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How many patients use NGH Emergency Room Services?

29,000 Annually/ An average of (85) patients daily

When to Come to Emergency:

The emergency department is intended to provide emergency medical care. That is when you have a serious condition - stroke, heart attack, severe bleeding, head injury or other major trauma. Don't take a chance with anything that might be life-threatening, come to the emergency department.

What to Expect in the Emergency Department?                     

Soon after your arrival - regardless of whether you arrive by ambulance or by your own means - a triage nurse will assess your condition based on the Canadian Triage and Acuity Scale.

This assessment allows us to determine the seriousness of your injury or illness. Once the assessment is complete, we will register you and, based on several factors, direct you to either a treatment area or the waiting area.

Please note, patients are seen based on the severity of their condition, not the order that they arrived. For example, a patient experiencing a heart attack will be seen before someone with a more minor health condition. However, if your condition worsens while you are waiting, please advise the triage nurse.

Do Ambulance Patients come as a Higher Priority?

Ambulance patients are treated the same as patients who enter on their own. Upon arrival to the hospital patients go through the same triage process and may be required to wait to be seen by a physician in the waiting room.

 

Why does Emergency get so Backed Up?                           

On occasion, our emergency department gets backed up for any of several reasons.

  • Critically ill patient requiring a greater level of care
  • Volume of patients
  • Available treatment beds.
  • Available acute care beds in the hospital to accept patients from the emergency department thereby causing patients to wait on emergency beds.
  • Wait for diagnostic testing (X-ray) or laboratory results.

 

What are examples of medical care that can typically tie up the resources of our ER Team?

Trauma, multiple traumas, sick child, cardiac arrest

In any of these cases, patients can expect a longer wait for service.

Additional factors that can increase wait time:

  • Late discharges from nursing units: Discharged patients may not have gone home yet
  • Bed availability on the units. An Emergency Room bed may become tied up by a patient waiting for an acute bed in the hospital.
  • Isolation rooms on the units preventing non isolated patients from sharing these additional beds
  • Shortage of private rooms

What are some of the most common reasons patients seek medical treatment from our ER?

Soft tissue injuries, respiratory infections, abdominal pain

The Emergency appears to be quiet. Why is it taking so long to see a physician?

A physician may be confined to caring for a critically ill patient. This can back up the ER and increase wait times.

It may be sometime until a second back-up physician can be made available. Critically ill patients also put a huge strain on the resources of our Emergency Room Team. Efforts are made to allocate additional nursing resources where available.

Even though it may appear to be quiet in Emergency, the ER team may be attending to a trauma or cardiac patient and resources are fully consumed.

We encourage our Triage Nurse to practice open communication with patients in our Waiting Room area and help them understand sudden changes to the volume in our ER.

 

What to Expect at Triage- (Prioritization):

Patients are triaged by a trained Triage Nurse according to their acuity. A nurse will ask the patient questions, assess their vital signs and review their health history. With this information she determines what triage level the patient is. At NGH we use the CANADIAN TRIAGE AND ACUITY SCALE (CTAS) to asses all of our patients. Nurses must go through this course to be assigned to triage.

Example: Broken arm: depends on mechanism of injury. How did you break your arm, was there a fall from a large distance, putting a patient at risk of having a head injury or internal injuries. At NGH we also use a Pain Scale to identify appropriate triage level. If a patient has a lot of pain they will be triaged as more acute. Other factors include; health history, medication, risk of bleeding etc.

Triage will determine if your care is minor or complex. Our triage nurse is educated to make the best possible determination.

As a patient, I feel I have not been given the correct level of priority

We are always working to improve our patient communication and do our best to determine the proper level of care required. Once a patient has been triaged and is waiting, the Triage Nurse will reassess a patient. Sometimes volume/workload prevents a nurse from performing this task. Our nursing team will do their best to reassess patients in the Waiting Room area. Some may be required to be reassessed every 30-60 minutes.

 

What are the Wait Times at Norfolk General Hospital?

Wait times at Norfolk General Hospital fall under two categories:

  • Wait time for Complex conditions
  1. The wait time, for this indicator, begins when patients are registered and ends when they are admitted to a hospital bed. Ordering tests and waiting for results in order to determine the best course of treatment will add to total times, as will waiting for a hospital bed to become available.
  • Wait time for Minor Conditions
  1. The wait time, for this indicator, begins when patients are registered and ends when they are sent home. As these patients require less time for diagnosis, treatment and observation.

Wait time rates may be accessed anytime at www.myhospitalcare.ca

We understand the frustration and anxiety wait times may cause.Here are some suggestions to help pass the time:

  • Log on to our wireless internet in the hospital with your smart device
  • Bring in reading material
  • Waiting Room TV’s
  • Toys for kids

* Remember to advise the triage nurse if your condition worsens, you have to leave the waiting room for a few minutes, or you decide to leave without being seen by a physician.

How is NGH reducing Wait Times?

  • We are currently testing a Rapid Assessment Zone to reduce length of stay for patients with minor conditions
  • Constantly working to improve our patient communication/education
  • Real Time patient feedback surveys
  • NEW ED information pamphlet

Rapid Assessment Zone: Test Pilot

We are currently testing a pilot project in our ER. Designating two streams of patient care following triage: where less critical patients can already be in the department and be quickly assessed by a physician.

