mobilizing staff to move patients through the ED

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Over the years I’ve written a lot about our annual holiday surge, when we typically see an increase in patient visits over the festive season. But higher patient volumes are quickly becoming the new normal.

Over the last six weeks, many hospitals across the Greater Toronto Area, including Osler, have seen higher than normal patient visits to the ED. Dr. Naveed Mohammad, Osler’s Vice President of Medical Affairs, recently told the Brampton Guardian, “We’re seeing record numbers. [On March 14], we saw 500 patients in 24 hours.”

The recent surge in patient volumes are the result of many factors: increased flu activity, reduced hours at walk-in clinics due to vacations and a shortage of in-patient mental health resources in the community. Even though we’ve made improvements to the ED to help increase the flow of patients and communication, we’re still feeling the pressure and have responded with a new approach called Code Gridlock.

Here’s how it works. Osler uses a stoplight system to monitor patient flow conditions to determine if the demand exceeds our ability to provide timely service – green (normal), yellow (urgent) and red (critical/gridlock). Each colour triggers a different response and when we surpass all three, and have more than 30 patients waiting for admission in the ED with less than 10 patients confirmed for discharge, we call Code Gridlock.

We know that high patient volumes don’t just effect the Emergency Department (ED), the impacts are felt hospital wide. Code Gridlock mobilizes the entire hospital to help reduce the number of patients waiting in the ED for admission to an inpatient unit.

Osler treats Code Gridlock like any other emergency situation and sets up a command centre to ensure our response is consistent and well organized. The command team directs our internal teams and engages with our partners at the Central West Community Care Access Centre (CCAC) and Headwaters Health Care Centre (Headwaters) to help move patients through the local system more efficiently to reduce pressure in Osler hospitals. Some measures include:

  • Integrated Care Coordinators at Etobicoke General attend rounds to help identify non-critical patients that can be discharged with CCAC services;
  • Additional Care Coordinators can be brought in at Brampton Civic to participate in family meetings so hospital staff can support more discharges; and,
  • Some patients will be moved a hospital, closest to their home, that can provide an appropriate level of care, such as Headwaters.

Code Gridlock, along with numerous other preventative measures, is helping to keep our patients safe and ensure access to care during these extra busy times.

Celebrating 100 blog posts (and counting)

I can’t believe that this is my 100th blog post to the community! Over the last 3.5 years I’ve had the privilege of sharing some of Osler’s most remarkable moments with you.

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From the launch of our Strategic Plan to showcasing clinical innovations to highlighting our work with health system partners, we’ve had quite the ride and we can only go further from here. While we’ve touched on a number of topics over the years, a few have struck a real chord with readers. Here’s a little flashback to some of the posts that have resonated most with you:

Thank you for reading and sharing your thoughts on the amazing work done by Osler’s staff, physicians and volunteers every single day. I take great pride in sharing these achievements with you and challenging some of the traditional thinking around the delivery of health care in the community.

I’m not the only one who thinks we have a lot to share. On the heels of another busy holiday surge, a crew from CBC recently visited the emergency department (ED) at Brampton Civic to showcase our facility while exploring alternative care options for non-critical patients at Urgent Care Centres in the community.

As one of the busiest EDs in Canada, our teams are constantly working provide patient-inspired care to a high volume of patients in a fast-paced environment while making changes to improve the experience for everyone who receives or provides care.

  • Nurse Practitioners in acute areas of the ED and the addition of more physician hours are helping us to better manage patient volumes, reduce wait times and shorten length of stay.
  • With our community partners at Peel Regional Police, Osler is working to decrease offload times and transfer of accountability for Mental Health patients in the ED so officers can return to the community faster.
  • Displaying wait times at nursing stations in the Ambulatory Treatment Centres (ATC) is helping to improve collaboration and problem solving around patient flow.
  • Our new ED Patient Experience Team is a dedicated resource that offers comfort and enhanced communications to patients, families and visitors waiting for treatment.

