Picture the flow of patients through a hospital, from the emergency department to discharge after being admitted to an in-patient bed upstairs, like a river.
Given hospitals are caring for patients with all sorts of complications and setbacks, it's rarely going to run like fast-moving rapids.But the hope is the flow will work like a steady stream, moving patients through the system.The problem is, most Ontario hospitals are dealing with a huge dam at the end of the process: seniors and other patients with complex chronic conditions who should be in nursing homes, rehab hospitals or long-term care centres.But because there are no beds for them in those facilities, they are being cared for in acute care hospital beds.That's often why patients in the emergency department who need to be admitted instead spend hours or even days stuck in a kind of limbo.But thanks in part to a fairly new job called patient flow facilitators, who act like lock keepers finding ways to move patients along the stream, Humber River Regional Hospital has managed to cut the time patients spend in the ER, said Dr. Rakesh Kumar, chief of emergency services. Kumar, who is also the emergency department lead for the Central Local Health Integration Network (LHIN), which oversees health care planning for northern Toronto and communities north of the city, said the time patients spend in the ER is a good barometer of how patient flow in a hospital is working.Thanks in part to Humber River's half-dozen patient flow facilitators and other initiatives, he said the hospital has shaved several hours from the time patients are spending in the emergency department before either being discharged or admitted.In April 2008, patients coming to the ER with serious illnesses or injuries spent 21 hours in Humber's Church emergency department before being admitted or discharged. By May 2010, that was down to 15.3 hours, a 27 per cent improvement. At the Finch site, the number dropped from 22.8 hours to 15.6, a 32 per cent improvement.For more minor illnesses and injuries, patients spent 5.5 hours in the Church ER in April 2008. By May 2010, that was down to 4.3 hours, a 23 per cent improvement. At the Finch site, patients spent 4.2 hours in the ER in May 2010 compared to 6.1 hours in April 2008, a 30 per cent improvement."It (a patient flow facilitator) is a navigator to help a patient and the families to navigate through different systems in health care so the flow from ER to the hospital is faster and discharge to home or rehab or long-term care is faster," Kumar said."I think they are doing an excellent job. This is an ongoing process, it is an evolving process. Overall, this program is really patient-focused and is trying to improve the quality of care patients get and improve the experience patients have when they come to the ER."Patient flow facilitators perform a number of functions to get patients moving through the system, from trying to locate a long-term care bed to speeding up the cleaning of an in-patient bed so an ER patient can be admitted faster to arranging emergency home care for a patient who can be discharged but whose family is unable to pick them up and care for them for a few hours.Humber River is one of four hospitals in the Central LHIN to have patient flow facilitators. The other three are Markham Stouffville Hospital, Southlake Regional Health Centre and York Central Hospital, all in York Region north of Toronto.The positions are funded through the pay-for-results project, a provincial program that gives incentives to hospitals that meet specific targets and reduce the time patients spend in the emergency department.Hospitals in the Central LHIN have achieved the third-best rate of improvement in Ontario for ER wait times, according to the LHIN."Hospitals in the Central LHIN have also achieved this improvement without losing focus on patient safety and quality of care," a statement from the LHIN said."The number of people discharged from the emergency department that need to return within seven days, a key indicator of the appropriateness of the care received, continues to be the lowest in the province."York South-Weston MPP Laura Albanese is pleased patient flow facilitators have helped Humber River."Patient flow facilitators have assisted in reducing the amount of time patients spend in the emergency department," she said.