Emergency improves flow
January 6, 2010
Dr. David Chaulk, deputy chief of the Alberta Children's Hospital emergency department, speaks about how 'flow beds' have significantly reduced wait times, even when dealing with high volumes of patients.
For patients and families, a trip to the emergency department with a child can be a stressful experience. Add a lengthy wait and the experience can be overwhelming.
With patients and families in mind, staff and physicians at Alberta Children’s Hospital (ACH) streamlined the triage process so children would see a doctor in a much shorter time.
During typical peak times in the past year, more than 200 children a day visited ACH’s emergency department, waiting as long as eight hours.
“We have very efficient processes for patients who are very acutely ill and for those with minor illnesses and injuries like lacerations or broken bones, but we were finding that the patients who come in with middle acuity illnesses were having the longest wait times,” says Dr. David Chaulk, deputy chief of ACH Emergency.
The department assembled a team to analyze how patients move through the department. They quickly found about 60 per cent of patients requiring care fell into the middle acuity category.Their problem was how to sort the patients to find out who really needs to stay and who can go home without further care. The solution: to use “flow” beds to deal with high volumes of patients.
The flow beds provide a transitional triage area where physicians are able to quickly assess patients and determine their need for further treatment.
Flow beds, the team found, significantly reduce wait times. The second wave of Pandemic 2009 (H1N1) provided the real test.
“During the busiest point of the H1N1 second wave, we were seeing about 315 patients each day, but on average, the wait time was less than four hours. It was so impressive to see the staff handle these volumes so efficiently,” Chaulk says.
“Because we have taken the time to sort out patients’ needs right from the start, there are beds available for sick children. That makes a huge difference.”
With the introduction of flow beds, patients are spending less time waiting in beds that could be used for sicker patients. This also frees up nurses to tend to those with greater needs.
Rod Iwanow, the manager of ACH Emergency, says this method of seeing patients is unique.
“We have combined the concepts of waiting room care and physician liaisons at triage, which are used in other emergency departments across Canada. Neither of those fit our model, so we needed to find a hybrid system that would work here,” he says.
“We spend a bit longer assessing the patients to determine who should be seen in the flow beds, but the result is that those who do end up transitioning into our department beds are those requiring more care. It gets those who need to be seen in, and treated faster.”