3 True Story… A sweet grandmother telephoned St. Joseph 's Hospital. She timidly asked, "Is it possible to speak to someone Who can tell me how a patient is doing?" The operator said, "I'll be glad to help, dear. What's the name and room number of the patient?" The grandmother in her weak, tremulous voice said, "Norma Findlay, Room 302." The operator replied, "Let me put you on hold while I check with the nurse's station for that room."
4 True Story (cont) After a few minutes, the operator returned to the phone and said, "I have good news. Her nurse just told me that Norma is doing well. Her blood pressure is fine; her blood work just came back normal, and The grandmother said, "Thank you. That's wonderful. I was so worried. God bless you for the good news." The operator replied, "You're more than welcome. Is Norma your daughter?" The grandmother said, "No, I'm Norma Findlay in Room 302. No one tells me anything."
5 VISION Edmonton Clinic will be a leading, state-of-the-art enabler of integrated, patient centered clinic care, education and research (Functional Program 2006)
6 Vision 2020 Goals Providing the right service, in the right place and at the right time Enhancing access to high quality services in rural areas Matching workforce supply to demand for services Improving coordination and delivery of care Building a strong foundation for public health Source: Vision 2020: The Future of Health Care in Alberta, 2008
7 AHS Ambulatory Care: Past & Future Location of Ambulatory Clinics –Walter Mackenzie Centre –Clinical Sciences Building –Aberhart Centre –College Plaza –Garneau Professional Building Ambulatory Current State –Competing inpatient & academic requirements –Internal department silos; team care increasing –Emphasis on customer service, access –New services & technologies (e.g., eClinician) –Significant process variability –Provincial resources impacted by Alberta economy –Trailers (various) –Glenrose Rehabilitation Hospital –Van Vliet Centre –Dentistry/Pharmacy Centre
9 AHS Ambulatory Care Inpatient philosophy –Specialty care –Complex patients –Higher resource per case –Privacy –Safety –Family-centered care –Focus on transition of patients from acute to sub- acute/secondary facilities Ambulatory philosophy –High volume –Repetitive transactions –Lower resource per case –Customer service & consumerism –Convenience & accessibility –Coordination of related services –Flexibility & modularity –Shared support
11 Guiding Principles: Ambulatory Care Gold Standards I can easily access and schedule my care and navigate through AHS. My providers share one source of information about me and coordinate my plan of care. I have choices in my health care and my decisions are respected. I know what to expect and have information and assistance as I need it. Everyone shares ownership for delivering my Gold Standard experience. I feel comfortable and secure in a caring environment.
12 Core Operating Principles Patients and their families can easily access Care and navigate through the Alberta Health System. Providers share one source of patient information and coordinate plans of care. Patients have choices in their healthcare and their decisions are respected. Note: Core Operating Principles have been adapted from Ambulatory Care – Gold Standard Patient Experience (Jan 2007) and based on feedback from the 6 Operational Planning Sub-groups.
13 Core Operating Principles Patients know what to expect and have information and assistance as needed. Everyone shares ownership of the Ideal Patient Care Experience. Patients are comfortable and feel secure in the patient care environment. A Team Care model will be the standard model for care within The Clinic.
14 Benefits of the Edmonton Clinic Integrated Ambulatory Care experience for patients Enhanced research opportunities Implementation and support for an interprofessional model of care Optimal use of clinic space
15 A centralized, common scheduling platform & basic functionality of an electronic health record (EHR). Limited number of providers will be assigned offices in EC based on clinical need. General Clinic hours of operation will be 0800 -1800 Mon. – Fri. with exceptions as clinically appropriate. Clinical exam rooms will be flexibly assigned, not owned. Clinical programs will have level schedules. Overall Guardrails
16 Programs will share common spaces (e.g., waiting, lounges, interdisciplinary rooms & conference rooms). Standardized approach to assigning resources throughout the building to ensure minimum service standards are met (e.g., check- in, patient rooming, room turnover). Team Care is coordinated appropriately for the needs of the patient. Each clinical area will develop an education/learning and clinical research plan to ensure that adequate space is available to support these missions. Overall Guardrails
18 Patient Centered: Implementation of pre-registration processes Consistent check-in processes across clinics Booking of follow up appointments Building design features an on-stage, off-stage concept Intuitive way finding principles
19 Student Centered: Interdisciplinary rooms located on each floor, in close proximity to the clinical areas Rooms equipped with Telehealth to support participative education and learning for both patients and staff
