Emergency Department
Volunteer Handbook
Niagara Health System
Thanks for being
an Emergency Department Volunteer
Thank you for your commitment to a great experience for our patients
and their loved ones in the ED. There has been much change this past
year throughout the transition to our beautiful new hospital. We
know change can be hard and appreciate your support, flexibility and
patience. Volunteers contributed a great deal to ensuring a smooth
transition.
Now that everyone has settled in our new environment, we have
identified some key ways Volunteers can have an even greater impact
on addressing the needs of those we serve.
We have engaged Emergency Department Management, Staff and
Volunteers to standardize our care delivery.
Some of these initiatives include:
Development of this Emergency Department Volunteer
Handbook to empower current Volunteers with
information that will help you deliver the best care to
For All
Emergency patients
Volunteers
New ED Volunteer Communication Binder and
New Sign-In Process
A bi-annual intake process for new volunteers joining
the team – held in September and May each year
For New
An improved process for departmental orientation and
Volunteers
training including development of the New Volunteers’
Training Checklist and the Trainer’s Guide
Please take a few minutes to review this Handbook. We know that most
of this information will be familiar to you and ask for your cooperation
in ensuring success of these new strategies.
Thank you!
2
Table of Contents
ED Volunteer Communication Binder and Sign-In………Page 4
Volunteer Position Description………………………………… Page 5
Role of Volunteers…………………………………………………….Page 7
Patient Centered Care……………………………………………….Page 9
Emergency Department Floor Plan……………………………Page 11
Emergency Department and Urgent Care Center……….Page 12
Emergency Department Overview ……………………………Page 13
Communication……………………………….……………………….Page 23
Factors Affecting Wait Times ……………………………………Page 27
Infection Prevention and Control………………………………Page 30
New Volunteer Orientation and Training Process…… Page 32
Leadership Opportunities and Questions…………………..Page 34
Our Goal:
A full roster of Volunteers
A full roster of
who
are… who are…
volunteers
Patient
Centered
Visible
Skilled
Confident
3
NEW PROCESS
FOR SIGNING IN & OUT
IMPORTANT NOTE: Emergency Volunteers will now
sign-in and out at the start and end of their shift in the
ED Volunteer Communication Binder.
Please DO NOT sign-in or out at the Information Desk
after November 22, 2013
LOCATION: ED Volunteer Communications Binder
is kept on the shelf behind the Charge Nurses’ Chair
at Care Station A1.
(It is White with a Label on the Spine)
The ED Volunteer Communication Binder contains helpful
resources to assist you in your role as well as up-to-date
Memo’s and Information about the Hospital and the NHS.
Please be sure to spend the first five minutes of every
shift reading to catch up on the news. Having up to date
information will help you help patients.
You are encouraged to share your ideas about additional
resources and/or information that would be helpful.
4
5
6
Role of ED Volunteers
Communicator
Care Provider
Volunteer
Educator
Clinical
Support
Communicator
 Directly with Patients: to comfort them, answer questions,
provide information and represent the Hospital
 With Staff: to share information about patients, to seek
guidance and direction when unsure
 With Volunteer Resources: to be informed and stay up to
date about Hospital information, policies and procedures
in an ever-changing environment.
7
Educator
 Share what you know from orientation, training, your
experience in ED and the Hospital, your interactions with
staff and from reviewing new information in the Volunteer
Communication Binder at the start of each shift.
 Explain processes, share why things work the way they do,
reasons behind wait times and other information to help
patients and loved ones feel informed
Care Provider



Comfort Measures for Patients and their Loved Ones
Warm blankets, conversation, dim the lights, adjust the
bed, relay information to the Charge Nurse, assist their
loved ones, get information when needed, advocate
1:1 support for patients with special needs such as
anxiety, confusion, small children
Clinical Support







Fulfill roles requested by staff
(get approval from Charge Nurse when asked to do things
outside of position description scope)
Retrieve items, errands to other departments etc.
