One of Canada's wealthiest families is giving $15-million to help Toronto's Mount Sinai Hospital build the emergency room of the future – one that could serve as a model for institutions around the world.
More than half of all patients are admitted to hospital through emergency, and tens of thousands of people with chest pains, stomach discomfort, broken bones or other medical emergencies pass through each year. Increasingly, many patients at emergency are older and have multiple health problems.
The new emergency department, which will be double the size of the current one, will incorporate state-of-the-art design principles to maximize patient comfort, increase efficiency and encourage faster turnover. Many of the new design features are aimed at helping the elderly.
"I think what we're doing is an example that other facilities can follow, both the integration of the physical design and the operations for access and quality," said Howard Ovens, director of Mount Sinai's Schwartz-Reisman Emergency Centre.
The new department, which does not yet have an opening date, will be able to accommodate up to 80,000 patients a year, up from 56,000. It will be more than 28,000 square feet, compared with the current 11,400.
The gift, donated by Gerald Schwartz, CEO of Onex Corp., and his wife, Heather Reisman, CEO of Indigo Books and Music, will usher in a new era for emergency medicine catering to the growing demographic of elderly, chronically ill patients. The donation will also finance a new emergency medicine research institute, the first of its kind in North America, that will identify ways to fix bottlenecks and eliminate long waits.
Mr. Schwartz and Ms. Reisman said they wanted to focus on revamping emergency because it touches most patients.
"There's probably no time in someone's life when the stress is so high and the risk is potentially so high as when they're in the emergency centre," Ms. Reisman said on Thursday at the official announcement of plans for the new department. "The opportunity to have a positive impact is really strong."
The new department will incorporate design principles that Dr. Ovens said will help improve the department's efficiency and patient flow. In the current system, patients lie on stretchers for long periods awaiting tests or assessments. That can lead to bottlenecks as others wait for a stretcher. The new department envisioned by the hospital will have internal waiting rooms and use chairs for patients who do not need to lie on a bed. The hope is this will allow others to be seen more quickly.
The department will be built with the needs of older, complex patients – increasingly the biggest users of the health-care system – in mind. Aspects of senior-friendly design that will be incorporated include numerous bathrooms throughout the department to encourage older patients to get up, which is crucial to preventing a decline in mobility. Many rooms will have natural light, helping patients recognize the time of day, which could help prevent delirium, an often-deadly condition in older patients.
But a new department will not solve the major problems at emergency rooms across the country. A report last month by the Canadian Association of Emergency Physicians declared overcrowding and waits in ERs a public health emergency. Part of the problem is the shortage of available beds that forces patients admitted in the emergency department to wait there to be transferred. This creates backlogs affecting other patients. Staffing levels are also a problem, the report said. Although Ontario has made changes to reduce waits and is often singled out as a good example, many ERs still report lengthy waits that could put patients' health at risk.
Emergency medicine as a specialty is only a few decades old. Before, doctors from other departments staffed emergency. But increasingly, patients are seen by physicians who specialize in emergency medicine and are familiar with its challenges. Mount Sinai hopes to fund research that will look at improved decision-making in emergency, improving accuracy and efficiency of diagnosis and treatment, and how to improve handling of patients with infectious diseases and the growing threat of hospital superbugs.