3 steps to managing wait times for emergency care
Emergency Departments (EDs) do their best to minimize wait times, and technology is increasingly becoming part of that effort. At our annual user conference, Allscripts Client Experience (ACE), the team from Alberta Health Services talked with us about how the organization uses data to manage EDs efficiently.
Alberta Health Services (AHS) Calgary Zone provides 480,000 visits each year through its EDs, which include four adult sites, one pediatric site and two urban urgent care centers, all using SunriseTM Acute Care and SunriseTM Emergency Care.
The Alberta government sets targets to ensure the quality of emergency care. For example, patients must be seen by an MD within one hour of triage, discharged with four hours and/or admitted within eight hours. A new guideline requires all patients to be seen within an hour of arriving at the ED.
To meet government targets and minimize wait times, AHS takes a three-pronged approach:
1. Input: Balance patient loads
AHS developed an early warning system to help distribute the number of patients equally among ED sites. Pre-hospital and acute care data from Sunrise feeds its third-party Real-time Emergency Patient Access and Coordination (REPAC) system. The dashboard considers patient volume, acuity and staffing patterns to project wait times at each ED facility, which AHS publishes online*. While it’s hard to judge how the public is using this information, it does help the city’s ambulance service provider determine which hospital to go to.
2. Throughput: Track real-time progress
AHS uses Sunrise Emergency Care tracking boards to help clinical teams track how long patients are waiting. Every end user has a different view, task lists and alerts, based on role, to help manage their work. Visual cues and alerts help the team stay coordinated as patients are seen, assessed, admitted and discharged.
3. Output: Measure performance
With data from Sunrise, AHS was able to determine that some of the delays were coming from patients waiting for consultations or available hospital beds. Now ED clinicians can proactively address these issues. For example, a new custom “bed huddle” report aggregates data to help stakeholders anticipate where delays might occur and to better manage the flow of patients.
Dr. Tom Rich, MD, CCFP-EM, FCFP clinical informatics, shared a specific example of how data shed light on a simple change that helped reduce wait times:
“It’s amazing when you show the data how motivating that is, because they actually don’t believe it until you show them. Like, if your average length of stay for every patient you see is 14 hours, and this consulting service can do it in eight, what’s your issue? And then you go back and look and it’s something as simple as the surgery service is doing service and they’re on call [for ED consulting]. Well, they’re in the OR with a case for six hours when a request comes in…so one of the [ED] sites said, ‘that’s not appropriate’ and they now have an on-call surgical team that is not doing the operating…it’s a pretty powerful tool for us to use.”
Thanks to Dr. Rich, Kim Jessen, RN, clinical information systems specialist, and Kelsey Kiapatuik, clinical information systems specialist, for sharing the AHS story at ACE.
*A recent study found AHS’s proactive EMS destination selection through a real-time integrated electronic surveillance system enhances regional capacity and flow management while significantly reducing ambulance diversions.