Could NGH ER benefit from a Nurse Practitioner?

Norfolk General Hospital has examined this option. A practitioner would have the ability to order tests and discharge patients and could help alleviate some of the pressures of the ER. However, at this time, government funding is unavailable.

 

Typical Peak Times of the ER Unit

10am-10:00pm. Sunday, Mondays, Fridays

 

How many physicians are designated to the Emergency Room?

At NGH, there is always just one (1) Emergency Physician on duty. A second physician is on from 1pm to 9pm. We do have the ability to call in an additional physician from a back-up roster. However, there are challenges filling this roster. We have a back-up roster for two reasons:

  1. 1.If our ER physician has to go out on an ambulance transfer
  2. 2.An additional physician may be called in to help with patient volume.

Physicians are not employed by our hospital. They have credentials and are given privileges to work in our ER. We are funded by the Ministry of Health and Long Term Care for physician hours. 

If a Physician is required to accompany an Emergency Transfer; what policy is in place to fill their spot?

A back-up physician must be on site before the ER doctor can leave the hospital to assist a critically ill patient and assist in the transfer to another health care facility.

Why not add additional Nurses to the Emergency Room?

Hospital management uses workload data and trends in patient volumes and acuity to help decide how many nurses are assigned to work in the ER. We must also work within our available resources. NGH does however routinely allocate nursing staff to areas of the hospital which require the greatest level of patient care based on the availability of resources.

 

The Role of the ER Nurse: (Limitations)

An ER nurse must have a physician’s order to implement any intervention. There are a few medical directives where a nurse can go ahead and order x-rays, lab work etc. Typically, an ER nurse cannot order tests or prescribe medication. The nurse can provide basic care such as ice, elevation, as well as assessments to assist the physician.

 

Unique Challenges to the NGH Emergency Room

  • Norfolk County has a shortage of family physicians which results in more patients coming to the ER for primary care..
  • ER patients who do not have a family doctor and require follow up (lab investigations) are assigned to the ER doctor.
  • Norfolk has the largest proportion of migrant workers in Canada. We experience larger volumes of ER visits during harvest.
  • Lack of availability of public walk-in clinics.
  • Increases in volume during peak tourism months (June, July, August) in Norfolk (Lake Erie South Coast Region).
  • ER does not receive additional funding for seasonal increases in volume.

 

Is the public using ER appropriately?

With limited options available for patient care in our community, sometimes there are few alternatives. The NGH Emergency Room may be the only option for patients who seek immediate medical attention. Sometimes patients come to the ER because they are unable to get a family doctor’s appointment. These patients may need medication or they have chosen to visit ER because their condition has worsened.

If a patient feels there require immediate medical attention, Emergency is the best option.

 

General Concerns Raised in Patient Satisfaction Surveys

  • Wait time       
  • Lack of information/education
  • Communication
  • Making follow up appointments
  • Explaining danger signals to every patient
  • Pain control

As a patient, how can I provide feedback about my experience in the ER?

Communication with your care provider is valued and welcomed. We will be providing real time surveys to our patients at random intervals. The information we receive from these surveys is very valuable in helping us allocate resources; promote patient safety, education and patient relations. We take this information very seriously. It is very important that patients provide us with this feedback.

The questions on this survey are reliable, highly researched and tested. Using this survey also allows the Emergency Room to benchmark with other hospital in the province and helps design our Quality Improvement Plan.

Survey responses are managed by the Director of Quality and Clinical Practices.

You can also visit our website www.ngh.on.ca and complete a Share Your Experience form.

 

As an ER patient, how can I improve my overall experience in the ER?

  • Provide the Triage Nurse with a full list of current medications you may be taking and bring along your medications.
  • Bring your Ontario Health Insurance Plan card or other health insurance information.
  • Bring identification (i.e. driver’s license).
  • Come with a list of allergies.
  • Draw attention to a Medical Alert Bracelet, if you wear one.
  • Talk to a nurse if you decide to leave without seeing a doctor.
  • Do not eat or drink without checking with a nurse.
  • Ask questions if you are unsure of anything. Don’t be afraid to ask!

 

Alternatives to Using the Emergency Room

  • If you have a family doctor, call first to see if you can make an appointment
  • Call Telehealth Ontario at 1-866-797-0000 (Access to a Registered Nurse — 24 Hours a day, 7 days a Week.)
  • Health care options directory http://www.hco-on.ca/English/Search/Default.aspx

 

Frequently Asked Questions                                                 

  • Can I call Emergency to find out how long the wait is?

Don’t call the Emergency Department to ask how long the wait times are. Your waiting time will depend on your condition and the number and condition severity of patients that arrive before you arrive and while you are seated in the waiting room.

  • Can I book an appointment?

We cannot offer appointments or put your name on the waiting list prior to your arrival. You must be assessed by a triage nurse to determine the severity of your condition.

  • Will you provide advice over the phone?

We cannot offer advice over the phone. You must be assessed by a triage nurse to accurately determine the severity of your condition.