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Island’s busiest emergency room keeps calm
If there is one word to describe the general mood at Nanaimo Regional General Hospital’s emergency department these days, it’s calm, said Dr. Drew Digney, site chief for emergency and trauma services.
“We don’t have anybody in the hallways anymore, that is just a no-go, which is fabulous for patients having their own rooms,” Digney said. “They’re not packed in next to each other with the ‘curtain of silence’ hanging there.”
After a rough period of transition in its newly expanded facility, which officially opened its doors in September, average patient care times are starting to fall back into line with pre-existing percentages.
“It was a way bigger change than I think any of us appreciated,” Digney said.
“Absolutely everything was new. We’d done practice days and we’d had people go through and do scavenger hunts so they’d know where stuff was and we’d run drills and practices but when you’re in the heat of the moment, when there’s patients there and you’ve got five to six of them at a time, all these visuals cues we used to have and other little parts of our workflow were gone.”
October was a particularly difficult month for ER staff as they adjusted to the changeover. The ‘left-without-being-seen’ rates crept up to 3.5 per cent, around the national average, but by January those rates were back down to 1.2 per cent.
Emergency patient care times are not tracked by ‘wait time’ but by the length of time it takes to have a patient seen, treated and discharged, if hospitalization has been deemed unnecessary.
Patients are categorized by the complication of their condition.
On average, 80-85 per cent of patients with more complicated issues are discharged within four hours, while about 70 per cent of patients with less serious conditions are back out the door within two hours. Overall, the Nanaimo ER is sitting at about 75 per cent, whereas they’d like to be at 80 per cent or higher, Digney said.
“We’re doing much better than we were,” he said. “Even today, with things not where we want them to be, we’re probably still doing better than most emergency departments in the province.
“Rarely are people waiting more than a couple hours to be seen.”
He added that every day is different in an emergency department, where quiet moments suddenly turn hectic, but the pace is ‘round the clock.’
Christmas proved to be a busier time with approximately 190 patients a day averaged over a period of 10 days. But on New Year’s Day, despite 217 patients coming through the door, target times were met approximately 90 per cent of the time.
NRGH continues to be Vancouver Island’s busiest emergency department. By the end of 2012, patient numbers had increased to 60,200 for the year, up from approximately 57,000 in 2011.
The new ER wing, which tripled the department’s size, has required adjustment from staff as they learned the new computer systems, the new environment and ironed out staffing crunches caused by the larger facility.
In addition to two ‘pod’ areas which contain private rooms for emergency patients, the department has also expanded its Clinical Decision Unit from five beds to eight.
The unit is a protocol-driven area where patients who meet the criteria can go and be assessed over a shorter period of time.
Physicians in the unit complete assessments every six to eight hours, whereas in a hospital bed a patient could wait up to 24 hours.
“What that does is not only frees up space for that other patient that could go upstairs and get out of the emergency department, but it also reduces the total length of stay people would need in the hospital,” Digney said.
Perhaps one of the biggest successes of the expansion is the Psychiatric Emergency Services department, which was previously run in a single room in the middle of the old emergency wing.
The psychiatric services station is a secured 3,000 sq. ft. space which is managed and staffed by mental health workers within the Vancouver Island Health Authority, but works hand-in-hand with the ER. In addition to secured treatment rooms, it also includes rooms where mentally ill patients receiving treatment can safely move around, as is crucial to their condition.
“It has made an enormous difference for patients and staff,” Digney said.
“The amount of stimulation those patients would get was just ridiculous and that’s not what they need.”
The expansion also generated the creation of a new stocking unit clerk position within the department, which is staffed 24/7.
Before the expansion was complete, staff completed an exercise to determine what tasks doctors and nurses were doing throughout the day that could be streamlined by another position.
“Their job is to make sure that the department stays at a level of stocked readiness all the time,” Digney said.
“They’re responsible to make sure all the major repairs get done if there’s a piece of equipment that’s not where it’s supposed to be ... they’re like the ‘Radar O’Reilly’s’ of the ER department – they know where everything is.”
Beginning in March, the emergency department will also add more unit clerk staffing hours to fill in gaps in the evening when staff is sparsely spread out in the new facility.
VIHA is currently constructing the Oceanside Health Centre, a 39,000 sq. ft. facility providing primary health care, specialty services and urgent care for residents in the Parksville-Qualicum area.
The health authority plans to provide some of those services at the centre by July.
An Expression of Interest request was posted on B.C. Bid Feb. 4 for physicians interested in providing urgent care services and relocating their practices to the new facility.
While it has been said that the new facility will relieve pressure on NRGH’s ER, Digney is cautiously optimistic.
“I hope it does, but we’ll wait and see,” he said.
“It’s a different [care] model, so nobody knows at this point.”