Pictured above: Facing extremely high patient volumes, the Urgent Care Centre staff at St. Joseph's Health Care London created a decant waiting area that is making a significant difference to the patient experience, safety, access and flow.
Under the strain of burgeoning volumes and unprecedented pressures on the health care system, St. Joseph's Health Care London's dedicated Urgent Care Centre (UCC) team has been tirelessly addressing the patient experience, access and flow - with remarkable success.
Not only has the team moved the needle on those metrics in a big way, their efforts are being recognized by grateful patients – in person, in letters and even through donations to St. Joseph's Health Care Foundation.
“Your Urgent Care staff is second to none," wrote one patient recently. “From the moment a smiling attendant provided me with a visor mask, to the time another cheery attendant wheeled me outside, I enjoyed nothing but smiles and cheery conduct. Such a sense of professionalism can only come from very special people….With its solid organization and wonderful staff, St. Joseph's Urgent Care is one of the best places I've experienced."
The complexities of providing care during a pandemic, staffing challenges, long wait lists for tests, procedures or surgeries, closures in regional emergency departments, access to primary care and more are all contributing to demands on the UCC never before seen.
A steady increase in volumes began in 2021 and by the summer patients were waiting for extended periods in a line outside the building. The centre would become gridlocked when the exam beds were filled and the UCC waiting room reached capacity based on infection control protocols. This resulted in a pause on triaging patients until a care spot was available.
“Both staff and patients were distressed with these long waits and delay to triage," explains Nicole Fragassi-Arbique, UCC Coordinator.
But unusual times require innovative solutions, and the team went to work.
In November 2021, a waiting space was created in the seating area off a main corridor a short walk from the UCC. This decant area is for UCC patients who can safely wait away from the department.
Patients are triaged and registered before being sent to this waiting area. With capacity for 40 patients, the space is staffed by a registered nurse and a clinical receptionist assistant to monitor patient safety and ensure patients return to the UCC when it's their time to be seen. It is opened when the UCC main waiting area is at capacity and the unit is full, which usually occurs within two hours of UCC opening its doors at 8 am.
“Patients in the decant waiting area are observed, medical directives/orders are completed as appropriate, patients are reassessed, and patients are organized to return to the UCC when it is their turn to be seen or to receive test results," says Nicole.
The team's work has resulted in excellent outcomes:
With the decant waiting area available, patients can be triaged quickly, which enables the unit to know who requires to be prioritized according to Canadian Triage and Acuity Scale
With improved patient flow, patients are being triaged at unprecedented rates with an average 120 patients in six hours. (This would be equivalent to an emergency department seeing 480 patients in 24 hours).
There has a been a sustained significant decrease in code blue calls for patients waiting in the UCC line up outside the building, from an average of 15 codes a month from July 2021-October 2021 to an average of four codes per month November 2021- June 2022.
As one patient recently noted, the team's focus on serving patients with respect, excellence and compassion has never faltered.
“I am so impressed with how well the UCC is run," the patient wrote. “The staff are amazing and friendly and kind even in such a busy environment where it would be easy to get impatient and overlook people. The care I received was excellent. The nurses and doctors I saw were amazing, friendly yet professional. They made me feel comfortable and in good hands. I had the best possible experience and am so thankful you are there for the community."