#14 - ED Expediter Tile

Andy Day: Hello and Welcome. This is Andy from the Command Center team.

And today we're here to talk to you about the ED Expediter Tile. You see we're at Tile viewer, which is our landing page. Whenever you log into our system you come here and you see a variety of Tiles or apps to pick from, they'll be different for each customer, but today we're here to talk about ED Expediter.

So let's click there to dive into the Tile. So before we look at the body of the Tile or the actual content, I just want to orient you to the navigation of the Tile. In the top left, you see always the name of the Tile, of course. As you move across to the right, in the top right, you'll see this is the rapid Nav button where you can quickly switch between hospitals or EDs or views that you've saved.

To the right of that is the ‘i’ or info button. That's where the Legend lives. You can always see the definition of any icon or symbol on the Tile. You don't get a cheat sheet or a lookup guide. It's always on the Tile available to you. And then to the right of that, is the gear button or the Settings button. And this is where individual users can change how the Tile appears for them. And they can change things like changing the scrolling behavior of the Tile. Right now, it's set to scroll like the Hertz board at the airport if there's more than fit on a screen. You can condense and un-condense.

The header, you can change the way the alerts are sorted. And most interesting, you can apply filters that you might find interesting. Let's actually play with the condensed header for a second. The top section is what we call the header. We're going to turn that on and hit apply, and that will take that header bit and collapse it. So it leaves a lot more room for alerts. Now, this feature's specific to the ED Tile, because people tend to spend a lot of time fighting the alerts, which is great. And we wanted to give the ability to hide or unhide the header information.

So let's go ahead and undo that. And then the very bottom left corner of the Tile, you see the little flickering bars going back and forth. That's the Freshness Indicator, that just tells us that the data is fresh. We refresh the data typically every 30 seconds. So we know that the Tile has got data in near real time. And of course, the data today is mock data as it's a demo, but it's very representative what you'd see in the real world in this Tile as it's used.

So now let's look at the Tile itself, the information in it. As you go to the header bar, let's start in the top left. There, you see by ESI or acuity score, how many patients have arrived in the last hour and what the census is by acuity score. Next over is a bunch of different counts for either patients or ED bays that are interesting. And then to the right of that, you see in the last five hours, the arrival and departure patterns into the ED, so you can see a re-building or decompressing as we go.

To the right of that is divert status, depending on if any of the EDs or zones are in a divert state, you'll see alerts for that there. And then to the right of that is pressure score. Different clients use different pressure score mechanisms. Depending on your specific situation, we can use NEDOCS or whatever it is you use and calculate it in real time. And then you'll see each of the pressure in the zones of the ED or the different EDs in that heat map. And we can click on that to filter the Tile to just that. So let's click on 2K2.

Now we're seeing just the alerts for 2K2, and so you might want to save that as your default, if you're the 2K2 manager and you want that down in your zone. So now let's look at the actual body there, you look at care progression. These are alerts that are for patients where they're experiencing a delay or something going wrong in the progression of care in the ED itself, the normal ED treat to street or treat and release process. And so you see no sign up alerts.

These are where a ED physician has not yet been signed up to the patient. Results in no disposition, let's click on that. All these have hovers, so you can see more information. And this is a patient that's had something ordered. We got it resulted, and nothing's happened with the patient. So this alerts that there might be an opportunity to tell the physician that they have results, and we might need to do something. Below that, consult delays, et cetera. And there's a variety of different ones that are available to you.

The next section over to the right is Post Disposition. And what that is, is that patients in this zone of the ED that we filtered to, you see a bed ready alert. This is a patient who has a bed assigned, that bed is clean, available, and ready to take the patient and the patient hasn't moved. So we need to get transport moving and get it done. And then to the right of that, you see consults, imaging, and labs, these three critical task types. You can see how many have been ordered, how many have been resulted, et cetera. Just to get a glance at those things that tend to be the most heavily utilized by the ED and how many of them we're waiting for, et cetera. Let's go back up to the gear button.

Another interesting thing to look at is applying a filter. And so now I can filter in on a specific type of alert, and let's say for example, I'm really responsible for consults. And so let's select consult delay and look at any of those consults alert or warning or critical, hit apply. And now I'll see just those consults that are outstanding. And so this is something that I can then make sure we follow up with all the consulting physicians and get those consults done. So this is again the ED Tile, very useful in advancing patients through the ED, getting patient level alerts when things are delaying the progression of care, and being able to take action.

Thanks so much for your time. And with that, I'd like to turn it over to a user of the Tile to give their comments on their experience with the Tile.

Jane Casey:

Hello, my name is Jane Casey, and I am the Director of Emerge and the Command Centre at Humber River Hospital in Toronto, Ontario, Canada, and I’m a registered nurse by background. We launched our Command Centre in November 2017 and our goal was to combat hallway medicine, but also to improve our patient experience and our quality outcomes. At the time, we were dealing with very high volumes of emerge patients, and a projected shortfall of medicine beds.

I'm pleased to say 3 years later, with 21 Tiles live, we have had great progress meeting this goal.

The Emerge Status Tile, is currently in the Emergency Department and in the Command Centre, and it helps us support flow through the Emerge by highlighting when the patient volumes are delayed and need to be actioned. A few of the key, real-time alerts we watch closely is our medical imaging turnaround times. The number of psychiatry admits waiting for a bed and how long patients are waiting to see physicians in each zone.

The latest alert we added is our Sepsis Risk Alert that flags when patients meet our surge criteria in our EMR and no followup is documented. In this fast paced Emerge environment, this Tiles summarize at a glance, where the nurses, doctors and leaders can intervene to help patient care keep on track. Ontario has a paid-for-results program that provides variable funding based on the Emerge wait time targets.

With our Command Centre, this has helped us and we have achieved top ranking in the province.

We are number 1. Thank you!