Emergency innovations
The QEII Health Sciences Centre’s emergency department is new in more ways than one

You can almost hear the pulse beat of the unit that is the emergency department team. It’s a clinical team that assesses, treats, moves patients along to beds or admissions, or sends them home. Patient flow – the movement of patients through the system – had slowed and, at times, stopped; the sight of patients on hallway stretchers and lineups in the waiting room was common. The QEII emergency department needed help. The department, designed to handle 35,000 patient visits per year, was now seeing 60,000. The pulse was strong but overtaxed, and even the most dedicated staff could not provide beds that weren’t there.

A team of stakeholders including the Capital District Health Authority, Nova Scotia’s Department of Health, Emergency Health Services and Halifax Regional Municipality went to work planning a much-needed renovation, with funding announced in August of 2007. That long-term solution was essential but staff needed more immediate help, so, doing what they’ve always done, they pooled their resources, assessed the situation, identified the most critical areas and took action.

“We thought there were some things we could do internally to make our world a little more manageable,” says Louise Cornish, chief operating officer for emergency medicine. The team included emergency physicians, nurses, management, operations, EHS and information technology personnel. They looked at the number of patients waiting to see a physician and at how beds and stretchers were used in the department.

With input from those who know the system best, and some clever work by the information technology department, the team created and launched a pilot of the patient dashboard in July of 2007. The term “dashboard” refers to a user interface that provides information on the number of beds, patients, ambulances and so on, in different sections of the emergency department. David Urquhart, Department of Emergency Medicine information technology manager, says the patient dashboard is linked to the emergency department information system (EDIS) and to other Capital Health facilities. (EDIS manages patient information while they are in emergency; its access is restricted to ensure patient privacy.) The Patient Flow Dashboard captures views from EDIS and displays it on the monitors in the department and at workstations within administration of the hospital. It was first given to physicians and nurses in charge of the department to be used as a decision-making tool. Clinical staff can view the dashboard to get an overall impression of the department status and can switch to EDIS to get specific information on an individual patient.