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.

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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.

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.

Emergency Department flow

When people come to the Emergency Department (ED) they want to receive care as quickly as possible. That is our goal at Osler and we are constantly refining and fine-tuning how we do things throughout the hospital to make sure patients receive the best care in the timeliest way.

Every day about 600 people come through the doors of our two EDs seeking treatment and care and Osler’s staff responds by ensuring that every patient gets the best care possible. It takes an incredible amount of teamwork and coordination to move patients both through the ED and to other areas of the hospital, when needed.

Based on numbers we are doing as well as, or better than other hospitals in Ontario.  This past Thanksgiving weekend, we saw 1,506 people in our EDs, and we performed on par with, or better than, the provincial average in every area with a target, including wait times and discharges.

Nine out of 10 patients with minor conditions received treatment within the provincial target of four hours or less. We have consistently been better than the provincial target for a number of months, and to improve the length of time from registration to discharge in the ED, we increased the amount of physician coverage in September.

We are also asking patients and families about their experience while in the ED.  We receive feedback from about 1,000 people a month through these surveys. This information is shared with our front line teams delivering care so that we can make any adjustments necessary to improve service.

We’re also conducting surveys with ED patients upon discharge.  This feedback gets shared with our front-line staff in real time so that we know what our patients want and we can make changes quickly and respond to what matters most to you.

I always point people to the ED video we created earlier this year.  It’s a great way to familiarize people with the ED so they understand what happens there on a typical day.

Service excellence is a priority for Osler.  I’m proud of the way we’ve been making progress and I look forward to continuing to improve and enhance our services in the time to come.