Working to meet our targets

A letter from the Winnipeg Health Region

Winnipeg Health Region President & CEO
Wave, March / April 2015

Arlene Wilgosh
Arlene Wilgosh

It's not unusual for someone visiting an emergency department to wait for a time before being seen by a doctor in an examination room.

Traditionally, that is the way the process works at many hospitals. Patients are registered and triaged, and are then seen by a doctor based on their level of need. Once inside the examination room, the doctor is able to examine the patient and make the appropriate decisions regarding diagnosis and treatment.

Last year, patients visiting hospital emergency departments in Winnipeg waited an average of about 2.8 hours to see a doctor. For less-urgent patients, the wait to see a doctor can sometimes be longer.

As readers of this column will know, we here at the Winnipeg Health Region believe we can reduce emergency department wait times by enhancing the flow of patients throughout the hospital. Readers will also know that we have established key targets to measure our progress in achieving this goal. While we still have a ways to go to meet our overall targets, there is reason for optimism. Recent trends at the Grace Hospital, as outlined here, explain why.

During the last year, the team at the Grace, led by Kellie O'Rourke, COO of the Region's Winnipeg West Integrated Health and Social Services, which includes the hospital, has implemented a number of measures to reduce wait times for patients once they have been registered and triaged.

One example is nurse-initiated protocols. They allow a triage nurse to flag a patient for a quick assessment, which may include ordering lab tests or X-rays, while they are still in the waiting room. This ensures that clinical information for decision-making is available when the patient sees the physician.

Another change is the creation of a rapid assessment zone. Under this initiative, a patient must see a doctor within a certain time. If not, the patient is brought into the "zone" by a nurse who then works with the emergency doctor on duty to assess the patient and set in motion any procedures needed for treatment, such as a diagnostic test.

As O'Rourke explains, the doctor may not be available to immediately examine the patient in question. "But they can at least determine if the patient needs a CT scan, for example, and get their treatment and care underway."

Nurse-initiated protocols and the rapid assessment zone are just two examples of changes implemented at the Grace. All in all, O'Rourke says her team has introduced more than 15 major changes in a bid to enhance patient flow throughout the hospital.

In addition to these specific initiatives, efforts have also been made to effect cultural change by ensuring that everyone understands the important role they play in making things work better for the patient. "There has been much more focused attention on the role that every single member - from housekeeping to physicians to nurses to labs - plays in patient flow within not just the emergency department, but the entire campus," says O'Rourke.

And the result of these efforts?

One of our key targets is to ensure that 90 per cent of patients who are not admitted to hospital can get in and out of emergency in less than four hours. In March of 2014, only about 24 per cent of patients at the Grace were able to do so. By December of 2014, that number jumped to about 38 per cent. That is a gain of about 58 per cent - a significant improvement.

There has been progress in other areas as well. As the chart on this page shows, the Grace has recorded improvements in three of the four key patient flow indicators between March 2014 and December 2014 - even as emergency visits jumped from about 1,900 a month to 2,300 a month.

As you might expect, many of the ideas that have worked at the Grace will be implemented in other hospital emergency departments throughout the city. Likewise, ideas that work well elsewhere will find their way to the Grace. It is through innovative efforts like these that we will succeed in enhancing the flow of patients in all our hospitals. By doing so, we will also be able to meet our targets for reducing emergency wait times and better serve the patients who come to us for care.

Grace Hospital Patient Flow Indicators

Click here to enlarge

This graphic lists key patient flow indicators and targets for all Region emergency departments. The chart shows improvement at the Grace Hospital in three of four patient flow indicators between March and December of 2014.

Wave: March / April 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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The Winnipeg Regional Health Authority acknowledges that it provides health services in facilities located on the original lands of Treaty 1 and on the homelands of the Metis Nation. WRHA respects that the First Nation treaties were made on these territories and acknowledge the harms and mistakes of the past, and we dedicate ourselves to collaborate in partnership with First Nation, Metis and Inuit people in the spirit of reconciliation.
Click here to read more about the WRHA's efforts towards reconciliation

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