Ambulatory treatment centre helps lower emergency department wait times

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In 2008-2009, William Osler Health System’s Etobicoke General Hospital had over 64,000 emergency department visits, making it one of the busiest community hospital emergency departments in the province of Ontario. Despite the high volume, according to the Ministry of Health and Long-Term Care’s Emergency Department Wait Times website, Etobicoke General has continuously posted wait times that are among the best in the province for those with less severe conditions. A major contributing factor to this positive wait-times performance is the Ambulatory Treatment Centre.

The Ambulatory Treatment Centre (ATC) was created in the winter of 2007 and was set up in Etobicoke General’s emergency department. The ATC is a renovation from a previous model of emergency care, known as the Rapid Assessment Zone (RAZ), that has since had a remarkably positive impact on wait times and patient flow in the department.

“The concept of the RAZ actually started in late 2003 in a two bed unit. It was successful in the flow of our ambulatory CTAS 3 patients so we expanded it to four beds and subsequently renovated to create the 14-bed ATC,” says Dr. Naveed Mohammad, Chief of Emergency Medicine at Osler.

The ATC is intended for patients triaged as CTAS 3, 4, and 5 who were previously seen in the RAZ and Fast Track. But the ATC is a better use of space, staff time and patient flow and is able to provide faster, more efficient service for patients. Like urgent care, the ATC treats patients with urgent but non life threatening injuries, such as abdominal pain, minor shortness of breath, fractures and urinary tract infections, plus many more aliments, injuries and infections that could potentially progress to a serious problem requiring emergency intervention.

Unlike many urgent care clinics that have set times, the ATC is open 24/7 just like the emergency department. As well, unlike most urgent care clinics, which typically treat those triaged as CTAS 4 or 5, the ATC also treats those that are categorized as CTAS 3; however, all of those who come to the ATC must first be triaged through the emergency department.

Upon entering the emergency department at Etobicoke General, patients are met by a triage nurse. Based on the acuity of their conditions, patients are directed to the acute care area or the ATC waiting room, a separate space down the corridor from the main emergency department, to wait for their turn. The ATC treatment area has 14 beds, where various tests, reassessments and ECG’s take place. It also has an eye room, a suture room, a fracture room, and a women’s health room. There are also four chairs for patients with IV medications or waiting for certain results. Once all tests and assessments are completed, they return to the waiting room to wait for results. This helps open bed space and accommodate the flow of patients in the area. Roughly, 80 per cent of emergency patients are triaged into the ATC daily.

The ATC is staffed by experienced and skilled nurses, physicians, and administrative staff, including a clerk, a Resource Nurse, two Registered Nurses (RNs), a Registered Practical Nurse (RPN) and a waiting room RPN. The waiting room RPN is dedicated to meeting the needs of the patients waiting for results, continually checks the vitals of patients, communicates with patients and their families, and follows up with the medical team with any worsening conditions.

According to Lorrie Halliday, the Interim Director of Emergency Services, it is the nurses which make the ATC so successful. “It is all about patient flow,” she says. “With such high patient volumes, our nurses work in a very challenging environment. Often there are 30 emergency patients waiting for hospital beds each day and they make it happen with minimal patient complaints.”

Erica Coobs, Acting Patient Care Manager, Emergency echoes Halliday’s sentiments. “We have excellent doctors and nurses who are committed to providing the best possible patient care each and every day. Patients are most satisfied when they know staff are doing their best to minimize the time spent in the emergency department.”

The ATC has a very good working relationship with diagnostic imaging, the laboratory, and other hospital departments and services which help manage the flow of patients through diagnostics and treatment.