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to implement this innovation. “We post our wait times in our waiting room and online,” says Dr. Arcand. “It’s pretty accurate, and it allows folks to know what they’re up against when they walk in the door.” People waiting to see a doctor can view, in real-time, information about the current state of the ED. The average wait time to see a doctor is about an hour; the worst-case scenario sits at two hours; however, care is often initiated by a triage nurse before the patient sees a doctor. “We’re ranked in the top 10 in the province [for wait times],” says Dr. Arcand, who adds that almost all patients are seen by a provider within two hours. The least complex patients stay just over two hours, and those with more complicated issues – such as those that require blood work, ultrasound scans and CAT scans – could result in a stay of four or five hours, or more. MSH also has processes in place to help prevent a return to the ED and provide reliable and timely follow up assessments, and ED patient referrals to clinics is helping to reduce the number of hospital admissions. “We have a robust follow-up process with our consultants,” says Dr. Moran. “I have the ability to arrange follow up with surgeons, allergists, gynecologists, you name it. I also have access to a number of clinics at the hospital for acute follow up, such as fracture clinics, stroke clinics and internal medicine.” In addition to telling a patient to check in with their family doctor to get tests done, Dr. Moran can ensure those tests happen in a timely manner and that patients have the appropriate follow up with the right people. “That’s something that’s quite unique to Markham.” MSH’s Paediatric Ambulatory
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Markham Stouffville Hospital Foundation
Clinic, for example, provides consultation for patients, from newborns to 18-year-olds. This clinic sees patients referred from ED, where it’s been determined that additional assessment by a paediatrician would help define the best plan of care (and who otherwise might return to the ED). There’s also an Early Pregnancy
We’re ranked in the top 10 in the province
Assessment Clinic, as part of Obstetrical Outpatient Services, supporting women under 20 weeks of pregnancy with threatened or real pregnancy loss. “Those are patients who we have traditionally seen back in emerg,” says Dr. Arcand. Once patients are discharged, MSH is making it easier to maintain a care plan through Dash MD. For easy access to discharge instructions, patients can download the Dash MD app onto their smartphones to access treatment-specific after-care instructions, and manage medications and follow-up appointments. “Historically we have given our follow-up instructions in pamphlet form,” says Dr. Arcand. “We could do that, or we could encourage you to download this app that has a certain selection of our pamphlets in an online form. It also allows you to book follow-up appointments and send reminders – it’s something patients really like.”
Patients can also use the ‘Discover Community Care’ section to connect with external care providers, and use the ‘To Do’ checklist and ‘Medication’ and ‘Appointment’ tools to better manage their treatment. Aside from making the ED experience better for patients, MSH is investing in innovations to improve service and care. One of the biggest innovations in emergency medicine, for example, is the bedside ultrasound, which is used at the point of care to evaluate an emergency medical condition and make immediate patient-care decisions. It can be used for anything from cardiac issues to trauma, internal bleeding, early pregnancies, eye issues and nerve blocks – where conventional diagnostic methods would take too long in an emergency. “Our program is in the early stages and we really need to grow it,” says Dr. Arcand. “Currently, we have one machine and we see 250 patients a day.” With funding from the MSH Foundation, the ED will now be able to purchase a second machine. “We’re in a situation where we can expand our program, so that’s something that will really change practice for a dramatic number of doctors.” Another innovation that’s evolving is paramedicine. York Region’s EPIC (Expanding Paramedics in the Community), for example, is a pilot program that links York Region Paramedic Services with several Family Health Teams to perform scheduled and unscheduled home visits for at-risk patients. While much is being done to improve the patient experience when patients are often at their most vulnerable, these types of innovations will help ease the burden on emergency services, and ultimately provide even better care to the community.