Grey Nuns Community Hospital (GNCH) General Internal Medicine-ED Triage Consultation Service

Student Researcher:
Paul Barber

Supervisor / Principle Investigator:
Pam Mathura

Additional Authors:
L. Chivers
A. Brisebois
Department of Internal Medicine Physicians Bed Management Team
Multidisciplinary Teams - Medicine, GNCH, P. Mathura & P. Barber

MD Class of 2021


The Grey Nuns Community Hospital (GNCH) has approximately 75,000 ED visits annually with an average Emergency In Patient Length of Stay (EIP LOS) of 26-28 hours. GIM Physicians must care for both ward and ED patients simultaneously. This leads to GIM physicians working longer ward hours due to frequent pages and visits to the ED. Similarly, ED physicians must wait for available GIM physicians for consultations, have increased ED physician handovers and delayed ability to transfer patients to the wards. The project aims to improve Medicine patient flow through the GNCH ED and ward by developing an ED GIM consultation service, streamlining the consultation/disposition process and allocation of patients to the appropriate medical service team.

The main opportunity for improvement identified was the physical placement of a GIM consult physician directly within the ED from 0700-1700 Monday to Friday. A 3 month Plan-Do-Study-Act (PDSA) cycle to evaluate the service impact was completed. To support acceptance of the change, frontline project champions led weekly sessions capturing real time issues along with solution tracking and supported consistent physician attendance at bed management meetings. Preliminary results indicated a sustained decrease in the Average Length of Stay (ALOS) -ELOS ratio for PDSA #1. However, there was minimal impact on ED consult time and EIP LOS. Qualitative data suggested improvements in physician and bed management workflow, improved sign over practices and attendance of ward rapid rounds. Both desire for patient unit cohorting and trainee experience regarding continuity of care were identified as potential areas for further improvement to support the ED GIM physician service. Overall, GIM ED Physician service has a direct impact on both ED and ward patient flow; strengthens interdisciplinary teamwork and communication.