20 Research Focused: Research space designed into the building to facilitate clinical trials and research Education and Research Committee in place to review ways to enhance research activities in the Edmonton Clinic Enhanced research opportunities with the EMR
21 Flexibility: Exam and procedure rooms designed on a grid to enable flexible scheduling of rooms between providers Standardized room size, layout and furnishings to accommodate changes in use of the space Like clinics located adjacent to each other to promote sharing of space as well as developing linkages between programs
22 Information Technology Wireless IT infrastructure eClinician – Scheduling & electronic medical record (EMR) solution for clinics moving into the Edmonton Clinic Interconnectivity to the University of Alberta for ease of access for clinicians
27 Access to EC (cont) Level 0: Northeast Tunnel West side loading dock
28 Amenities: Staff Washrooms Lockers: –Staff side of building northwest corner –Limited clinics/departments have lockers –Managers determined assignment –Staff provide lock Staff Meeting rooms: –Include TV, fridges, microwaves & phone –No coffee pots or bottle water dispensers
29 Amenities: Public Vending Machines & water fountains public elevators Public vs. patient washrooms: –Public in main corridors (north – south) –Patient within clinic space –Barrier Free –Non-Gender specific
30 Amenities: Public ATM level 1 & 2 near parkade Phones: 1 pay phone level 1 near parkade DATS & Taxi 1 each level 1 near parkade Public Resource Learning Centre (Level 1): –Like a library with computers and printer –For public & staff –Open Mon-Fri from 0800 to 1615h
31 Amenities: Public Prayer and Meditation room: –Level 2 –Multi-denominational Food Market & Coffee Bar RFP presently Locker: –Limited clinics/departments Padlock operated
34 Leadership in Energy and Environmental Design LEED EC is being constructed to achieve a silver certification Third-party certification program and an internationally accepted benchmark for the design, construction and operation of high performance green buildings. Why is this important to AHS?
35 Design Optimize energy performance Water efficient landscaping 30% Water use reduction Staff and Clients are encouraged to use other means of traveling to and from the Clinic
36 Construction Construction waste diverted from landfills Use of building materials from recycled material Over 20% of the materials in the building are extracted and manufactured regionally Over 50% of the wood products come from a sustainable source certified by the FSC Low emitting materials used
37 Other Features Ongoing measurement and verification to monitor utility usage Green housekeeping Green education
38 Paging.. Quiet philosophy –No overhead paging –Fire Voice Activation System for Emergency Preparedness code red
39 Emergency Power Limited emergency power due to size of generator Building code affected degree of emergency power Generator can only have 80% of load Life saving measures is NB: –Fire pumps, fire alarms, smoke evacuation fans –2 elevators
40 Emergency Power: Specific Examples Egress lightening in hallways power to offices, meeting/classrooms, power to exam rooms Procedure rooms: –Procedure light no power –Lights either side of stretcher have power
41 Emergency Power: Specific Examples Medical gases Medical vacuum (suction) power medication fridges, Pyxis medstation, blood fridges Biomedical waste cooler Dentistry has unique power
42 Emergency Power: IT Laptop works if battery charged Wall clocks battery operated UPS for ~ 5 – 15 min: –Wireless access & Network –Security Cameras –VOIP phones PC/Printers
43 Quick Facts? You need to page a staff member to return to your clinic. How would you do that? Where are the public elevators? How can you tell difference from staff vs. patient washrooms? Where is the staff side of the building?
44 Parking: 8 levels with ~ 1200 stalls 10 short term parking stalls at front of EC Entrance and exit to 115 Street; no access to 83rd Ave Vestibules/elevators: –Pay on foot stations –Wheel chair corals Blue help phones near stairwells
45 Parking (cont) Level 0: –Loading dock & mail room Level 1: –Parking Office –Access to EC –DATs, Taxis, & ambulances –Short term & courier –Reciprocal –Bike storage
48 Room Types # of Clinical rooms: –Consult: 21 Exam: 181 –Procedure: 28 Other types: 251 # of Non-clinical rooms: –Communication Centers –Interdisciplinary, meeting & conference –Offices (limited) –Staff meeting Total number of rooms is 1199
49 Security: What is the Philosophy? Goals: –Well defined perimeter security –Controlled access to public areas –Staff call for assistance, panic alarms & CCTV Mid level threat: –Vehicle theft – B & E, Assaults –Workplace violence
50 Security: What is in place? Landscaping Intermittent in size & texture Signage consistent, uniform & able to be seen from street CCTV cameras: –Entries & exits –Elevator lobbies –Public waiting & reception areas –ATMs & vending machines –Access to Pharmacy –At risk hallways/areas –Some stairwells in the parkade
