Raising the Bar in Emergency Medicine Through Education

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‘The essence of education is not to fill the empty void but rather to light a fire’ AnonymousFor a community hospital corporation, there is a lot of education taking place at William Osler Health Centre.

Sir William Osler believed that education was more than just textbooks and classrooms. He brought learning to practice and to the bedside. Today, that tradition continues in the emergency departments (ED) at Etobicoke, Brampton and Georgetown Hospital Campuses where close to 170,000 people are seen each year. If ever the words 24/7 had profound implication it is here.

Yet despite the busy pace in the ED, staff has access to some very comprehensive on-the-job training and learning opportunities that help them to enhance their skills. All members of the emergency staff receive education in a number of creative ways. This learning environment means that these same staff share education with others – both health care providers and patients.As well as regular Continuing Medical Education sessions and rounds, conferences such as the annual ED summer conference hosted by the ED physicians at the Brampton campus, the Lalji Emergency Conference held in the fall, and nursing conferences are all effective ways of learning about new trends in care and research.

“We have been running these ED conferences for the last 14 years in the summer,” notes Dr. Keith Greenway, Chief of Emergency Medicine. “The conference has a couple of unique aspects: one is that it is not just for physicians. Nurses, paramedics and other health-care professionals who work in emergency medicine attend. Secondly, we always choose a really nice setting for these conferences such as Niagara-on-the-Lake and this year at the Deerhurst Resort. Attendees can bring their families and combine work with some important relaxation time. I think this aspect is key because it allows for greater participation since often the people who attend make it a mini vacation. We cover a wide range of issues such as the myths of ED medicine and this year we covered something that is quite unique for a community hospital such as ours Ñ ultrasound at the bedside performed by ED physicians. The presenters are sometimes controversial but always leading edge.”

The emergency departments themselves are very active training grounds for medical students and college residents.

Both the Brampton and Etobicoke Hospital Campuses with significantly diverse populations have large industrial and farming bases and are close to the airport and many major arteries meaning that all types of cases are seen in large volumes.

“The physician group across our three sites support a full range of physician trainees from students to family practice and emergency residents. Trainees are assigned to a supervisor but also do shifts with various physicians so that they can experience the different styles and pace,” explains Dr. Frank Martino, emergency physician. “We have doubled our training days over the past year and we expect an increase in the coming year.” William Osler Health Centre has recognized this role and has a paid position to coordinate the Program.

One of the key challenges to ensure staff has access to the learning opportunities they need is timing. Emergency Departments must have full staff 24/7; creative solutions to this problem are in evidence.

The idea of nursing skills days came through the education team. Held at each campus two weeks apart, nurses from across the sites can attend a session as their shifts allow.

Partnering with vendors and their trainers for clinical equipment, health-care specialists from other parts of the hospital and the education team in the ED creates different skills stations. Staff travels from station to station with a passport. The passport is later used in a draw for prizes. It is a hands-on daylong learning event that is fun as well as educational.

“As a result of this approach, we have had better than 80 per cent participation across the Corporation,” says Heather McGillis, Administrative Director for the Emergency Program.”We also offer our nursing staff Lunch and Learn sessions,” notes Kathy Wortley, Corporate Educator for the Emergency Department. “Staff, on their own time, come to lunch at a nice restaurant supported by a business partner where we incorporate an in-service. We cover topics such as changes in protocols for clinical situations, new research or therapies. These types of activities are coordinated in partnership with the clinical resource nurses who help to provide education and on-the-job learning to ED staff.”

Given that between 21 and 31 per cent of patients seen in the ED at William Osler Health Centre are pediatric, there is a lot of education for this patient population. ED staff work in partnership with Pediatric nurses to exchange information and learn from each other.

“We do monthly mock code training with nurses, physicians, respiratory therapists, paramedics and orderlies,” explains Wortley. “These are effective sessions. After running a straightforward pediatric/neonatal code, nurses and doctors sometimes trade places so that each can learn the protocols from the others’ perspective.”

Shirley Andrechek, manager of emergency at the Georgetown Hospital Campus sees first hand the need for continued education in the ED. “Our staff is faced with daily challenges as more and more complex cases are presenting in the ED. In a community setting such as Georgetown, we see a wide range of people from the very young to the elderly so that the ED nurse must have a broad range of knowledge. It requires a very high level of skill to treat the diverse populations we serve and thanks to comprehensive education at William Osler Health Centre we have some of the best trained ED nurses.”The Osler commitment to education and on-the-job learning opportunities has also helped the organization in its recruitment efforts. “Last year we tripled the number of student nurses involved in preceptorships,” notes Deborah Hill, manager of emergency at the Brampton Memorial Hospital Campus. “Quite often these student nurses become part of our staff because they like how we do things here I think the commitment to education we embrace is a key factor in their employment choice.”Orientation for new nursing staff is a major component of the ED education program. In fact last year more than 50 new hires took part in the comprehensive five to six week orientation which gives new staff a thorough overview of emergency care. The clinical resource nurses then work closely to arrange supervision and mentorship within the departments, developing these nurses from managing straightforward cases over time to the clinically challenging acute and resuscitation areas. Orientation and learning is enhanced through participation by Addiction Services, Crisis, Pharmacy, Renal Dialysis, Respiratory Therapists and Pediatric Educators.

“I like the mentorship program because it is an effective way of introducing new staff to how we do things at William Osler Health Centre,” says Mike Travers, manager of emergency at the Etobicoke Hospital Campus. “The clinical resource nurses, who work alongside our nursing staff, help to counsel the less experienced and problem solve with senior nurses in challenging situations. The clinical pharmacists working directly in the departments also guide staff and patients when medication issues arise.

“We also offer paramedic training every two months which is a very successful program. Our EDs being among the busiest in Toronto are a good training ground for them. We partner with the Base Hospital Program of Peel, located at the Brampton Campus of William Osler Health Centre, on several education initiatives. This is a mutually beneficial arrangement for both paramedics and nurses.”

Even non-medical staff benefit from education opportunities.

Clerical and registration staff are offered more advanced computer training to hone various skills and clerical knowledge in support of the departments.

With the advent of technology, a new phrase is emerging. e-Learning is the next evolution in the learning experience at William Osler Health Centre. Using web-based technology, an Intranet is being created and one of the strategies this technology will utilize is e-Learning, direct information and training modules open for all staff.

“I think this will be an exciting and very welcome system,” says Heather McGillis. “Staff will be able to access learning tools from their computer when it is convenient for them.”

Through education, staff at William Osler Health Centre seems energized by their knowledge and skills. Informed staff feels comfortable sharing so, in turn, patients may not even realize it but they too are learning more. They learn about their condition. They learn about medication and dressings. They learn that when they come to the ED at William Osler Health Centre, they are in the best possible hands.