New role improves patient flow in emergency department

An innovative approach to patient care at Rouge Valley Health System (RVHS) is helping to move ambulatory patients more quickly through the emergency department (ED), while still delivering high quality patient care.

The patient navigator, a registered nurse in the ED who is responsible for managing the patient’s journey through the ED, helps to ensure that clinical services are delivered within the province’s targeted timeframes. This innovative approach to the ED care process helps to streamline a patient’s stay in the ED from triage through to discharge. Since the addition of this role to Rouge Valley’s two hospital campuses in east Toronto and west Durham Region, the hospital has seen an improvement in how quickly low acuity (CTAS levels four and five) move through the ED, from the time they arrive, right through to discharge.

First introduced last November as a pilot project at Rouge Valley Centenary (RVC) as a way to improve in the ED, it made such an impact on patient wait times for non admitted patients that it was extended to include Rouge Valley Ajax & Pickering (RVAP).

Nearly 80 per cent of all the patients who come into the EDs at both hospital campuses are seen and treated in the ambulatory care areas (ACA) of each department. The nurse navigator has played a key role in reducing wait times for these patients. They help to make sure that these patients are seen by the physician quickly, and that test results like lab reports and x-rays, are received and seen as soon as possible so that patients can be discharged from the ED within the provincial targets.

“The addition of the patient navigator has made a significant impact on the time patients are first seen by the physician. Now, the patient is ‘delivered’ to the physician, which is a much more efficient way to move patients through the ED,” explains Dianna Harrison, manager, emergency services, RVC.

In all, three registered nurses at RVHS share the role between the two hospital campuses, working from Monday to Thursday. The success of the patient navigator hinges on the team effort within the ED. Each staff member there, including physicians, nurses, patient support representatives (PSR) and clerks, works together to keep things flowing smoothly.

ED physicians at RVHS are especially pleased with the critical role that the patient navigator is now playing in the ED. “They provide huge assistance to ED physicians by getting the patient the care they need sooner in the ambulatory care area,” explains Dr. K.C. Moran, program chief, department of emergency medicine, RVC. “With their assistance, the patient is able to be seen by the physicians much faster and more efficiently in the ED. They know where the delays are in the ED, and are able to get things moving,” he adds.

“Within the first month that the patient navigator was introduced at RVAP, we saw an improvement in our patient wait times. We have also seen our patient satisfaction improve as well. As we continue to improve our patient flow in the EDs, we are now seeing proportionately more patients, and we believe this is related to our improved wait times,” explains Dr. Gary Mann, program chief, department of emergency medicine, RVAP.

The patient navigator also helps to keep the physicians moving as well, making sure that any patients waiting to be seen are seen, or that test results are received. All of this helps to prevent any further patient delays so that the patient can be released from the ED well within provincial wait time guidelines.

Registered nurse and RVC patient navigator Dianne Gilpin has been able to see the improvements first-hand. “It runs very much like a clinic. Our goal is to keep everything flowing, and it’s working really well. We’re getting great feedback from our patients, physicians and nurses. Our patients are also commenting on how quickly they’re now able to move through the emergency,” explains Dianne.

She starts each shift by first checking the ACA, located just outside of the ED, to see how busy it is. It helps to indicate how patient flow is moving on that day. She then comes to the triage area to go through the patient charts, pulling out those less urgent. She then organizes them in the order in which the patients arrive, unless someone with a higher acuity comes in. A PSR then brings those patients to the ACA waiting area.

The ACAs at both hospital campuses are comprised of two to three patient treatment rooms, and four to five treatment chairs where patients can receive care. The space is designed so that their treatment can begin in the ACA, and if further examination is needed, they can be moved into one of the patient rooms.

If tests are ordered, such as x-rays or blood work, these patients are usually able to go to that area of the hospital to receive them. Once the patient is seen, they are moved back into the ED waiting area so that an ACA chair can be used for another patient, allowing the flow of patients to continue. Even the charts are organized according to what test results are still pending.

Jacqueline Werry, registered nurse and patient navigator at RVAP helps to ensure that patients are being properly monitored as they transition from one area to another, acting as a liaison between the ED, lab, and diagnostic imaging.

“I help by making the system flow, and keeping things running smoothly. It’s now less stressful and chaotic,” she explains.