While we continue to make improvements to the programs and services provided at Osler, we are looking forward to the opening of Peel Memorial in the not too distant future. This new facility will provide even more care options, including an Urgent Care Centre, for the Brampton community.

A record setting start to 2016

Happy New Year! After spending some quality time with family and friends, I’m ready to start off another exciting year at Osler. I hope you made some special memories with your loved ones this season, too.

While many people slowed down for the holiday season, the pace at Osler was ramping up as we set a new record for patient activity. On December 26, a record 455 patients come to the emergency department (ED) at Brampton Civic. That’s more than any other hospital in Ontario. Etobicoke General was also busy with significant volumes that peaked at 242 patient visits to the ED in a single day.

While the ED is often the first place we feel the surge, impacts are felt throughout the hospital. Our inpatient, diagnostic imaging, laboratory and support service teams – in collaboration with many others – also worked tirelessly to provide an exceptional experience for patients during this busy time.

By the official end of the two week surge period, we provided care to almost 24,000 patients. When we break it down, it looks like this:

Osler holiday surge infographic

High patient volumes are nothing new for us. Even though we are one of the busiest community hospitals in Canada, caring for this exceptionally large volume of patients is no easy feat. The way Osler staff, physicians and volunteers rallied in response should be acknowledged and commended.

In addition to managing the holiday surge, our teams have rallied to support the Syrian refugees arriving in Canada. There has been little impact to Osler from refugees arriving at Toronto Pearson airport but our surge planning ensured that we were ready to provide care to anyone who came through our doors.

I’m also pleased to report that we have received so many donations of winter clothing and personal hygiene items from staff that we are asking you to pause on further contributions at this time. As we take stock of the collected items, donations to support Syrian refugees can be made to United Way of Peel. Some hospital staff have taken donations one step further and fundraised to bring an entire family to Canada – a truly inspiring act of kindness!

The teamwork they displayed during this challenging time was tremendous. Thank you for going beyond to provide patient-inspired care without boundaries. Cheers to a job well done and to a successful new year!

Osler staff shines during holiday surge

While many of us are returning to our regular schedule after the holiday season, the fast pace continues for Osler staff, physicians and volunteers. Osler is home to some of the best health care providers in the industry and the last two weeks reminded me just how incredible our team really is.

Between December 22 and January 4, more than 8,800 patients visited our emergency departments (ED) and more than 1,000 patients were admitted for inpatient care. This is a six per cent increase in patient visits over last year. We also saw an early spike in flu activity as 350 patients with confirmed cases of the flu came to our EDs for care during these same two weeks, which added to the holiday surge.

The surge continues with an increase in patient volumes caused by high demand and activity.

Brampton Civic Hospital has the busiest ED in the province – if not the country – and typically sees about 380 patients in the ED on any given day. Throughout December it averaged about 400 patients per day, with a peak of 450 patients on December 26. The ED at Etobicoke General Hospital saw unprecedented level of activity as more than 260 patients came to us for care on December 28.

Osler staff, physicians and volunteers continue to do a tremendous job of providing patient-inspired health care to all patients and their families during this busy time. Spending the holidays supporting the health care needs of the community is a true testament to the exceptional people that make Osler such an incredible place.

We expected to see higher than average patient volumes over the holidays and planned accordingly by temporarily moving outpatient clinics to increase the inpatient capacity on the units, placing medical patients on surgical units and increasing our staffing. Much of our original surge plan remains in place as we continue to experience higher-than-normal patient volumes.

As we continue to respond to the increased patient activity, we are asking the community to do its part. We’ve posted some helpful tips and information to Osler’s website and Facebook page to help you assess your health care options to receive the right care, in the right place, by the right health care provider.

Please continue to visit our website, follow us on Twitter and like us on Facebook to get the latest information about our initiatives and ongoing service improvements efforts across Osler.