Like the rhythm of a pulse, staff work to the beat

When the phone rings at the McGill University Health Centre (MUHC) Emergency Department (a process at both the Royal Victoria and Montreal General Hospitals) it means only one thing: an ambulance is bringing in a patient in need of urgent care. In a resuscitation case, immediately the back doors that lead directly into the resuscitation rooms are opened. A team of various professionals prepare the area and themselves for the arrival of the patient. If Urgence Santé has inserted a breathing tube, a Respiratory Therapist will also be present. As soon as the ambulance rolls in, the patient story is told; including where the patient was found; how long they were down; what heart rhythm they had; whether they were breathing on their own; and then the work begins. From ring to start of resuscitation, only minutes will have passed.  

Last year at the MUHC, the MUHC adult Emergency Departments (ED) saw 70,000 patients. Cases range from the elderly feeling dizzy, to broken arms, to gunshot wounds, to cardiac arrests and organ transplant complications. No matter what your job is, the pace is always fast, multitasking is essential and prioritizing critical. As a fly on the wall, you would see very quickly the skill staff adopts to survive and thrive in this environment. A good attitude and perhaps the traits of an adrenaline junkie are also a must.

“This is a very stimulating environment,” says Dr. Jean-Marc Troquet, MUHC chief of the adult sites Emergency Departments (ED). “Every shift is different and has its expected challenges and this means we are constantly faced with having to learn and acquire new skills. In the end, everyone who works in the ED does the same job: we work with emergency situations. The only difference is, we offer different skills and have different responsibilities.”  

Patient Flow

According to Dr. Troquet, ensuring optimal patient flow, which means getting patients to their care destination, is what contributes to best patient care. This requires that all partners of the ED, like the lab, radiology, social services, and so on are working in harmony. The fact is, the ED is one of the most co-dependant departments in the hospitals so it is impossible for it to work in a vacuum. “The Emerg is often the main door when people come to a hospital,” says Dr. Troquet. “We are number one in the food chain, so if it blocks anywhere after us it has an effect on our performance.”

In the RVH ED cases are often very complex so ensuring optimal patient flow is challenging. “We see the sickest of the sick,” says Dr. Fred Dankoff, director of the RVH ED. “We take care of liver, heart and renal transplants and the patients who are in the failures of those organs or on their way to transplant. We also see many cardiology and neurological cases. Not all are complicated though; the problem is that the cases that are, are very resource heavy and as a result they tend to stay for a long time. So it becomes challenging to keep good patient flow from the ED.”

Dr. Joe Nemeth, director of the MGH ED, says that at any one time an Emergency physician can be caring for 10 to 50 patients. “You really have to prioritize who is more important to see; we have our mental list to keep the flow optimal. This means that some people do have to wait longer than others, but ultimately this does mean better patient care overall.”

Emergency Department Program Development

There are three main areas in Emergency that are currently being developed: Traumatology (mission of MGH), Toxicology (expertise of RVH), and Disaster Medicine. “When disaster strikes you have to be ready; it is not if it will happen; it is when it will happen,” says Dr. Troquet. “There could be a train derailment, ice storm, tornado, flood, war, disaster from terrorism…Disaster does not happen every day, but when it does you have to be ready or the losses could be substantial. We will be embarking on doing disaster simulations as part of this program development very soon. We will be ready for our move to the New MUHC.

A look ahead at the New MUHC ED

“Our main challenge right now is to make sure that when we open at the Glen we get it right,” says Dr. Troquet. “For this new ED we want a modern model of functioning that is at the forefront of health care. This is giving us an opportunity for change, which will include improving patient flow, better supporting disasters if they happen, and overall better patient care due to layout and a better working environment for our staff.

At The Montreal Children’s Emerg, Children come first…
The Montreal Children’s Hospital pediatric Emergency Department is one of the busiest in North America. It sees 70,000 patients a year and the team offers a spectrum of services for those with minor problems to others who are critically injured. “We do this well because all the resources come together quite quickly,” says Dr. Harley Eisman, director of the Emergency Department at The Montreal Children’s Hospital. “The virtue of dealing with kids and working in the environment where obviously it is patient and family focused, just happens. What concerns us the most is the child, his state of mind, and the context around the family. Part of that comes from the department’s philosophy and part of that comes from the individuals who gravitate to a pediatric institution. The extra dimension that adds to this is our so-well incorporated Child-Life program that is present for most hours in the ED.” (see Child Life Specialist article).