​Part of the team who helped refine the green zone idea at the ED value stream mapping workshop.

By: Amber Daugherty, Senior Communications Advisor, Unity Health Toronto

Patients in the Emergency Department (ED) at St. Michael's Hospital might soon find themselves sent to the "green zone," an area where rapid assessment will take place for patients who are likely to be in and out of the ED quickly. Here, they will see a physician and nurse at the same time, have access to diagnostic imaging if needed and get all results and recommendations quickly before being sent on their way home.

Planning for the green zone has been in the works for more than a year but the idea of having joint assessment by a physician and nurse was brought forward at an event called the ED value stream mapping workshop earlier this year. Representatives from every group that works in and supports the ED – doctors, nurses, porters, social workers, environmental services, labs and more – as well as patient and family partners came together to look at how to make the experience of moving through the ED better.

When the group took a hard look at the path patients take through the ED, they found a lot of what they called "waste" – moments where patients were waiting unnecessarily or there were staff frustrations or bottlenecks. So they started brainstorming how they could reduce that waste, making sure they weren't just creating another step but actually streamlining the process. One of those steps was having a physician and nurse assess a patient at the same time to provide a teaching and learning opportunity for staff – and so patients don't have to tell their story separately to different people.

"The most surprising thing I learned was how many steps are involved in a visit to the ED," said Jennifer Schultz, a patient and family partner who participated in the workshop. "We had it all laid out with post-it notes and it was satisfying when you saw it go from the mess it was to a streamlined version where we'd gotten rid of redundancies. Even though it was still just on paper, it felt like we just did something very important."

Part of the process involved participants going into the ED and observing how everyone moved through – a practice known as "Gemba." They were asked to think critically about small changes that could be made that would have a significant impact. One of Jennifer's recommendations was related to communication.

"Telling someone that it will take about an hour for results to come back after they've had their bloodwork done helps manage expectations," she said. "That way, patients aren't stopping a staff member every five minutes asking for an update. Anything you can do to help mitigate stress is very important in the ED."

With many potential streamlining opportunities identified, the team is exploring all of them, including the small changes that can be made quickly and the bigger process shifts that require a bit more thought and finessing – like the green zone, which required some time to run simulations. For Jennifer, that's big news.