Windsor Star

How one of Canada’s busiest ERs made progress against overcrowdi­ng

- MICHAEL TUTTON

Five times a day, senior managers at Toronto’s North York General get alerts on the ever-rising tide of patients arriving at the hospital’s emergency department.

The updates are colour-coded — and too many “red status” alerts prompt immediate action, with managers huddling with nurses and doctors to find space on medical units.

It’s just one tactic used to make inroads against overcrowdi­ng in one of Canada’s busiest emergency rooms.

From a “bed traffic control room” to a special outpatient clinic that strives to keep patients out of hospital, chief executive Dr. Tim Rutledge, a veteran ER doctor himself, cautions there’s no single way to drop wait times for the 107,000 patients arriving each year.

“It’s hundreds and hundreds of small projects getting to the root causes,” he said during an interview.

Across Canada, stories of patients languishin­g in emergency department­s peaked this winter — including a case of woman with internal bleeding who spent five days in the hallways of the Brampton Civic Hospital and a Halifax man dying from pancreatic cancer who was left on a gurney for seven hours before being seen by a physician.

The stories about patient indignitie­s are prompting rising interest in what’s gone right at North York General.

Five years ago, statistics at the mid-sized community hospital showed 90 per cent of emergency patients admitted to hospital were moved to an in-patient bed within 25 hours — meaning some waited all day and a night for a spot in a ward. As of late last year, the key measuremen­t has fallen by a third to about 19 hours — a drop that occurred despite a 22-per-cent hike in the number of patients.

When adjusted for volume, North York General’s rank is now first among the 74 hospitals in ER performanc­e, says Rutledge.

Behind it all, there’s been a decade-long shift in culture aimed at seeing ER overcrowdi­ng as a problem that needs a hospital-wide fix.

“The emergency department and the whole in-patient side were in different worlds. We actually brought those two worlds together,” said Karyn Popovich, the vice-president of clinical programs and chief of nursing.

Medical department­s that once saw a patient languishin­g in ER as another doctor’s problem began to volunteer to bring them upstairs to a bed, she said.

There was also training that built understand­ing among the ghettoized specialtie­s in a facility with almost 3,000 health care workers attached to it.

“We had nurses from the in-patient unit come down to emergency and see what it was like there and we had nurses from emergency go into the in-patient units ... so that we all understood the others’ work environmen­ts and pressures,” said Popovich.

Meanwhile, the hospital became a poster child for the North America-wide Choosing Wisely movement, where medical staff make recommenda­tions on ways to eliminate wasted time and money.

Last April, the non-profit group recognized North York for reducing the number of ER laboratory tests by a third, chopping lab tests in the pre-operative clinic by 38 per cent, and cutting the number of ICU mobile chest X-rays by 12 per cent.

Dr. Donna McRitchie, vice-president of medicine at North York, says “physician champions” circulate through other department­s looking for ways to smooth the flow of patients.

“We had to ... make sure that everyone changed their way of thinking to, ‘This is our patient. We need to deal with them,’” she says.

However, while North York has one of the country’s best improvemen­t rates, the wait times for ER patients awaiting a hospital bed is still higher than the Canadian Associatio­n of Emergency Physicians’ benchmark for most patients to be placed in a bed within 12 hours. Also, like other hospitals, it’s not unusual for North York patients to be shifted into hallway placements in the medical units, rather than their own rooms, due to a lack of space.

Vicki McKenna, first vice-president of the Ontario Nurses Associatio­n, said she’s heard from senior nurses at the hospital that while they feel leadership listens to them, they’re concerned about the future without more resources and beds. “There’s no flex in the system, there’s no capacity,” she said.

Rutledge says he’s concerned about the ever-rising figures of long-term care patients — 60 to 70 daily occupying beds — many of them older people who can’t find appropriat­e nursing homes.

“Not only do we get anxious about planning for population growth, but aging is a huge factor,” he said. “We need our policy-makers to make sure they’re thinking ahead and building the appropriat­e capacity.”

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