Sunday, May 26, 2019 • 13:00 - 14:30
Track 3 - Crowding: It's a Crowded House
Track Chair: Dr. David Lewis
Room: 109

Crowding - What Have Policymakers Ever Done for Us!? - The RCEM Experience - Dr. Taj Hassan

Description: An overview of the major challenges / red flags of the past decade in the UK & how emergency care systems have evolved to meet those challenges. Wider system engagement and drivers to manage system performance linking to improvements in patient care. Staffing strategies to deliver and create sustainable careers to cope with increasing demand and complexity.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Understand the pros and cons of system performance standards as well as safety and clinical care in emergency care and role of system accountability.
  2. Describe the benefits and risks for emergency care and the impact on patient outcomes for the UK.
  3. Describe how the work of the emergency physician is evolving to meet these challenges.

Pearls

  1. Having a powerful ‘patient flow metric’ with system accountability is vital to allow the delivery of safer, quality care.
  2. ‘Gaming’ strategies by systems with bad culture linked to punitive financial penalties compromise staff satisfaction and affect care adversely.
  3. Co-design and collaboration linked to wider system strategies improves staff satisfaction and productivity in the ED setting.

Dr Taj Hassan is a consultant in Emergency Medicine at the Leeds Teaching Hospitals NHS Trust and also President of the Royal College of Emergency Medicine (2016 – 2019). He has previously held posts at NHS Improvement as Associate Medical Director for Urgent & Emergency Care, national RCEM Lead for Ambulatory Emergency Care and co-author of the national Directory of Ambulatory Emergency Care, Vice President of the RCEM and was Director of eLearning at the College (2005-2012) leading on the development of the eLearning platform that is now RCEMLearning.

Crowding - Canadian Status and Solutions - Dr. Alecs Chochinov

Description: Patient flow challenges continue to plague Canadian EDs. While output block has justifiably received most of the attention and research efforts, future planning must also examine throughput efficiencies and measures to reduce the input of complex medical and psychosocial patients who are increasingly contributing to ED crowding.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Provide an overview of trends in ED wait times across Canada.
  2. Review the respective contributions of input, throughput and ouput to ED flow.
  3. Explore areas for future study and collaboration to reduce ED crowding.

Pearls

  1. ED crowding is multifactorial and causes many vary sharply day by day.
  2. Choose Wisely, not only for better patient care, but for better flow.
  3. Over the long term, public health and social determinants of health may be the most impactful factors in reducing ED crowding.

Dr Chochinov is Head of the Department of Emergency Medicine at the University of Manitoba, Medical Director of the Regional Emergency Program in Winnipeg and CAEP President. His academic interests are in ED operations and flow, as well as hypothermia and cold-water drowning. Dr Chochinov intends to retire as soon as he solves ED overcrowding once and for all.

Debate: Redirection vs. Accommodation Strategies - Dr. Judy Morris and Dr. David Lewis

“Send them Away”

Description: A review of the existing literature will be presented on redirection strategies used in emergency departments. A brief description of the existing types of redirection strategies will be presented. Also, advantages and shortcomings of these strategies will be presented.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Be familiar with the different types of redirection strategies.
  2. Know about the advantages and disadvantages of these strategies.
  3. Know how redirection strategies can be used to help deal with overcrowding in the emergency department.

Pearls

  1. Redirection strategies work !
  2. Redirection can be useful as a tool do decrease overcrowding is the emergency department.
  3. Redirection strategies can be safe for patients.

Dr Judy Morris is an Emergency Physician at Hôpital du Sacré-Coeur de Montréal, a tertiary care trauma center. She is a member of the ED’s research group and a CAEP and AMUQ (Associaiton des médecins d’urgence du Québec) board member.

“Welcome Them All Here”

Description: This debate reviews the literature with respect to ED strategies to reduce the impact of crowding.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Know about the evidence for co-location of services in ED.
  2. Know how successful redirection strategies have been in NB.
  3. Give examples of successful co-location strategies.

Pearls

  1. Patients seeking care at the ED often doubt primary healthcare’s capacity to respond to ‘urgent’ problems. This belief results from cumulative past experience of care-seeking.
  2. It is very difficult to change patient behaviour.
  3. Changing patient behaviour – Six common errors – 1. It’s just common sense, 2.It’s about getting the message across, 3.Knowledge and information drive behaviour, 4.People act rationally, 5. People act irrationally, 6. It is possible to predict accurately.

Dr. David Lewis is an Emergency Physician, Associate Professor, Dalhousie Medicine New Brunswick. PoCUS Director and Informatics Lead. Co-Scientific Chair CAEP19

LO10 - Associations between ED crowding metrics and 72h-hour ED re-visits: Which crowding metrics are most highly associated with patient-oriented adverse outcomes? - Dr. Andrew McRae

Panel Discussion - Drs. Taj Hassan, Alecs Chochinov, Judy Morris, David Lewis

Description: This track will present the most up to date evidence on the outcomes of crowding solutions from Canada and internationally.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Review the outcomes (both positive and negative) of solutions to ED crowding experienced in both Canada and the UK.
  2. Examine the potential for both diversion and accommodation strategies in mitigating the effects of ED crowding.
  3. Enable audience participation and sharing of local solutions to crowding.

Dr. Taj Hassan

Dr Hassan is a consultant in Emergency Medicine at the Leeds Teaching Hospitals NHS Trust and also President of the Royal College of Emergency Medicine (2016 – 2019). He has previously held posts at NHS Improvement as Associate Medical Director for Urgent & Emergency Care, national RCEM Lead for Ambulatory Emergency Care and co-author of the national Directory of Ambulatory Emergency Care, Vice President of the RCEM and was Director of eLearning at the College (2005-2012) leading on the development of the eLearning platform that is now RCEMLearning.

Dr. Alecs Chochinov

Dr Chochinov is Head of the Department of Emergency Medicine at the University of Manitoba, Medical Director of the Regional Emergency Program in Winnipeg and CAEP President. His academic interests are in ED operations and flow, as well as hypothermia and cold-water drowning. Dr Chochinov intends to retire as soon as he solves ED overcrowding once and for all.

Dr. Judy Morris

Emergency Physician at Hôpital du Sacré-Coeur de Montréal, a tertiary care trauma center. She is a member of the ED’s research group and a CAEP and AMUQ (Associaiton des médecins d’urgence du Québec) board member.

Dr. David Lewis

Dr. David Lewis is an Emergency Physician, Associate Professor, Dalhousie Medicine New Brunswick. PoCUS Director and Informatics Lead.

Co-Scientific Chair of CAEP19.