Patient Management Over This Long Weekend: Medicine Patients

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Patient Management Over This Long Weekend: Medicine Patients

28-Aug-2017

Over this long holiday weekend, we are hoping and praying that our patients are provided with the best possible support in their healing journey and that they are free of the indignity of having their care delivered in an unsafe environment such as a hallway.

Situation

We are all aware of the pressure on inpatient beds that are the “norm” for long weekends and particularly for this influenza season. This often leads to significant overcrowding of the Emergency Department and its associated challenges to the safety, quality and timeliness of patient care.

Background

The evidence from the literature, including evidence gathered from our colleagues at Sunnybrook Health Sciences Centre, demonstrates that the primary reason for overcrowding is not additional admission volume; rather the issue is a failure in advancing the patient’s journey through delays in prompt decision-making in diagnostics, treatment and discharge planning.

The evidence confirms that a lack of: access to daily rounds; timely assessment of results of investigations; prompt response to consultation requests or effective discharge assessments and decisions contribute to increased length of stay. This delay occurs more frequently during and immediately after the holiday period and it may take up to four to six weeks to clear the system of the resulting overcrowding.

Assessment

In reviewing our bed management data over the past three years we have evidence of two levels of need:

  1. We need to improve the time for our decision making.
  2. We need to provide additional surge bed capacity.

Within the Medicine Service Line we will provide the additional capacity and we will expect prompt timely decision-making from our physicians, our nurses, and all clinicians.

Ms. Sharon Garratt, the Senior Leadership Team member on-call and the Medical Administrator on-call will be part of the assessment team which will receive reports on daily rounds on each medical inpatient unit at both RQHR sites.  The team will be looking for evidence of:

  1. Prompt access to physicians through daily rounds and rapid telephone access.
  2. Prompt decision making.
  3. Identification of barriers to advancing the plan of care whether those barriers are: diagnostic; therapeutic or discharge – LTC; CCC; Home Care.

Each day there will be an assessment and a determination of the need to facilitate the lifting of any barriers and to consider additional capacity if needed.

Our expectation is that our physician colleagues will fully cooperate by:

  • Conducting bedside rounds with the patient’s primary nurse on a daily basis including rounds on stat holidays and weekends;
  • Communicating the care plan and its amendments with your patient’s primary nurse;
  • Promptly responding to consultation requests;
  • Quickly deciding on diagnostic and therapeutic results; and
  • Active discharge planning including in particular transfers back to home hospital or RQHR rural facility as soon as possible.

We also expect that our nursing colleagues will process all orders in a timely way and will provide their best efforts to prompt the decisions requested of their physician colleagues. We also expect that access to home care services will continue through the weekend.

Submitted by: Dr. David McCutcheon, Vice President, Physician & Integrated Health Services