2020 CHIA Award Winner Western Hospital ED Decanting Project

December 16, 2020 – 2020 Patient Care Innovation Award goes to Western Hospital ED Decanting Project (Health PEI/Western Hospital/Maple). Patient Care Innovation Team Award honours private and public sector team effort by recognizing a for-profit healthcare IT company and client team that has successfully implemented a health -IT solution that has positively impacted patient care in innovative ways within the past 12 months.

Western Hospital in Alberton, PEI and Maple, Canada’s leading virtual care provider, have launched an innovative first-in-Canada pilot program. The program will dramatically reduce ED wait times for patients with non-critical needs. These same patients have waited up to 8 hours in some cases to speak with a doctor at the Western Hospital ED in recent months.

In the pilot phase, the program is limited to select patients who meet predefined criteria for the duration of the pilot (e.g., CTAS 4/5 patients), and will be evaluated at the 3 and 5-month marks in order to determine whether it can address a wider array of patient concerns across PEI, which has the longest ED wait times in the country for non-emergent cases. Maple has already heard from other hospitals in the Maritime provinces as well as Ontario who are interested in exploring the deployment of this very solution.

In this program, all patients are triaged by a nurse upon arrival at the ED, based on acuity level and urgency. If the triage nurse determines a patient’s condition meets the inclusion criteria for the program, they are given the option to wait for an in-person doctor’s consultation or immediately connect for a virtual consultation through the Maple platform. Throughout the visit a remote physician assesses the patient, while nurses are on site to take vitals, facilitate examination and rapid testing, or provide stat medications as directed by the doctor.

As an additional benefit, this model of care will allow Western Hospital to keep the ED open even when physicians can’t be on-site in the hospital. This situation closed the ED 19 times in 2019, as the region grappled with physician shortages, retirements, and the burnout of current staff who frequently work 16-hour days to provide care to the community.

In just the first week of the ED Decanting Pilot launch at Western Hospital, the patient maximum of 10 was being reached on many days (sometimes representing up to 33% of the patient volume going into the ED). Maple and Health PEI achieved the objective of decanting or diverting low acuity cases to a virtual care physician, with shortened wait times and strong patient satisfaction. On the first day of the program 9 visits were done, with an average wait time 5 minutes and every visit being rated 5 out of 5 stars.

Prior to the program launch, on-site nurses and doctors were burnt out and completely overwhelmed from staying 2-3 hours later each night to get through the patients. They would leave every night feeling defeated and were unsure if they would be able to continue working if the circumstances remained unchanged. Patients were also affected by the long wait times, some leaving the emergency room after waiting up to 8 hours without being seen.

Alberton was a town that struggled with physician recruitment for years. However, the ED Decanting Pilot has proved to the community and hospital the power of leveraging the right resources at the right time. Physicians with available capacity in other areas of the country and province are able to use that capacity to support cases that do not require hands-on care. This, in turn, is changing the way that care is delivered. Patients with low acuity cases are receiving appropriate treatment through virtual care in significantly less time, allowing for on-site physicians to focus on providing in-person care to patients who need it.

The program launched with 8 physicians, and with the current positive outcomes, many additional physicians have expressed interest in participating (approx. 22 so far Maple’s network across Canada).