When Trillium Health Centre embarked on a project to transform and redesign its emergency care system, it took a multifaceted approach. Teams were assembled to look at every aspect of the health centre’s busy ER operations – over 81,000 emergency visits at the Trillium Mississauga ER annually – and how they interact with and are supported by the other health systems and business units.
The ER transformation and redesign project involved all areas of the hospital in the goal of finding innovative ways to improve the patient experience and reduce wait times.
“It is not just the ER’s problem, we all own the patient flow and access pressures,” says Patti Cochrane, vice-president, patient services and quality. “It has been a tough, creative and rewarding process. Redesigning our care processes meant taking a hard look at all of our access pressure points. We looked at everything.”
One of the multidisciplinary teams – made up of clinical, clerical, patient relations, volunteer resources and security partners – was tasked with building a plan to create the ideal patient experience in the ER waiting room. “We asked patients what was most important to them,” explains Lina Rinaldi, director, emergency and medicine health system. “Surveys identified two key patient needs: to feel cared for by ER staff and to have more information available.”
To help patients feel connected to the staff inside the ER, Trillium introduced patient pagers in the waiting room. Since May 28, 2008, restaurant-style coaster pagers have been given to patients who, after being triaged and assessed, were determined to have higher acuity conditions (CTAS Level 2 and 3). The patient keeps the pager until called for treatment. This gives them flexibility to leave the waiting room and not miss being called by ER staff if they need to stretch their legs in the lobby or head outside for some fresh air.
“Patients are very receptive,” says Tammy Walker, an experienced ER nurse and ER process redesign resource. “They understand the pagers because they’ve used them in restaurants. It’s a new use for a simple, common technology. The pagers are especially helpful for patients and families whose first language is not English.”
The pagers also improve confidentiality since patient names are no longer called out. Once paged, the patient reports for treatment, and the pagers are cleaned, recharged and ready for use again. “We’ve had positive feedback from patients about the pagers and we have experienced a decrease in the number of patients who leave our facility without being seen after the pager implementation in June,” says Rinaldi. “People tell the ER staff they feel more comfortable because they know we can reach them.”
To address information needs, new digital signage was installed at the ER entrance to welcome patients and provide instructions. Patient Liaison Coordinators were added to greet arriving patients, answer questions and direct them to Triage and Registration.
Several other initiatives have been implemented within the ER, across the organization and with external partners. Trillium created a “Reassessment Zone” or RAZ to improve patient flow by freeing up stretchers. It is a creative use of space: eight chairs replace four stretchers. Ambulatory patients who have been seen by a nurse and doctor, and who have had initial tests ordered, are transferred to the RAZ lounge to await results in a reclining chair.
The Enabling Patient Access team implemented successful system-wide flow initiatives. When the ER is nearing capacity, “Bed Alert” or “Code Gridlock” calls are issued to mobilize everyone. Discharge of patients is re-examined by each physician and patients are informed of the need to expedite discharge to open acute care beds.
The Urgent Care Centre (UCC) at Trillium’s West Toronto ambulatory care location, which will also have patient pagers this month, provides alternate patient access to emergency services. The UCC sees over 43,000 patients annually and its recent redevelopment will help relieve pressure on the ER at Mississauga for low acuity patients. It is open daily from 8 a.m. to 10 p.m.
“Improving patient flow requires a concerted effort by everyone at Trillium to help move patients through the ER as quickly as possible, to discharge or provide appropriate care. It also involves working closely with community services and agencies like the Local Health Integration Network, Community Care Access Centre and Emergency Medical Services,” says Cochrane. “We still have work to do, but the patient pagers are certainly creating a buzz about Trillium’s ER transformation and redesign.”