Like air traffic control: Meeting patients’ needs when bed space is limited

By Roderick Benns

Like air traffic control: Accommodating patients’ needs when bed space is limited
Ross Memorial asks that people whose illnesses or injuries are minor consider alternatives to the emergency department.

Every morning at the Ross Memorial Hospital, representatives from each patient care area gather for a ‘bed meeting.’ The best way to describe this meeting is with an air traffic control analogy, according to Kim Coulter, coordinator of employee & community relations at Ross Memorial Hospital and RMH Foundation.

“Just as air traffic controllers monitor incoming and outgoing air traffic with an eye to safety and efficiency, the team at the bed meeting tracks patients’ bed needs at the Ross:  how many are coming in, how many are being discharged, and what to do when those numbers don’t match.”

The discussions include the following:

· How many patients in the emergency department have been admitted and are awaiting a bed on an inpatient unit?

· How many patients require a bed in the intensive care unit? Do they need to be ventilated?

· How many patients have conditions that are contagious and require them to be isolated?

· How many beds are available for patients needing telemetry or negative air pressure?

· How many patients need to be repatriated from other hospitals (i.e. in Toronto or Kingston) where they’ve been receiving specialized care?

· How many same day surgeries are scheduled?

· How many women are in labour?

· How many patients in the emergency department are awaiting mental health crisis care?

· How many patients require palliative care?

· How quickly are we able to get patients off-loaded from ambulances so paramedics can get back to their work in the community?

· How many long term care facilities are in outbreak status and thus unable to take residents who have been discharged?

· How many patients have special security requirements (i.e. wandering patients)?

· How many extra, unfunded beds are open and do we have staff available to work extra shifts?

· Are there extra resources that could be provided through community supports that would make it possible to discharge patients safely back home?

On days when the bed needs are particularly challenging, a second bed meeting is scheduled in the afternoon to address the needs pending on the night shift. The meetings are surprisingly quick. Those involved can picture every room, the type of bed and special mattress, and where stretchers can be placed for a short time to help free up space in the emergency department.

During times of patient surge, this information is summarized in a daily conference call that takes place with hospitals and health care organizations throughout the Central East LHIN (Local Health Integration Network). With a big picture view of regional needs, organizations can ask for help or offer it, depending on the day.

“We understand how frustrating it can be for our patients and their families when their waits are long or when they’re being transferred to another bed in another unit, sometimes more than once,” says Anne Overhoff, vice president patient care and chief nursing officer.

“Flowing patients safely through the hospital and back home is a complex process, and one that patients and their families should pay close attention to. Any preparations they can make in patients’ homes to help with that transition after discharge is important. They need to think about coming home – wherever home may be – as soon as they are hospitalized.”

Overhoff also asks that people whose illnesses or injuries are minor consider alternatives to the emergency department.

“We want you to receive the timeliest and most appropriate level of care for your problem. Your family doctor or health clinic might be an option. People can also call Telehealth Ontario toll-free night and day if they’re not sure if their situation requires a trip to the emergency department.”

“If it does, please remember to be patient. How long you will wait depends on how sick you are and how many other people are being treated at the time of your visit. If we are treating many critically ill or injured patients, you may have to wait longer.”

Telehealth Ontario is available at no cost 24 hours a day at 1-866-797-0000.

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