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Emergency Department of the not-too-distant future

Toronto, December 11, 2012

By Leslie Shepherd

Three patients arrive in the newly renovated Emergency Department of St. Michael's Hospital early one morning in 2018.

The first, a man who sprained his ankle playing basketball, is directed to the ambulatory area to be seen by a health care provider as soon as possible.

The second man, suffering hallucinations that suggest he may have schizophrenia, is immediately taken to the new mental health area. Like 20 per cent of the patients at St. Michael's, he has no fixed address, a stress factor that may have triggered this episode.

The third patient, a woman who was critically injured in a car accident on the Gardiner Expressway, arrives via ambulance in the new enclosed ambulance drop-off area, and is transported directly into the trauma suite, bypassing the triage and other public areas.

Friends and relatives who in some cases rushed to the hospital to be with all three patients are referred to a smaller, calmer, less noisy waiting area, with ambient lighting, chairs arranged in small pods and other evidence-based design features to reduce aggression and anxiety.

Welcome to the Emergency Department of the not-too-distant future, a more patient-centred area with more space for diagnostic imaging equipment, dedicated care space for mental health patients and workspace for ED staff. The renovations are part of the larger St. Michael's 3.0 renewal project.

"The best-in-class Emergency Department that St. Michael's should expect in 2018 will deliver the right care to the right patients at the right time, despite the great diversity in our patient population," said Dr. Glen Bandiera, chief of the Emergency Department.

Dr. Bandiera said one of the most notable changes will be the mental health area, a quiet, soothing and secure area, physically separated from the rest of the ED. It will be staffed 24/7 by dedicated, specially trained crisis workers and health care providers.

The current three mental health beds are located in the intermediate area of the ED near a busy central nursing station with no privacy. The area is loud, chaotic, busy and bright, a very stimulating environment that can be overwhelming for someone in a mental health crisis, Dr. Bandiera said. The patients are often acting in a loud, aggressive or assertive manner, which can be uncomfortable for other patients being treated for chest or abdominal pains.

The new ambulatory area will provide streamlined care for what are known as "vertical" patients – those who are upright on arrival. They'll be seen by a health care provider as soon as possible and treated using a pre-existing protocol, such as the Ottawa ankle rules for our fictitious basketball player.

A quick decision will be made whether to send the patient for an X-ray, which will now be located adjacent to this area. The patient will wait for any test results in a recliner in a waiting area, where he can watch TV or stay with relatives – rather than occupy a treatment room or a stretcher.

Trauma patients who need CT scans will also have those done in an area within the ED. Now, they have to be transported with a team and monitors three floors up, even though they are some of the sickest patients in the hospital.

Dr. Bandiera said he's also excited about the prospect of having a better patient and family meeting room, where ED staff can talk to family members and deliver bad news in a confidential and sensitive manner.

For the first time, there will also be proper workspace for ED staff to communicate during shift changes in private and without the interruptions that can lead to errors.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.