Escort mobile patients to general locations
(Ex. Discharge support)
Stock blanket warmer
Disinfect wheelchairs
Tidy the waiting room
8
Patient Centered Care
o NRC Picker – Patient Satisfaction Surveys
o A Harvard study, in partnership with NRC Picker,
identified 8 behaviours that ensure a quality patient care
experience
o These behaviours help patients heal sooner with a
decreased likelihood of re-admission
POWERFUL VIDEO ON EMPATHY
Could a greater miracle take place
than for us to look through each other’s eyes
for an instant?”
~ Henry David Thoreau
http://www.youtube.com/watch?v=zh55e6U_XPM
9
Delivering Patient Centered Care
o Person-centered philosophy
o Consciously adopting the patients’ perspective about what
matters.
o Care for the patient expands to loved ones
o Ask questions. Listen! Find out their story
Seek to understand
o Patient Involvement
o “Nothing about me without me”
o Patient needs vary
o Whole person approach to care
o Meet them where they are at
o Don’t make value judgments
o Focus on a Customer Service Approach
o Polite, Kind, Helpful, Consistent, Needs Met,
Relevant, Timely
o A good patient experience is achieved by making every
little interaction positive
10
The Emergency Department Floor Plan
11
Combined Emergency Department
Introduction to the Department
and Urgent Care Center
 Combined Emergency and Urgent Care Center
Emergency Department
•
•
•
•
•
•
•
•
Severe bleeding
Difficulty breathing
Chest pain or pressure
Broken bones
Mental health emergencies
Trauma or injury to the head
Sudden dizziness/difficulty seeing
Severe abdominal pain
Source: St.Joseph’s Healthcare Hamilton
Urgent Care Center
• Minor abdominal pain (nausea,
vomiting, flu)
• Coughs, colds, fever
• Ear, nose, throat and eye problems
• Cuts that may need stitches
• Sprains, strains, sports injuries
• Minor asthma attacks or allergic
reactions
Source: Niagara Health System
Support for Volunteers
Charge Nurse – Located at Care Station A1
- Primary contact for Volunteers on duty
Triage Nurse – Located under “Start Here” and/or
Triage Room 1, 2 and 3
Manager – Lisa Hildebrand
TLC Volunteers – For assistance with Hospital Information
Volunteer Resources
12
Overview: Emergency Department
1. Information Desk in Lobby
• Please sign-in and out and read important communciation
updates in the Emergency Department Volunteer
Communication Binder located behind the Charge Nurse at
care station A1
• ED Volunteers will no longer sign-in at the Informaiton Desk
in the Lobby.
2. Volunteer Resources
• Volunteer Vests are stored in the Cloak Room
• Volunteers can validate Parking Passes
• Volunteer cupboard located in the Activity Room near the
computer
3. Waiting Room
• Familiarize with the Quick Assessment - Triage Registration process. Patients enter and see Triage Nurse
under START HERE
• See: Factors affecting patient flow and wait times page 17.
• Parking machines, wheelchair storage, washrooms and
security office
• Communicating with patients in the waiting room. See
page 16.
13
4. Main ED Doors and Hallway
• ED floor plan
• Accessible washroom (on the corner)
5. Hallway to Ambulance Offload Area
• Role of Registration staff - complete registration paperwork,
take patient's personal information
• Overview of triage/quick assessment/ambulance offload
nurse role
• CCAC, EMS, Police offices
6. Ambulance Offload Area
• Patients come in through garage, get triaged, and moved to
a room from this area
• High traffic; Fire code restricts this area to paramedics,
hospital personnel, and patients. Visitors should be directed
to waiting room until patient is assigned a room
• Water machine, washrooms and decontamination room
• Ambulance garage
14
Unit A:
7. Care Station A1
• Care station, charge nurse's computer, know which nurse
cares for which patients
• Patients that are cared for in A (Unit A= more Acute, less
stable)
• Code red procedures; A1 is the meeting place for
instructions (to call an emergency code- dial x 55555)
• ** ED Volunteer Sign-In and Communication Binder stored
on shelf behind Charge Nurses' chair
8. Resuscitation Room Hallway
• A1 nurses care for these patients
• Patient washroom, soiled utility, clean supply room
9. Soiled Utility Room
• For disposal of items used by patients
• Used food tray cart stored here
15
Unit A:
10. Blanket Warmer Corridor
• Volunteers are encouraged to offer warm blankets to
patients as a comfort measure with the exception of
patients who have a fever
• Familiarize yourself with the items on the linen carts.
