Transforming patient care in the midst of a crisis

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In healthcare – and particularly a hospital setting – innovation and evolution can be a long and difficult process. From concept to approval, the most significant change happens as the result of a good idea that becomes a pilot project, which then is evaluated and assessed – and then sometimes further refined before taking flight. But when a crisis hits, immediate and innovative action can result in transformation that results in even better, more efficient and effective care.

On January 8, 2014 a fire hose standpipe burst at the Charlton Campus of St. Joseph’s Healthcare Hamilton (SJHH), flooding 12 state-of-the art operating suites, the sterile core, and medical device reprocessing department. Within minutes, water was flooding the floor below – including the Emergency Department (ED) and Diagnostic Imaging department. All told, more than 60,000 square feet of clinical and support space was affected – requiring immediate cancellations of scheduled and emergency surgery, the closure of the emergency department and delay in providing some diagnostic care.

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“The flood happened right at shift change and it was unlike anything I’ve experienced before,” says Michelle Burrows, RN, who has worked at St. Joseph’s for 11 years. Staff mobilized immediately, calling a hospital-wide Code Aqua (flood)  and Code Green (evacuation) for the emergency department, and launching into action to save millions of dollars worth of diagnostic and surgical equipment. Cory Fraser, RN, was also present at the time of the flood, “Everyone just knew what to do to keep patients safe; there was no time to overthink decisions—there was only time to act.

As water poured into the operating rooms, Chief of Surgery, Dr. Anthony Adili worked with staff to begin calling and notifying patients of the cancellations – in many cases, meeting patients at the department door as they arrived for care.

“In the emergency department, our priority was to evacuate patients to safe areas, and to establish an area where we could continue to provide acute care for those unable to move,” explains Dr. Ian Preyra, Chief of Emergency Medicine.

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St. Joseph’s made the difficult decision of closing its ER, resulting in ambulance redirection to Hamilton Health Sciences’ (HHS) Juravinski and General Hospitals. The redirect forced HHS into a Code Orange Standby – a situation that was both challenging for the team at HHS, and unsustainable for more than a short period of time. This is where the innovative transformation at St. Joe’s began.

“The doors to the emergency room never really close so continuing to turn patients away was not an option, even in the midst of a crisis,” says Dr. Preyra. SJHH is the city’s busiest emergency department, seeing more than 50,000 patients a year.  “We were down by about 60 per cent of our physical capacity, but we couldn’t redirect for long. We needed a solution to maximize the beds and space we had left.” Within 72 hours, the hospital launched a Medical Surgical Assessment Unit (MSAU) in surge space within Day Surgery on the 2nd floor, directly above the ED.

Despite staffing and communication challenges resulting from running an ED on two separate floors, the MSAU exposed a new level of efficiency. “It presented a significant shift in the way we process and manage patients. Consulting doctors were challenged to see their patients quickly and to prioritize differently,” says Preyra. The flexibility of specialists and other care providers enabled St. Joseph’s to resume normal patient volumes despite the crisis, and even reduce emergency room wait times.

“When you give people opportunities to provide better care they will”, says Dr. Preyra.

Similar innovation was happening in the surgical progam, as leaders there brainstormed how to bring surgical capacity back on line in the absence of a surgical centre. “Patients facing surgery – no matter how major or ‘minor’ face a lot of anxiety and stress,” says Dr. Adili. “Resuming surgery as soon as possible was our top priority.”

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To do so, the hospital leveraged its role as an academic centre by equipping four OR’s used for teaching and overflow to the same standard as damaged by the flood. Then, staff worked to equip the hospital’s King Steet Campus (an outpatient surgical and urgent care centre) with the equipment needed to perform additional, more complex surgical cases in ORs at that campus.. “Our ability to quickly mobilize new solutions was possible because of the innovative thinking of our team, and the flexibility of our specialists who were open to new ways of doing things – all in the best interests of patient care,” says Dr. Adili.

The MSAU and interim surgical plan were creative and necessary transformations that quickly enabled St. Joseph’s Healthcare Hamilton to restore care, despite the dramatic physical damage that occurred as a result of the flood. “In a hospital, we don’t have the luxury of closing while we return to ‘normal’ facilities and operations,” says President Dr. David Higgins. “It is amazing to see how a crisis like this one brings our visionary ideas, innovative thinking, and a true sense of collaboration and system-based care.”

System-based collaboration was a key element to St. Joseph’s ability to innovate and resume care so quickly, continues Dr. Higgins. “Our relationships with Hamilton Health Science, the Community Care Access Centre and the City of Hamilton’s Emergency Medical Services were critical during this crisis. Their people mobilized to support us and took on the extra burden of patients we couldn’t care for in the initial days after the flood. Our ability to continue operations would not have been possible without them.”

Discussions are underway at St. Joseph’s Healthcare Hamilton to determine if the new processes will be sustained even after repairs are complete, as staff, physicians and leaders see the benefit of innovative thinking in more efficient, patient-centred care.