Faster access to care at La Ronge Health Centre

RPIW1 (2)

During the week of October 6th to 10th, Mamawetan Churchill River Health Region held its first two Rapid Process Improvement Workshops (RPIWs).

The goal of RPIW #1 was to “Reduce lead time in La Ronge Health Centre Detox from the time that Addictions Worker and client agree that admission to detox is appropriate until client admitted to detox.”

What did we identify as issues and how did we address them?

Clients and staff state that too much paper is involved in the detox admission process.

  • Fix: the team focused on reducing the number of forms required from the time of referral to time of admission from 13 forms down to 8.

Clients and staff identified that some of the admission documents were out of date or contained insensitive wording.

  • Fix: there was a concerted focus on revising current documents to ensure that they were client friendly.   An example was the revision of the “Rules” document to a “Permissions and Protections” document, which better outlines helpful topics a new client being admitted should be aware of.

Having a medical form completed by a physician prior to admission was challenging for some clients.

  • Fix: The medical form was significantly revised to reduce the time required by a physician to complete. This means the client can be seen in a timelier manner.

The length of time between referral and admission can take from a few hours to a few weeks.   As well, there was a perception that the process for admission is done differently based on acuity of client or type of addiction.

  • Fix: Over 10 new work standards were developed, including the referral and admission processes, retention and destruction of documents, as well as chart set up and client registration.

The goal of RPIW 2 was to: “Reduce lead time for CTAS 3, 4 and 5 patients at the La Ronge Health Centre Emergency Department from the time a patient registers to the time a patient first sees the physician.”

What did we identify as issues and how did we address them?

Patients were waiting more than 15 minutes following registration before being triaged by a nurse, which was a safety concern.

  • Fix: Patients waiting to see the nurse are now seated in a highly visible area outside the waiting room. Each patient’s chart has a timer attached to it, and the unit clerk reminds the nurse if a patient’s wait time is nearing 15 minutes. A surge protocol was developed to allow nurses to bring in extra help if needed during busy times.

The waiting room was filled with old posters, the TV had no remote and patients did not know why they were waiting or for how long they would have to continue to wait.

  • Fix: Our patient representative developed posters for patients explaining the emergency room process, a remote was ordered for the TV and signage was developed to tell patients who the care providers are for the day and how long the expected wait time is for non-urgent patients.

Physicians are responsible for managing patients via phone from the outpost clinics, and can be interrupted by phone calls for patients that are not urgent.

  • Fix: Non-urgent patient consultation requests from the outposts are now faxed in by the outpost nurses using a designated form, so that these patients can be triaged and slotted into line with the other non-urgent patients in the waiting room.

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