A cure for what ails hospitals

JOE.BRYKSA@FREEPRESS.MB.CA Enlarge Image

Dr. Ricardo Lobato de Faria says Seven Oaks General Hospital's emergency room focuses on creating the optimal patient experience.

Patients might find it hard to believe but there's a lot of Disney World in the emergency room at the Seven Oaks General Hospital.

Sure, Mickey Mouse and Donald Duck are nowhere to be seen and the only rides you can take are on strollers, but the traffic flow model is right out of the Magic Kingdom.

In fact, the entire ER, a $15-million facility that opened in the summer of 2008, was based on creating the optimal patient experience with a focus on reducing "wasted time waiting."

That meant the old system whereby patients were triaged by a nurse, registered by a clerk and then sent back to the triage nurse and the waiting room was thrown out. Instead, hospital staff spend much of their time moving around the patients. For example, blood tests and blood pressure tests are now often done in the waiting room and a mobile suture cart means patients can be stitched up where they sit.

"The patient should be moving the least amount possible and when they do, it should be in one direction. We learned that from Disney," said Dr. Ricardo Lobato de Faria, the medical director of both the Winnipeg Regional Health Authority Emergency Program and the Seven Oaks ER.

"You don't realize how much you're waiting (at Disney World) because you're very busy doing things in between. Your lineups are different. You get introduced to your ride, then to the theme of your ride and then to the ride. You don't have to repeat the process, you're always on your way out. Now we can have a closer relationship with the patient, respond to their needs faster and spend less time nursing the chart and more time nursing the patient," he said.

The proof is in the numbers. Seven Oaks has seen the volume of patients treated daily increase to between 115 and 120 today from 90 just a couple of years ago, while the length of their waits has continuously gone down. The average amount of time spent in the ER over the same span has dropped to fewer than four hours from seven hours.

While the numbers bounce around from week to week and month to month, Lobato de Faria said the Seven Oaks ER is one of the most efficient processors of patients in the country.

"Sometimes we're No. 1, sometimes we're No. 2," he said.

Traditionally, ERs had rooms designed for individual functions, such as suturing or casting, a set-up that could cause a bottleneck if there was a sudden run on people with broken bones. At Seven Oaks, these satellite rooms can be used for any purpose so as soon as one opens up, regardless of what was being done in there previously, it's filled.

The responsibilities of the staff for maintaining the ER's flow have increased in the new facility, too, Lobato de Faria said.

"Every person in the department has to be very aware of how many patients are in the waiting room. Everybody has the responsibility to make sure the flow is moving. We have physicians go and get patients in the waiting room. The next person available brings them in," he said.

"It's the push-pull effect. There's the push from the waiting room to send patients in but we also wanted to create a culture of pull. 'I'm not busy so give me some work.' We've been very successful with that."

Another feature at Seven Oaks is an abundance of windows and natural sunlight in the ER, which is in stark contrast to the fluorescent lighting most hospitals have to offer. He said it's the single most appreciated element by staff but it also promotes less confusion with elderly patients because they can easily tell the difference between day and night.

geoff.kirbyson@freepress.mb.ca

Passing on the knowledge

THE Seven Oaks ER is described as a "community site," which means it can handle patients who have had heart attacks, need to be resuscitated or have a rash or sore throat. People who have been involved in a major accident and need emergency surgery, however, are sent to the Health Sciences Centre.

But before people flood Seven Oaks hoping for a quick ER experience, Dr. Lobato de Faria said its team is passing on what it has learned to other emergency facilities in the city.

"All of these process improvements are being expanded to other (ERs). We're seeing improvements and we expect more. It's a learning process, part of a much bigger plan to make sure emergency care is consistent across the city," he said.

Republished from the Winnipeg Free Press print edition March 3, 2010 B1