The bad old days of crammed emergency facilities and shamefully long patient waits, often with dire results, are mere memory now at busy St.'s Paul Hospital in the heart of downtown Vancouver.
"All our measurements are better," said Eric Grafstein, head of the hospital's emergency department. "The time to see a physician is down, the length of stay is down, and the number meeting our targets is up. Even though we are busier, people are being processed faster."
St. Paul's is one of the key architects of a changed approach to emergency care in the province that has significantly eased long-standing patient bottlenecks at many major B.C. hospitals.
Although Dr. Grafstein is quick to admit that there continues to be room for improvement, the average waiting time for emergency-room patients to be treated at St. Paul's has dropped from about an hour to 35 minutes since 2007.
"That's almost a 50-per-cent reduction," he said Friday. "We don't have people dying in the waiting room any more."
St. Paul's has streamlined procedures with a four-bed rapid assessment zone, a special diagnostic and treatment unit, increasing the number of nurses and physicians, and a comprehensive, computerized, data-collection system.
"If you can't measure it, you can't change it," said Dr. Grafstein.
The hospital's emergency department has also become part of the province's pioneering program of patient focused funding.
Once a basic target level has been achieved, St. Paul's receives $600 for each patient admitted to emergency who leaves within 10 hours. Each non-admitted patient sent home within a few hours provides St. Paul's with $100.
"When you attach monetary value to a process, it seems to resonate with people," said Dr. Grafstein. "It allows people on the front lines to be empowered. They think: 'If I make a difference, the hospital will be rewarded.' "
Above all, however, the veteran emergency physician emphasized that changing the system for the better requires leadership, a commitment from the top.
"It doesn't take a lot of money. It takes a leader or hospital CEO to say that improving the emergency department is a number one priority, that this is what we're doing," Dr. Grafstein said. "Leadership is everything. If you don't make it a priority, then it's hard to change."
"It didn't take much, just telling people that this is your job, that you're going to get people out of the emergency department."
Dr. Grafstein said he disagreed that having lots of patients visiting hospital emergency wards is necessarily a bad thing.
"People understand that they can get pretty good care there, and I also happen to believe that emergency departments are cost-effective."