51 Security: What is in place? Audio-visual phones in high risk areas (e.g.. Health Records, Pharmacy) Duress alarms: –Areas of financial transactions (e.g.. Foundation, Cashiers, Admitting & Registration) –High risk areas based on detailed design (e.g.. Interview stations & all Reception Desks) Duress alarms & IP cameras Protective Services
52 Security: What is in place? Financial transactions: –Security IP camera –Money intake floor mounted safe –Point of Sale limited areas –Cash rooms signage does not indicate purpose Convex mirrors: –180 degrees dome flush with no arm –Found in areas hard to see around corners
54 Security: Keying Strategy for Common Rooms Interdisciplinary Oxygen Storage Staff Meeting Housekeeping Wheelchair Storage Waiting
55 Lost and Found: Oops Only Found Found: –Responsible for found items –Send found items to EC Protective Services –Transferred to WMC –Call Protective Services at WMC to determine if a found item is present
56 Wayfinding: AKA Signage 3 levels of signage: –Exterior –Corridors & main public area –Inside clinics Types of signs: –Dynamic electronic signs that may be updated –Static never change, frequent sign at WMC
57 Wayfinding (cont) Dynamic: –Monoliths: Level 1 & 2 Only –Ready boards: outside waiting rooms Static signs: –Frequent signage –Variety of types, including sizes
58 Wayfinding (cont) Each floor has unique colour to assist with wayfinding Consider EC like your home…limited signs as need to invite patients inside
60 A to Z of Clinical Facts Code Blue Stretcher Patients
61 Emergency Preparedness: Code Blue No cardiac arrest teams, except tunnel or MET Provide BLS until EMS arrives they take over AEDs (18) throughout EC –Emergency Carts (11) in limited locations –Only BLS supplies (e.g.. tape, razor, portable suction)
63 Emergency Preparedness: Code Blue Process Clinic Space With Emergency Cart: –First Responder: Determine unresponsiveness, call help, activate nurse call & start BLS – Second Responder: Call help, dial 9-9-1-1, call security @7.8347 Obtain emergency cart Place towel outside door Assist with BLS
64 Emergency Preparedness: Code Blue Process Spaces Without Emergency Cart: –First Responder: Determine unresponsiveness, call help, retrieve closest AED, dial 9-9-1-1 & start BLS – Second Responder: Call help, ensure 9-9-1-1 activated, dial 33# Obtain emergency cart, if possible Assist with BLS
65 Emergency Preparedness: Code Blue Tunnel: –Cardiac Arrest Teams respond –Use blue help phones indicating location –Paged only in WMC as Edmonton Clinic Tunnel Code Blue Parkade: –Use blue help phones indicate location –Control centre call 9-9-1-1 & inform Protective Services –Return to patient & perform BLS
66 Stretcher Patients EC is like your home Stretcher patients not to been seen in front of house to maintain patient dignity Specific entrance: corridor 1X114 –Card access reader from parkade into EC –AHS Transport Services staff will have access –Non AHS Transport staff will need to be escorted Patient taken directly to clinic room registered & checked in Remain in room until patient picked up
67 Stretcher Patients (cont) Process for Non AHS Transport staff: –Call ADM reception desk state clinic & Level –ADM Receptionist call Medicine Service Worker –Service worker: To corridor 1X114 to provide access Escorts Transport staff to service/staff elevators lobby for appropriate clinic
68 Quick Facts? Which entrance would a patient in a wheelchair use to gain entrance to EC? What is the turn around time when AHS Transport Services is contacted for ambulance pick-up?
69 We will give up some level of control by adhering to common guidelines (The Guardrails) –Common scheduling platform (eClinician) –Limited physician offices in The Clinic –Exam rooms are flexibly assigned –Programs will share common spaces But we are receiving advantages in return –Efficiency –Outcomes : Demonstrated performance –Social –Time/convenience –Satisfaction –Economic Ambulatory Care: Past & Future
79 EC - Telephony Telephone types: –VOIP daily use Located throughout the building –Analog daily use and can be used when the network is down Located primarily in staff meeting areas and locker rooms –Emergency (orange) phones Can be used when the PBX is down – i.e. all phones including analog phones are not working Allows for outgoing calls / internal calls only if dialed directly Located primarily in Reception areas and some communication centers –Blue Phones Emergency phones outside of the main building Located in the parkade and tunnel
80 EC - Telephony 1120e model: 1140e model: Analog model: Blue Phone:
81 Soiled Utility Sinks Each soiled utility room has the two sinks above. Which one is the hand washing sink?
83 Nurse Call New kind of nurse call system! Push button or pull cord All calls configured as Emergency Illuminate flashing red with a fast ding dong tone Clear only at station of origin
84 Ceiling lifts Lifts are installed in 6 different locations One in Diagnostic Imaging (patient holding) Two in Neurosciences (EMG and procedure room) Two in Medicine Clinics (procedure rooms) One in Surgery (procedure room) Maximum weight capacity 625 lbs.
85 Portable Oxygen Within the Edmonton Clinic, portable oxygen for patients will be supplied by Grab and Go cylinders
86 Panic Buttons Located at registration desks classrooms Security dispatched