The Emergency Services Program at St. Joseph’s Healthcare Hamilton is the busiest in town.
With the ER numbers at the downtown Hamilton acute care hospital site combined with referred cases from Urgent Care Services at St. Joe’s Centre for Ambulatory Health Services visits hit 90,000 per year. And until recently, triage was handled with early twentieth-century technology – a white greaseboard.
The greaseboard was manually updated and could only be viewed in the observation area, where it was located. Staff in the emergency reception area didn’t have easy access to information on a patient’s location when answering inquiries of physicians, staff and visitors.
Data for planning of allocation of resources was difficult to come by, and mostly based on anecdotal evidence.
But the introduction of a Care Manager application that included an Emergency Department Tracking Board (EDTB) has changed all that. Only a handful of hospitals in Ontario are currently using the system and St. Joseph’s is the first in Hamilton to install it.
The EDTB provides an up-to-date electronic display of all patients in the department and their location. It also provides information on the patients time of triage, triage level, physician and admission status if applicable. All of the information is available at PCs located throughout the department, as well as on a large display board listing patients in the most critical and active areas of the department. Data can be entered on any PC in ER and will automatically be available to all.
EDTB was the first component of the Care Manager application implemented at St. Joseph’s. The application provides staff with a tool to continuously monitor the status of bed availability and patient flow in the department. Staff in any area of the department is able to respond to visitor and physician question to locate a patient.
Isabelle Hayward, an administration director for clinical programs at St. Joseph’s whose responsibilities include emergency services, says, “We’re constantly looking at how we are meeting standards of care. In the past, a lot of the information was anecdotal or had to be manually extracted, which is time consuming and difficult. For instance, everyone has heard of long waits in ERs. One of the things that’s great about this new system is that we are able to track if we are meeting the time standard for our clients, and if not, why not. It not only tracks times to nurse, times to physician, it tracks if they are out of the department for diagnostic reasons and for how long, and it tracks response time to consultant. This system will give us hard data to then look at strategies for delivering better care.”
The EDTB database offers a wealth of information on all emergency and urgent care patients e.g. who, when, where, presenting complaint, physician, care provider, service, length of visit and disposition. This information will provide the tool to track how the community is utilizing the Emergency and Urgent Care Centre. Statistics can provide information on patient volume, acuity and workload to validate the resources required to provide quality patient care.
“We struggled to find the funding for this system because we believe it is an essential part of emergency care,” says Hayward. “And while we may be the first in this area to work with this system, we won’t be the last. Other hospitals are coming to look at it and recognize that it provides a better understanding of ER issues. We will have consistent data, the accuracy of which will not be challenged.
“This is a tool that will assist nurses and physicians to feel more in control of such safety factors as how long patients are waiting and assist us in showing whether we’re improving with the strategies we put in place. I can only see this as an adjunct to what we’re trying to accomplish with our quality of care.”