Hamilton General Hospital ED demonstrates ‘epic’ ability to rise to the challenge – Hamilton Health Sciences

Shortly after Hamilton Health Sciences (HHS)’s new digital recording system went live on June 4, an ambulance helicopter carrying a trauma patient landed on the roof of HHS’s Hamilton General Hospital, and then an ambulance arrived with a stroke patient who immediately had to be treated.

Simulations helped prepare the ER at Hamilton General Hospital for Epic’s launch.

It was a trial by fire for the Emergency Department (ED) team, who had just been granted access to Epic’s new hospital information system for the first time, when these two patients walked through their door.

“We didn’t expect perfection when Epic launched, but our team was well trained and ready.” — dr David Quinlan

With the flick of a switch at around 5:30 a.m., Epic replaced dozens of electronic and paper systems and made every patient’s medical information available online in one secure location. Immediately, long-established medical and administrative workflows changed dramatically.

dr David Quinlan, emergency room physician and head of the trauma team at HHS’s Hamilton General Hospital

Epic’s many benefits include improved communication between HHS doctors, nurses and other healthcare providers, faster access to patient information, including test results, and improved patient safety.

Advance pays off

The ED team was well prepared for the transition thanks to months of practice in advance using Epic’s training tools. But there was a learning curve once the new system went live.

“We didn’t expect perfection when Epic launched, but our team was well trained and ready,” says Dr. David Quinlan, ED physician and leader of the trauma team at HHS’s Hamilton General Hospital.

The training included practicing nine simulations in the weeks leading up to launch – three code blues meant vital signs were missing; a stroke simulation in which the patient required anticoagulant therapy; and five trauma simulations, including an air ambulance scenario.

“The stroke and air ambulance simulations were very similar to what the ED team experienced on launch day,” says Quinlan. “As a result of all their practice and preparation, including these simulations, our patient-centric goals and treatments were not delayed. That’s what counts at the end of the day.”

Sarah Hayhow, Clinical Instructor for ED at HHS’ Hamilton General Hospital

The simulations were prepared by a focus group that included Quinlan and ED clinical instructor Sarah Hayhow. They were paraded in the trauma bays during quiet times, with mannequins posing as patients. All those involved in ED care participated, including physicians and staff from radiology, surgery, transfusion medicine and allied health services such as the pharmacy team.

“We ran these simulations as if these emergencies were happening in real time,” says Quinlan.

“For example, when we simulated our response to an ED patient who needed a blood transfusion, we used dummy blood products to represent real blood. This included ordering blood products through the Epic system’s practice tools. These sham blood products were placed in a cooler and retrieved by a porter who took them to the emergency room. Units of blood were then checked and hung over the mannequin for transfusion.”

rise to the challenge

Hayhow was instrumental in co-implementing the simulations with Quinlan. “Our team really had a chance to practice,” says Hayhow, who worked the morning Epic went live to help with troubleshooting.

“Our team members stayed calm, dug in, and quickly got our patients the help they needed because that’s the emergency route.— Sarah Hayhow, Clinical Instructor for ED

“We had just turned on the Epic system when the ambulance arrived, followed by the stroke patient about five minutes later,” Hayhow recalls. “Each nurse attempted to log into Epic for the first time and access the equipment needed to work in the new system. But our team members stayed calm, pitched in and quickly got our patients the help they needed because that is the emergency route.”

Although there were some glitches on launch day, the team was able to efficiently fix them.

“For example, there were difficulties printing blood labels, but we were prepared with a backup plan,” says Hayhow.

Since the launch, ED team members have continued to work on smaller challenges, such as adapting to the new workflows and processes.

“Everything has changed, from the way we document to the way we do blood tests to the way we administer medication,” says Hayhow. “Every day, through hands-on experience, we learn more about how it all works and looks in an ED environment. And every week it gets easier.”

Change for the better

While change is never easy, in the case of Epic, it’s welcome.

Epic is recognized as one of the best systems in the world and is used internationally by many top tier hospitals. Hamilton Health Sciences is among the first hospitals in Canada to implement Epic’s state-of-the-art, fully electronic system.

dr Barry Lumb, Executive Lead of the HHS team implementing the new Epic Hospital Information System.

“Epic’s clinical applications and tools are unparalleled and will enable our staff and physicians to continue providing the best possible care to our patients,” said Dr. Barry Lumb, Executive Lead for the implementation of the system at HHS.

Michelle Leafloor, HHS vice president of health information and technology services and chief information officer, calls Epic the future of healthcare.

“With Epic, not only will we be able to do even more to improve our patients’ health outcomes,” says Leafloor, “we will also be able to contribute to research that will transform the lives of countless patients beyond our own community. “

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