• Pneumatic Tube System--The Bullet
11. Clean Supply Room
• Overview of commonly retrieved/seen items (from this
room)
• Especially; urine bottle, toilet hats, bed pans
12. Care Station A2
• Orientate volunteer to the rooms these nurses attend to
16
Unit B:
Unit B:
13. Nutrition Centre
16. Blanket Warmer
Give volunteer
visual
reference
of Centre
location(new
the
• Be •familiar
with items
in the
Nutrition
warmer
is
located
kettle and microwave)
Overview
of items
on linen
carts
• Not•patient
dietary
restriction
procedures
(Ex. Renal
Diet) and always check with nurse before giving patients
anything to eat or drink
• Always assist loved ones/family in the Nutrition Center
17. Soiled Utility Room
• Orientate volunteer to what this room is used for
15. •Clean
Utility Room
Important notes: Used food tray cart stored here
• Be familiar with items commonly accessed in this room
• Especially; urine bottles, bed pans, toothbrushes, blue
18. "Big" Storage Room
shoe covers/slippers
• Good place to orient volunteers toisolation cart
and infection control procedures (See Page 20)
• Show volunteer what equipments can be found in
here
14. Nurse's Station/ Overview of Unit B
• Ex. Commodes, and isolation carts
•Patients are in this unit are more stable or are waiting for
a bed in in-patient unit
19. Isolation/ Negative Pressure Room
•See Care Station B
•ENT Room (Ear, Nose, and Throat)
•The three patient washrooms
• Explain this room briefly
• Discuss function of the pressure monitor on the
wall
17
Unit C:
20. Unit Overview
• Ambulance off-load patients who are waiting for an acute
care bed
• Offer assistance to staff - running errands, getting
refreshments for patients, etc.
21. Pod D- Domestic Violence and
Sexual Assault
• While Volunteers do not support patients in this unit it is
important to be aware of the services delivered and be
able to provide directions
21. Manager's Office
• Take a minute to introduce yourself to Manager, Lisa
Hildebrand
• Volunteer's are encouraged to approach Lisa if theres ever
an issue they need assistance with
18
22. Unit E- Psychiatric Emergency
• Patients being cared for Mental Health Illness are seen in
this area
• Not fully staffed; Currently operating with an on-call crisis
nurse
23. Family Consultation Room
• Space available for families to spend time away from the
patient
• Show volunteer how to get here from the main hallway
and Pod A
24. ED Team Room
• Volunteers are welcome! (Just remember we also have a
generously sized team room)
25. ED Locker Room
• Unlabelled lockers are available - remove locks at
shift end
• Volunteers can also use lockers in Volunteer
Resources clock room where they pick up and return
vests
19
26. Cast Room
• Familiarize yourself with this room and be comfortable
assisting patients with comfort measures
27. Urgent Care Center
• Orient yourself to the UCC floor plan and care station
• Volunteers are encouraged to assist patients and loved
ones in UCC with communication and comfort measures
4. Call Bell and Code Lights
• Singe solid white line= Bell is ringing
• Solid red= Needs nurse's assistance
• Solid yellow= Activity of daily living
• Slow green flash= Volunteer/Basic assistace
• Quickly flashing colour= Coordinates with the
emergency code
20
Patient Room Orientation
1. Features of Treatment Rooms
• Handwashing station
• Linen cupboard
• Overhead light controls
• Call bell and console
• Nurse's Cart
2. Bed Operations
• Review instructions for the various functions of the
bed (i.e. bed rails, incline/recline, foot pedals)
• Be aware about the dangers of 'tilting' the bed by
accident
3. Patient Telephone
• Patients are encouraged to use their cell phones
• If patient does not have access to a phone, ask nurse
if a cordless phone is available-- IMPORTANT to
disinfect after use and return to charger
21
7. Precautionary Measures
• Always ask the nurse if the patient asks for food/and
or water
• Remember to ask the patient if he/she has a
fever/cold before administering a warm blanket
5. Building a 'Mental Script'
• Build your own mental script when first introducing
yourself to patients
• Ex: "Hi, my name is... I am an ED volunteer. Is there
anything I can get for you?" "Is there anything I can
do to make you more comfortable?"
