What’s Going On Back There?
It is important to know that the longer
wait you sometimes experience is because patients are seen
in order of greatest need – the most life threatening cases
are seen first. One of the reasons patients in the waiting
room can't always tell how busy the actual ED is because the
ambulance entrance, where trauma and seriously ill patients
arrive, is out of view of the waiting room.
Also adding to wait times is the fact
that the severity of patient injuries coming to the ED is
increasing. At the same time, the number of patients being
admitted into the hospital through Emergency is increasing.
When inpatient beds are full,
Emergency patients must remain in the Emergency department
until a bed opens up. This causes a back up in the waiting
room because no new patients can be admitted into the
Emergency care area.
We understand that any wait is stressful.
Emergency Department Director Lori Miller says, "No
matter what the severity of the injury that brings someone
to our hospital, we know all emergency patients feel an
urgent need to receive care. We understand that for each
patient this visit is unplanned and a significant event in
their life."
How Do We Manage Emergency Care?
Upon arrival at the ED, patients are
triaged (assessed) to determine
the nature and severity of their illness
and are prioritized according to a five-level triage system
called the Canadian Triage and Acuity Scale (CTAS). The CTAS
levels are: Level 1 – resuscitation; Level 2 – emergent;
Level 3 – urgent; Level 4 – less urgent; and Level 5 –
non-urgent. Once triage is completed, the patient is
registered, a chart is begun and the patient is directed
either to the waiting room or directly into the ED, based on
the urgency of their condition.
We’ve recently
renovated the triage and waiting areas so that the
triage nurse can easily see all patients at all times and
respond immediately if someone's condition seems to be
deteriorating.
In order to ease the waiting time for
some urgent care patients, the Emergency Department recently
completed a pilot project to move Level 3 (Urgent) cases
through the system more quickly. Patients, whose conditions
met a strict set of criteria, were re-directed to a Care
Initiation Unit (CIU) where specially trained nurses were
able to order x-rays, blood work and other vital tests
before the physician's visit. Previously, a patient would
have to wait for a doctor, wait again for test results, and
then see the doctor for treatment. For the CIU patients,
test results were available to the physician the first time
he or she met the patient, speeding up the time for
diagnosis and treatment. While the results of the pilot are
now being analyzed, the initial results are encouraging.
According to Lori Miller, "The initial results are
excellent. Patient wait time decreased and patient
satisfaction increased."
Finally, in order to put a more friendly
face on the Emergency Department waiting room, the
department is developing a program that will have specially
trained volunteers greet patients and assist in providing
directions and updates to patients and families in the
waiting room.
"People want to be kept informed," says
Lori. "Patients are more understanding about having to wait
if they know why they’re waiting. It's a simple courtesy we
can help provide."
Although we will always continue to look
for ways to improve the experience of being in the Emergency
Department, we take pride in knowing that Headwaters'
emergency patients are seen more quickly than the
provincially mandated guidelines. Headwaters meets or
betters the guidelines 95% of the time.
Hospitals can't control the variety of
illnesses or the number of patients at any given time. What
they can do is more effectively manage the flow of patients
through the department. By decreasing wait times, patients
get in and out of the Emergency Department faster, patient
satisfaction goes up, patient safety improves and hospital
costs go down. And that’s good news for everyone.
