Transformations in Triage at Saanich Peninsula Hospital

Posted on: July 2, 2024

On an average day, upwards of 100 patients pass through the Emergency Department doors of Saanich Peninsula Hospital (SPH). As many as 20  of these individuals will receive an ECG as a part of their care.

About one year ago, the SPH ER team began evaluating access and efficiency of patient flow through the department, motivating the team  to undertake a thorough evaluation of their triage process with a specific focus on assessment and initiation of ECGs. Quality Improvement Consultants, Don Khullar and Marcia Pilon, collaborated with a dedicated site team at SPH to meticulously analyze every stage of the patient journey, from arrival to discharge, pinpointing for bottlenecks and inefficiencies in patient flow processes.

The evaluation uncovered multiple small but compounding issues, which were collectively impacting wait times. Frequent interruptions for triage nurses from back-end medical staff, challenges for technicians in easily identifying ECG patients in the waiting room, and a lack of privacy available for performing an ECG (which requires the removal of a patient's clothing) were identified as areas of struggle. Finally, a flaw in the overall procedure saw ECG results left in a designated tray for follow-up rather than being handed off directly to a physician or nurse, resulting in further stalls.

Armed with new insights, Don, Marcia and the SPH site team moved forward with implementing targeted improvements to the triage process. A private space within the waiting room was established for ECG testing and unexamined patients were immediately directed to reserved and labelled seats in the direct vicinity of technicians, whose workflow was revamped to place higher prioritization on ECG testing. Collaboration with back-end staff allowed for a reduction in triage interruptions and the introduction of a direct handoff system for test results ensured ECG tests results were reviewed promptly by medical staff.

The results speak for themselves: over the past year, average patient flow times in the SPH Emergency Room have improved by more than an hour. With the larger QI project now concluded, a local team will remain in place at SPH to monitor and audit ongoing patient flow times, safeguarding and sustaining the changes made so far. Data-driven results like these illustrate the critical value of continuous improvement in healthcare, and SPH is a shining example of how even small adjustments can have profound patient impacts.​​