Handheld ER notification devices eliminate repeat visits

A new technology that hoped to stop unnecessary repeat visits tothe emergency room (ER) has proved successful in its first fewmonths.

The electronic notification system is used to alert Community Care Access Centre(CCAC) staff if someone admitted to the ER at Toronto GeneralHospital or Toronto Western Hospital is a candidate for theirservices.

The CCAC provides, amongst other things, home nursing,homemaking and nutrition counseling.

“The objective is to decrease repeat visits to the emergencydepartment,” said Tracey MacArthur, director, Community CareInformation Management, Shared Information Management Services(SIMS). “We make sure that we identify all patients that come into ERs thatmay need some kind of homecare service that doesn’t necessarilyhave it.”

When a patient that meets the criteria is entered into thesystem, the system flags the patient, said MacArthur. An alert isthen sent to a CCAC coordinator on their BlackBerry who then goesto the ER and assesses the patient.

“Using (handheld digital devices) was essential because the CCACcoordinators are always walking around the hospital,” she said.”Since they don’t staff the hospital 24-hours a day, thecoordinator follows up with night referrals the next day byphone.”

The flagging criteria are based on age and what the complaintupon arrival at the ER is, for example, all patients over 75 areautomatically flagged for assessment, according to MacArthur.

The criteria had to be established and then narrowed down so thesystem would be effective, said Debra Davies, nurse manager,Toronto General ER.

“We had to make sure the poor CCAC rep wasn’t being paged withevery single patient that came through,” she said. “We actuallyhoned it down to something that was really valuable.”

Davies said another advantage is that the CCAC coordinatorbecomes part of the ER team and other members of that team get toknow the coordinator as an individual.

The criteria being used have produced positive outcomes,MacArthur said.

“We’ve seen that requests for assessment almost triple,” shesaid. “We’ve also seen that almost 80 per cent of those requestsfor assessment have actually resulted in some kind of a servicethat was needed.”

Automatic, electronic referrals take the guesswork out ofwhether a patient should be assessed, so ER staff don’t have tomake a judgment call about every patient, but staff can still refera patient manually, said MacArthur.

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