Royal Victoria Regional Health Centre – Blazing a Trail in Patient-Centred ED Solutions

In the first week since launching at the Royal Victoria Regional Health Centre’s Emergency Department (ED) in Ontario, more than 2,000 patients have successfully checked in using our new kiosk system. This innovation is already transforming patient flow and registration processes.

Key Insights from the First Week:

• Quick Check-ins: Patients are completing the kiosk check-in process in just 2-3 minutes, receiving a printed ticket with a call number to maintain privacy.
• Reduced Registration Workload: The majority of patients are matching with the EMR (Meditech Expanse), significantly reducing the registration team’s workload.
• Rapid Staff Adoption: Staff have quickly adapted to this new process, enhancing overall efficiency.

How It Works

Kiosk Patient Check-in Process

The check-in process involves matching patients to the EMR system using their health card or demographic details, with outcomes including:

• Full Match: Complete verification of patient details.
• Partial Match: Some discrepancies or incomplete data.
• No Match: No record found in EMR, triggering follow-up steps.

Presenting Complaint Capture and Triage

• Critical Symptoms: Patients reporting urgent symptoms (e.g., chest pain) are immediately flagged for clinician review on the Clarity dashboard.
• Non-Urgent Cases: Guided questions help capture detailed presenting complaints for non-critical patients, which are then accessible on the triage dashboard.

Upon completion of the check-in, a pre-admit HL7 message updates both the host system and the eCTAS tracker board with the patient information and their presenting complaint.

Ticketing and Wayfinding

A ticket is printed for each patient, featuring a randomly generated call number for privacy and clear instructions to direct them to the correct location within the ED. This helps minimize confusion and enhances patient flow.

Clarity Dashboard for Staff

Patient Matching

• Staff can quickly identify patients whose records were unmatched during check-in. Unmatched patients are called to the registration desk using their call number, eliminating the need for a line-up.

Alert System

• Critical Alerts: Clinicians are notified of patients with urgent complaints.
• Status Downgrade: Staff can change a patient’s status to non-critical or “fit to sit” for stable ambulance arrivals.

Pathway Analysis

The Clarity dashboard manages patient journeys through “Next Activity” steps, tailored to their arrival mode, triage status, and match status:

• Full EMR Match: The next step is “Call to Triage.”
• Partial/No Match: The next step is “Receive,” prompting clerks to complete pre-registration. After registration, patients move to “Triage.”
• Triage Completion: Matched patients then proceed to “Registration” for finalization.

Two-Way EMR Integration

All arrivals are displayed on the Clarity dashboard, which synchronizes with the EMR in real-time. This gives staff a clear, current overview of all patients in the ED, whether registered via kiosk or directly in Meditech.

Processed patients are automatically removed from the dashboard to keep the interface uncluttered.

Clarion – Patient Call Module

Patient Privacy and Flow

• Call Numbers: Patients are always referred to by their call number, ensuring privacy.
• Integrated Display: Call numbers are displayed and announced on waiting area screens, with repeat announcements if needed.
• Visible Wait Times: Transparent waiting times are also displayed, improving communication.

The electronic patient call system has proven transformative, with positive responses from both patients and staff.

Benefits of the New System

• Efficiency & Reduced Wait Times: Automated check-ins streamline patient flow, allowing clinicians to prioritize critical cases.
• Enhanced Patient Experience: Clear instructions, privacy protection, and effective wayfinding help reduce stress and confusion.
• Optimized Staff Workflow: Real-time dashboards and integrated patient pathways support effective patient management.

What’s Next for RVH?

QR Code Self-Registration

• How It Works: Patients use strategically placed QR codes to register via their smart device, replicating the kiosk process.
• Advantages:
  • Reduced kiosk waiting times.
  • Patients retain their call number digitally, minimizing the risk of it being lost.
  • Greater privacy and flexibility, allowing patients to register at their own pace.

With these continuous improvements, Royal Victoria Regional Health Centre is setting a new standard in emergency department patient flow management, putting patients first while optimising clinical workflows.