6. Common Patient Requests
• Blankets, bed incline/recline adjustments, water,
food, light adjustments, commodes, urinals,
particular linen
• Extra pillows (Ask the aides or housekeeping)
• Internet use (WIFI):
Username= nhsuser Password=nhspass
22
Communicating in the Waiting Room
Addressing patient concerns is very important in the waiting room as
unmet concerns have a major effect on the patient experience.
Volunteers in the waiting room have the potential to significantly
improve the patient experience even before treatment begins. We act
as a line of communication between patients and staff; we can answer
pressing questions, clarify the factors behind why wait times can get
long and simply provide a friendly conversation. Just listening to
patients and their concerns can go a long way in making the wait
more comfortable.
Starting with an introduction is the best approach to interacting with
patients in the waiting room:
“Hello, my name is… I am a volunteer. Are there any questions I
can answer? Or anything I can get for you?”
The most common question being asked is with regards to the wait times.
Wait times are constantly changing and are extremely difficult to estimate
due to the nature of the ED.
Management, clinicians and volunteers have expressed caution with
regards to raising hopes unrealistically as this can contribute to elevated
anxiety and frustration. Therefore, when asked about wait times or the
wait list, the most appropriate communication is reassurance and
advocacy.
23
Patient/Family Member Scenario 1:
Can you find out how long the wait is going to be? Or how many
people are ahead of me?
Volunteer:
First, ask the patient where they are in the triage process“Just so I understand; have you been to the Start Here window, through
the brown triage doors or to the registration window yet?” –Patient
informs you where they are in the triage process—
Second, explain why we are unable to estimate wait times, and insist on
confirming that everything is in order“I will be honest, we are unable to estimate how long the wait is going to
be because it’s constantly changing. But let me go back and check the
system for you to make sure everything is in order.”
–Go to Triage or Quick Look Nurse— To nurse:
“I just want to confirm that [name]…has been triaged and is in the system.”
If asked “Why?” by the nurse, simply respond:
“She is concerned and I just want to reassure her that everything is in
order and she is in the system.”
Third, report back to the patient“I checked with the nurse and triage is complete and you are in the
system. This means that the nurses know you are here and based on their
assessment, you are safe to be here for now. I know for a fact that they
are trying to get you in as soon as possible but unfortunately all the beds
are full.”
Fourth, inquire if anything else is needed“Is there anything else I can help with? A blanket maybe? If not, my name
is [name] and I will be here till around [time] so feel free to ask.”
24
Patient/Family Member Scenario 2:
I have been here for 5 hours and people who came after me have
already gone in!
Volunteer:
Guidelines for Scenario1 could be helpful for this Scenario but it’s very
important to educate the patient on why this may have happened-“After you have been triaged there are many factors that can cause you to
be bumped up or down the waitlist. Usually it has a lot to do with the
volume and severity of patients that are coming to the ED. Also, when
every bed upstairs is occupied by an admitted patient, a backlog forms in
the ED. The wait can be frustrating but I can definitely tell you that
everyone in there is working extremely hard to ensure you get seen ASAP
and receive the best care possible.
25
Patient/Family Member Scenario 3:
Can I get something to drink/eat?
Technically, patients cannot ingest anything until they have been
assessed by the physician. This has become a grey area since many
patients are waiting hours without water or food. This is especially
concerning for patients with diabetes.
Depending on the nurse, some are comfortable with patients having food
and/or water as long they don’t have gastrointestinal symptoms like:
Abdominal pain, nausea, vomiting, etc.
