Imagine it's your vacation and you arrive at your sunny destination only to be told your room isn't ready.
You sit in the lobby, watching the clock, feeling discouraged as minutes turn into hours, then days, and the waiting area becomes increasingly over-crowded, noisy, chaotic, and you can't find an employee who can tell you when the waiting will end.
Now, imagine if rather than a tropical resort it was a hospital emergency department, and the waiting was in a hallway and lasted four days.
This was a reality back in 2008 for Chris Taylor, now a UHN Patient Partner offering his unique insights in the development of UHN's Overcapacity Protocol and action plan.
Managing a 24/7 complex operation
Chris recently joined more than 80 UHN leaders and team members across four hospital sites and many disciplines – including nurses, physicians, professional practice, supports services and more – for a rigorous two-day workshop.
It was led by UHN's Lean Process Improvement team to kick-off the development of an action plan to ensure the right patient receives the right care in the right amount of time, especially when the hospital is in a state of overcapacity.
Emergency departments (ED) in Ontario – and across the country – experience critical overcrowding and heavy emergency resource demand. This is often due to the lack of availability of hospital beds to accommodate the number of patient admissions.
This can lead to prolonged patient wait times, increased anxiety and distress for those waiting, and overwhelmed hospital staff struggling to balance resources and accommodate mounting pressures.
EVP and Chief Operating Officer, Mike Nader, and Dr. Charlie Chan, EVP and Chief Medical Officer, are spearheading efforts to optimize clinical operations at UHN and recognize that while changing practices and organizational culture is difficult, it's also necessary for sustainability.
UHN's Overcapacity Protocol is one of several initiatives that will help UHN work safer and smarter.
"This work directly supports our focus on Caring Safely and team engagement," Mike says. "Healthcare is generally a reactive culture. When we shift from a reactive to proactive culture, we release more time for our staff to focus on the needs of the patient."
"We need to have more efficient processes in place to ensure the right patient is in the right location, being cared for by the most appropriate experts. We should admit patients who need our specialized acute care service. However, those who do not should be treated and supported in their transition back home and into the community."
Meet Chris Taylor
In 2008, shortly after experiencing a cancer relapse, Chris felt the full force of a surge in emergency patients and an overcapacity situation at one of UHN's Emergency Departments.
He arrived with a very white and cold hand. During the next five hours, he sat in an emergency room cubicle while an intern, resident, fellow, Attending and finally Chief of Surgery, examined his hand.
He was told he had no blood flow to his hand due to a Brachial Arterial Thrombus and was asked to sit in a wheelchair and await placement of an intravenous (IV) to receive a blood thinner.
He was advised he could not go home and had to be admitted – but there were no inpatient beds available.
So Chris waited in the ED hallway for the next two days in a wheelchair. On the third day, he received a stretcher, which made it easier for him to sleep.
Finally, on day four he was admitted to an inpatient bed – and on day five, he was discharged.
"I'm so grateful for the care I've received through the years because I've been given a second chance at life," Chris says. "But I do feel an obligation to share my experiences – so that I can help identify these gaps in processes to improve our healthcare system for future patients."
'We can and need to change how we do things'
Now Chris is using his experience to offer a patient voice and perspective to help shape UHN's Overcapacity Protocol.
The ability to manage fast-paced, complex operations is critical to the success of patient safety and patient care delivery at UHN. A number of unexpected events including a flu outbreak, people experiencing complications after surgery, a surge in ED visits or performing a large number of transplants in a few days can impact the organization's operations and the most effective processes need to be in place to accommodate these shifting needs.
"We need to do better by our patients," says Brenda Kenefick, Director, Lean Process Improvement at UHN. "The 'overcapacity' practice has become normalized for many hospitals and we need to reset the standard.
"Our hospitals are bursting at the seams. Our teams are doing their best to keep up the pace to care for our patients, but we need better processes in place to support them.
"We can and need to change how we do things."
At the two-day Overcapacity Protocol Development workshop, UHN teams extensively examined and debated their current practices – first by site, and then as a UHN collective – to identify and land on the triggers that cause the hospitals to go into overcapacity mode.
From there, they established four escalation levels and the actions that would be taken and resources needed to meet the demands of the hospital – and then how to de-escalate appropriately to get back to their regular state.
Moving forward, the hope is to employ real-time data management, live dashboards, and business intelligence tools that will enable UHN to optimize the flow of patients through its complex organization.
The plan is to finalize and approve the Overcapacity Protocol, train staff across UHN sites and implement the new practices by early spring of this year.
"These two days were an excellent step towards having shared goals and practices among UHN teams," says Tracey Noftall, Manager of Support Services at Toronto General and Princess Margaret Cancer Centre, who attended the two-day workshop.
"We are all striving towards the same thing – to improve flow and access for our patients. I was so happy to have a voice and be included in this process."
