How a dynamic duo is transforming emergency care


Ideas can strike at any time, and can come from the most unusual of places.

For this pair of Eastern Health care providers, their idea simmered, took shape over many discussions, and then one night after a long shift, it materialized on a hospital’s hallway glass window. It was the result of a brainstorming session that ended with a rough outline of ‘SurgeCon’ – an ambitious, game-changing digital solution and platform that aims to anticipate, and manage, patient surges in emergency departments.

(l-r): RN Paul Norman, patient flow coordinator and LEAN committee chair, Emergency Department, Carbonear General Hospital, and Dr. Christopher Patey, site clinical chief for the Emergency Department, Carbonear General Hospital, present SurgeCon at Eastern Health’s Health Innovation Fair in May 2018

A surge is defined as a strong, wavelike, swift forward movement.

In the Emergency Department (ED), a surge refers to a sudden sweep of patients bursting through the doors, and waiting to be seen.

One may think that surges happen from time-to-time, as a result of accidents or pandemics, but according to Registered Nurse Paul Norman, patient flow coordinator and LEAN committee chair for the ED at Carbonear General Hospital, surges occur on a regular basis.

“Although there are recognized national trends for medical emergency surges – i.e. during the fall and winter months, we see a higher number of illnesses related to seasonal influenza, and in the summer months, there is an increased number of vacation-related injuries. Surges are sporadic and uncontrollable daily occurrences in hospitals all over – they happen every day and everywhere,” Paul says.

Dr. Patey, treats patient in the Emergency Department., Carbonear General Hospital, Eastern Health

Dr. Christopher Patey, site clinical chief for the ED at Carbonear General Hospital, together with Paul, became enthralled with the concept of surges, and how to provide quality care when there are sudden waves of patients presenting for care at the same time, particularly in environments where patients do not have pre-set appointments to be seen.

“Emergency Departments are not easy to work in,” says Dr. Patey. “Because of their urgent nature, people are often on alert, emotions are running high, and there are a lot of moving parts – patients, care providers, families, equipment and processes to follow – all packed in a very short period of time.

“Under these conditions, efficient patient flow is crucial,” Dr. Patey says.

Patient Flow

As its name describes, patient flow is a concept used in health care to describe the movement of patients through the health-care system. Patients may come in through the emergency department, and depending on their circumstances, are discharged home or are transferred to a hospital floor for follow-up care.

Currently, in situations where the number of patients exceed capacity, the Emergency Department at Carbonear General Hospital, like other hospitals, uses what is commonly referred to as an ‘overflow capacity protocol’ – or OCP.

Emergency Department, Carbonear General Hospital, Eastern Health

“We use the OCP system when the emergency department reaches what it perceives to be at capacity,” Paul explains.

In such circumstances, the OCP system is a tangible recognition that the emergency department is in the midst of a surge.

“We cannot operate in overflow capacity protocol unless external forces are introduced,” Paul says. “When we cannot get patients out of the emergency department, anyone new walking into the emergency department will likely not be seen as soon as we would like,” Paul says.

Lightbulb moment

Members of the Emergency Department team discuss patient flow. (l-r): Laurie Bullen, registered nurse; Paul Norman, registered nurse; Andrea Hunt, registered nurse; Brad Hunt, registered nurse and Susan Snelgrove, nurse practitioner

These situations are precisely what prompted the creation of SurgeCon. The lightbulb moment was an acute recognition that the OCP system was not the most effective way to deal with surges.

“We wanted to focus on finding a solution to avoid getting into the OCP system in the first place. We thought about how we could avoid reaching that state, and squash potential surges from the get-go,” Paul says.

With this in mind, Dr. Patey and Paul set out to study the day-to-day, minute-to-minute surges that occur at their emergency department.

“What we found was surprising,” says Paul. “By using our own existing data, we could actually discern trends at this smaller scale, and to some extent, predict these types of daily surges.

“In a nutshell, that’s what SurgeCon is all about!”

On-the-ground

First working draft, and manual version of SurgeCon, Emergency Department hallway glass window, Carbonear General Hospital

Upon much collaboration, Dr. Patey and Paul came up with SurgeCon to calculate emergency department activity and patient load.

“We identified and recognized the factors that make the emergency department busy, and matched them with required actions in order to avoid going in overflow capacity protocol,” says Dr. Patey. “We manually tested this solution in our emergency department, on a hallway glass window, and made modifications depending on what we observed.”

SurgeCon measures several indicators that signal whether the emergency department is moving in the right direction.

According to Dr. Patey and Paul, SurgeCon is designed to improve patient access to emergency medical care by calculating patient flow through the emergency department and providing real-time information to ensure that surges are most appropriately managed and dissipated.

“Patient flow is like a chess match,” Paul adds. “You have to find the best strategy to provide the most efficient, quality patient care possible with the resources at hand.”

There is no telling when an influx of patients may occur, and because health-care delivery is such a closely integrated system, surges in one area generate ‘waves’ and disruptions in other areas.

“With SurgeCon, we have been able to gain valuable awareness of where and how our emergency department fits into the whole hospital system at a given point; and vice-versa,” Dr. Patey says.

Even at the manual stage, serious improvements were observed. “We saw significant reductions in patient wait times and in the number of patients who left the emergency department without being seen, despite a 20 per cent increase in overall patient volume!” Dr. Patey says.

Promising results

RN Paul Norman using the manual version of SurgeCon.

Results have been so promising than the team has been chasing an important Canadian Institute of Health Research (CIHR) grant, the Innovative Clinical Trials (iCT) Initiative, awarded at three different stages.

So far, and with the backing of several organizations, including Eastern Health and Memorial University’s Centre for Rural Health Studies, among others, Dr. Patey and Paul have been successful in the first two phases, securing over $100,000 in funds.

This has made possible the development of an automated, digital SurgeCon platform.

Following its digital adaptation, SurgeCon will be piloted at the Emergency Department in Carbonear General Hospital this November.

SurgeCon will also proceed to trial implementation and evaluation in other emergency departments to determine if the benefits can be achieved more widely in the province, and potentially beyond.

“Even at these early stages, we have seen a lot of interest in SurgeCon across North America,” says Dr. Patey.

“In Canada, we have a large burden of care in our health-care system due, in part, to our aging population and vast geographical areas.

“Although we are not business people, we have learned throughout this process that innovative medical solutions and ideas can come from anywhere, and we look to our clinicians to be innovative.”

SurgeCon is a clear example of front-line health innovation at its best.

Last spring, SurgeCon was short-listed among dozens of medical innovations across Canada to move on to phase three of the iCT Initiative grant, valued at $4 million dollars, and which would bring this solution to its next level of research and large-scale development. The grant applicant winner will be announced in April 2019.

“Ultimately, we hope that SurgeCon will become a standard solution in enabling front-line workers to provide quality emergency care to patients quicker, and therefore, contribute to a better, more efficient health-care system,” says Dr. Patey. ■

 

This story was written by Melisa Valverde, digital communications manager with Eastern Health.

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