The emergency department at West Coast General Hospital is using new technology to improve patient care.
In June 2017, the ER department began using FirstNet, an electronic triage system that helps keep track of patients in the hospital as well as those who are transferred to other medical facilities. FirstNet is an example of how Island Health uses electronic health records to improve patient care.
Kelly McColm, clinical care coordinator at West Coast General Hospital (WCGH) who is trained as a critical care emergency nurse, helped set up the “nurse-first” triage system and software when it was brought to the Port Alberni hospital last year.
Nearly a year later, McColm says the nurse-first protocol has worked well to improve flow in the ER. She has had first-hand experience using FirstNet at Nanaimo Regional General Hospital, so she was confident the program would work well in Port Alberni. Until the switch to FirstNet, WCGH’s record-keeping was purely paper-based.
Nurse-first triage “improves patients’ quality of care,” she said. “A patient would sit down and speak to a registered nurse first, who would figure out what’s going on: look at their chief complaint, the acuity of this patient, the urgency of getting to emergency.”
The biggest benefit to switching to FirstNet has been enhanced communication in the ER department: the system lets staff know where in the system a patient is, how long they have been waiting, whether they are in the waiting room or have been moved to a bed.
“It’s a more visible, transparent process,” McColm explains. “What’s great about this is it’s visible online to everybody. It follows this patient…there’s continuity of care.
“We also say it speaks for the patient who can’t speak for themselves. If someone is unconscious…their health record is there. So when someone comes in and the family says I’m not sure what medications they take, I don’t know if they have any allergies, there’s a safety aspect there.”
If a patient is airlifted or transported to another medical facility, for example in Nanaimo or Victoria, their electronic health record goes with them. “It’s an immediate dictation of their triage that will follow their journey,” McColm explained. Their record includes vital signs taken at a previous facility, so their health can be tracked over a number of days.
In order to implement FirstNet, WCGH had to upgrade its computer systems and purchase new vital signs machines—those that monitor blood pressure, heart rates and oxygen levels—that are “smart” machines. They are capable of uploading data to the computer system. The hospital also changed the structure of its waiting room and worked on finding the best place for the triage desk.
Another important role that FirstNet has played is giving hospital officials more accurate data to extrapolate from patient visits, which will help staff plan where resources are most needed. “Now I’m getting more accurate patterns,” McColm said. “It’s interesting, because in (emergency departments) all over Canada and the Island lots of things are similar: higher patient visits come around similar hours.”
The WCGH emergency department will undergo a renovation in the next year or so; it’s on the books as a capital project, and staff are waiting to hear exactly when work will begin. Design work was done in 2017, site director Pam Rardon said.
In the meantime, the triage desk will move back to where it was originally, closer to the emergency department “to provide improved confidentiality,” McColm said. For the past year they trialed having a smaller desk closer to the registration and admitting department, but decided the original spot is best. The area has been opened up with removal of a plexiglass wall, but McColm said patients “can tell us their stories a little more privately.”
There is room for WCGH to expand its technology: FirstNet is just one part of iHealth, which is used in other hospitals to varying degrees of success. “It’s kind of nice to start with small steps,” McColm said. “You get good with something when you start with small steps.”