Mount Sinai Hospital’s Emergency Department has made many improvements to its services over the past year.

First, it is endeavouring to improve its care to geriatric patients. In June 2008, a Geriatric Nurse Specialist (GEM) was hired for the Emergency Department. The nurse will perform assessments, identify at-risk seniors and assist in admitting and discharging older patients. Dr. Don Melady of the ED staff has been participating in several hospital and regional initiatives to improve Geriatric Care. These include:

• developing educational modules for nurses and physicians for elder care
• developing a curriculum for emergency trainees for the same purpose
• and arranging for a visiting professor, Dr. Neal Flomenbaum from Cornell, New York, an international expert on geriatric care, to provide educational support in the Emergency Department.

Mount Sinai Hospital is participating in Ontario’s Wait Time Strategy. Initiatives to improve patient flow, reduce waiting and improve the patient experience include:

• Setting up a Rapid Assessment Zone (RAZ) in the Emergency Department in July 2008. In the RAZ, an internal waiting room is used to assess patients who don’t require care in a stretcher on an ongoing basis, but do require privacy for their examination or treatment. The use of this waiting room allows patients to effectively “share” a stretcher, which speeds up processing and reduces wait times. 
• Establishing an “offload nurse” program on September 1, 2008, in which a dedicated nurse initiates care for patients who arrive by ambulance. The program and related initiatives have reduced wait times for those patients from two hours to 20 minutes and moved Mount Sinai routinely to best in class in the Greater Toronto Area for offload indicators.
• Providing porters to assist imaging technologists in moving patients, extending hours in CT, adding technologists on some night shifts and working closely with Diagnostic Imaging to reduce wait times for Emergency Department patients.
• Establishing the new position of Patient Flow Coordinator and supporting policy and process changes that have improved flow of admitted patients from the ED to in-patient units.
• Beginning the first year of a multi-year upgrade to the Emergency Department information systems to create a state of the art IT support system in the department. This year, the department enabled an electronic order entry system that saves time by allowing diagnostic imaging for patients to be booked electronically, rather than by fax.
• Dr. John Foote was promoted to Program Director of the Fellowship Program in Emergency Medicine of the Department of Family and Community Medicine at the University of Toronto in January 2009.
• Dr. Shirley Lee co-authored a chapter in the new text Practical Teaching in Emergency Medicine.
• The Emergency Department introduced a portable ultrasound as part of a co-ordinated project to add bedside ultrasounds in selected situations and procedures, in order to improve the quality and the safety of care. During the year, all of our full-time medical staff were certified as Independent Practioners in ED Echocardiography by the Canadian Emergency Ultrasound Society (CEUS), and four staff have become CEUS Master Instructors. This makes Mount Sinai the first ED in Canada to have a 100 per cent CEUS certified medical group.
• Dr. Howard Ovens was named the Acting Co-Chair of the provincial ER/ALC Expert Panel, the panel which advises the government on its wait times strategy for emergency departments.