Wait times at North Bay General's Emergency Room (ER) are poised to head south as several new streamlining initiatives get under way, thanks to $797,000 in funding from the Ministry of Health and Long-Term Care's Pay-for-Results program.
Part of a $100 million investment announced by the provincial government July 29th, the funding will improve patient flow and eliminate bottlenecks that tie up stretchers in ER and beds in nursing units. Hospitals in North Bay, Timmins, Sudbury and Sault Ste. Marie were allocated $3.5 million of the total and will be expected to reduce ER wait times by 15 per cent. Elsewhere in Ontario, the program has reduced wait times by 23 per cent.
The North Bay ER currently records as many as 48,000 visits per year. On a slow day, says Nancy Jacko, vice-president of the hospital's Medical Care Centre, the department sees 110 people, but during flu season, visits can peak at 140.
"We do an excellent job for our more severe cases and for most classifications of patients, but where we struggle to meet our goals is with our low acuity patients," said Jacko.
The provincial goal for low acuity patients coming in with flu symptoms or minor ailments is four hours from triage to discharge. North Bay is just slightly above the target at 4.1 or 4.2 hours.
Admission nurses
ER physicians, nurses and administrators came up with six initiatives to improve the department's performance, including the hiring of in-patient admission nurses to speed the admission of ER patients to nursing units.
"There's a lot of information that has to be compiled, including doctors' orders, medication orders and patient histories when a patient is admitted," explained Jacko. "A lot of times, the staff are really busy and, even though there's a bed up on the unit, there could be a delay of two hours to get up there."
The role of the in-patient admissions nurse is to pull together the paperwork and expedite the transfer, freeing up stretchers in the ER for other patients waiting to be seen.
The expedited processing of admissions will also ensure that family members accompanying patients are available to assist with the patient history and list of medications because, sometimes, the support person won't sit around waiting for the transfer to take place and will go home as soon as they know the patient has a bed, said Jacko.
The hospital will also be using the Pay-for-Results program to fund an Emergency Tracking System, a Meditech software module that will provide ER staff with a computer-based overview of patient flow and wait times.
The system will replace a white board currently in use in the ER. It will offer staff the ability to track how long patients have been in the ER, whether a physician has seen them and if blood work and diagnostic tests have been ordered. Staff will also have a snapshot of the number of people waiting to be seen along with their acuity levels.
"The tracking system will help us manage our patient flow and make sure that patients are being seen within the proper timeframes," said Jacko. "We can track how long it takes to get a lab test, X-ray or be seen by a physician, so we can focus on the exact areas we need to work on.
"All of this is being done manually now and, when everything hits at once, things can get lost in the shuffle."
The computer-based tracking system will be far superior to a white board that is visible to the public and relies on staff hand-writing the limited information that they are personally knowledgeable about.
New ER
The ER at North Bay General's new hospital, which opens in January, is significantly larger and staff won't have the same ability to eyeball patients, so electronic tracking will be much more effective, said Jacko.
The hospital is also establishing a decision support unit for the 20 per cent of patients who show up in ER and require some sort of treatment lasting anywhere from four to eight hours.
"It might be someone having an asthma attack, for example," said Jacko. "If we can get some medication into them, we can monitor them closely and send them home, resulting in fewer unnecessary hospital admissions.
Other initiatives will result in the establishment of a Fast Track Zone for treating lower acuity patients to speed turnover, and a discharge lounge, which will free up beds that would otherwise be taken up by patients waiting for a family member to pick them up or an ambulance transfer to a long-term care home.
The discharge lounge will consist of four to six stretchers and chairs in one of the in-patient units and will be staffed by a registered practical nurse.
A small fund will also be set up courtesy of the Pay-for-Results program to help patients return home earlier than would otherwise be the case by covering transportation, special dressings and home support costs.
