In the wee hours of Saturday, June 9, the doors were shut and the lights turned off as emergency department staff at the Royal Victoria Regional Health Centre (RVH) in Barrie said “Goodbye” to their last patient in the old ED and “Hello” to the first patient in their brand new department.
And that means the long wait is over for Dr. George Karasmanis.
As the clinical director of RVH’s emergency department (ED) he knows a thing or two about waiting. Not only does he know that patients often have to wait in emergency, he also knows that all the staff and physicians have been waiting too.
They’ve been waiting for the newly expanded ED to open in the Phase 1 Expansion Project. As the ED was among the first departments to open in the expansion, that wait is officially over.
“Our new ED has many features that will make it more patient-centred including four isolation rooms to safely care for patients with infectious diseases, 15 private treatment rooms, a dedicated area for patients experiencing mental health issues and nine resuscitation rooms – including two fully equipped trauma rooms,” says Dr. Karasmanis.
“And with the addition of more inpatient beds being phased-in with the expansion, we hope to be able to move the patients that require admission more quickly into those beds.”
The transition from ‘old to new’ was carefully planned and went extremely well due to the hours upon hours of preparation work done by the Planning Team and support by so many RVH departments. From ICT to Clinical Informatics; Pharmacy and Security to Business Development; Volunteer Resources and Communications; this move was truly a collective effort.
“I was so proud as I witnessed this move done with such precision. The energy level was so high — feeling more like midday rather than the middle of the night,” says Janice Skot, RVH’s president and CEO, who was on site during the early hours of the morning to share in the excitement of this historical transition. “Everyone had their oar in the water, rowing together in the same direction. It truly was incredible to watch.”
Averaging over 200 patients per day, having an Emergency department with the right resources at the right times is crucial to the health centre’s success in wait time reduction.
“The province has made the reduction of emergency room wait times a healthcare priority and we are implementing many strategies and systems to help us reduce those times at RVH,” says Kim Storey, Emergency Services director.
One of those strategies is to have patients initially assessed more quickly. “We have implemented electronic triage and a system where patients move into the Emergency department where they will be monitored by nurses and seen by physicians more quickly,” says Dr. Karasmanis. “We are continuing to improve patient flow processes to improve patient outcomes and overall satisfaction. We have made changes in our sub-acute area, where patients can be assessed in rooms, and then moved to chairs and loungers to await the results of their investigations and treatments, thereby allowing more patients to transition on through the beds in a timely manner.”
Dr. Karasmanis cautions that while the new ED has an expanded footprint, the number of stretcher spaces has not increased. The new department has more space for medical equipment, such as monitors that can interface with the hospital’s electronic medical records.
“There will be more space to relieve physical congestion and improve flow throughout the department. Our processes will be more efficient, we will be better equipped, and we will now have specialized areas within the ED. As we phase-in the opening of inpatient beds in the health centre, this will help prevent gridlock as patients can transition more smoothly to an inpatient unit if they require admission,” says Karasmanis.
Other initiatives designed to improve the flow of patients throughout the hospital have been implemented to free-up inpatient beds as soon as safely possible. Some of the patient flow initiatives include a dedicated Discharge Lounge for patients waiting for transportation home and a Nurse Practitioner (NP) Outreach Program aimed at providing urgent care for elderly patients in their long-term care homes to avoid ED visits.
Most recently, RVH has partnered with Community Care Access Centre to provide dedicated Registered Nurse Coordinators to assess elderly patients in the ED and work at providing support in their homes to prevent unnecessary admissions to the health centre.
“RVH has been successful in reducing wait times in the Emergency department through innovative programs and we will continue to seek ways to ensure we are delivering safe, high quality and timely care to our patients in the newly expanded ED,” says Storey. “Our new ‘home’ better allows us to provide the most appropriate care, in the most appropriate setting.”
The carefully-phased transition into RVH’s 400,000 square-foot expansion, which doubles the size of the health centre, will continue over the next few months with the Simcoe Muskoka Regional Cancer Centre becoming fully-operational. This opening of the new ED falls on the heels of the successful move of the Imaging department, the extremely successful opening of the new Respiratory Unit as well as extensive renovations to the space occupied by the Mental Heath and Addictions Program. The expansion’s 101 new inpatient beds will open gradually over the next few years as operational funding becomes available.
And for emergency department physicians like Dr. Karasmanis – they’re just glad the long wait is over.