Volunteer:
First, ask the patient if they have been triaged then ifPatient has not been triaged—
“Okay, we should just hold-off for now until the nurse has seen you in the
Triage Room. When you are in there check with the nurse and we can go
from there.”
Patient has been triaged—
“Great let me just check with the nurse and I will be right back.”
Second, Ask Nurse“Can [name] have [whatever patient requested]?”
26
Positive Communication
Instead of saying this: 
That’s inaccurate or I
disagree
I don’t know
I know the wait sucks
Ambulances came in
Try saying this:
That’s an interesting
perspective… here’s what I
know
I am not too sure but let me
check for you
I know the wait is difficult and it
can be frustrating but everyone
in there is working hard to get
you in as soon as possible.
Traumas came in
Parking Information
Short term Drop-Off Parking is located in front of the main hospital
entrance and Emergency Department free of charge.
Cars can be moved to Parking Lot A once the patient is seen by Triage.
*When parking in lots with the gated system, please be sure to take your
ticket with you after parking. Do not leave it in your vehicle. When you are
ready to leave the hospital, please pay at one of the Precise Parklink kiosks
located in the main lobby.
Please note that vehicles are not permitted to park alongside the sidewalk
adjacent to the main entrance. This restriction is in place to ensure the safe
onboarding and offloading of patients from patient transfer vehicles.
Current Parking Rates
 $2.00 per ½ hour
 $4.00 per 1 hour
 $8 for up to 12 hours (no in/out privileges)
 $16.00 Daily Pass (in/out privileges)
 $40.00 per 1 week (7 days)
 $80.00 per month (31 days, to be purchased at the St. Catharines
Site)
For more information, please email our parking office or call 1-888-7837275
27
Handling Complaints





Use effective listening skills when someone comes
forward with a complaint
Apologize on behalf of the hospital for their experience
Support the Hospital. Focus on the positives
Encourage them to speak to their care provider or unit
manager
Direct them to call the Patient Relations Specialists at
extension 44423
Think TEAM: Be supportive of Staff and others working hard to care
for patients. It is ok to let patients know that the ED is a busy place
and staff are taking care of many patients, some with critical illness
or injury.
Respond with HEART
Hear the Story
Empathize
Apologize
Respond and Take Action
Thank them for bringing forth their concerns
28
Understanding Patient Flow at SCS ED
The healthcare process begins as soon as patients walk through the
sliding glass doors. Their first stop is usually the waiting room and
this is where triage, registration and waiting takes place.
“Start Here” Window
 This is the patient’s first step
 The triage process begins here with a “quick assessment”
 The nurse completes a very brief work-up on the patient to
determine if the patient is stable (safe to wait) or unstable
(needs to be triaged immediately)
 If the patient is stable, they wait to be called by the Triage
Nurse.
Triage Rooms 1-3
 This is the patient’s second step
 This is where the Triage Nurses conduct a “full assessment”
and determines how severe or life threatening a patient’s
condition is
~FYI ~
Triage is defined as the process of categorizing patients based on the
severity of their symptom. CTAS is the scale used in Canada to rank
these patients
Registration Desk
 This is the patient’s final destination before waiting to be
brought into the ED
 The patient’s information is taken and their wristband is
printed.
* This new process can generate concern amongst patients so being
able to explain the process and clarifying the patient’s “next step” can
go a long way in alleviating stress.*
29
Factors Affecting Patient Flow and Wait Times
Patient flow describes the movement of patients through the
healthcare delivery process from admission to discharge. A patient
may experience wait times throughout this process.
Patient
Triaged
Waiting
Patient Brought
to Room or
UCC Chair
The wait time most commonly referred to is the time between arriving in
the ED to being brought to a room. As patient flow slows, wait times
increase.
What are the main factors effecting patient flow?
1. Volume of patients coming through the front door and the
severity of their illnesses.
2. Volume of patients coming in via ambulance and the severity
of their illnesses.
These patients may be rushed to a room immediately, or will be
brought to Unit C (ambulance offload unit), or if ED is
completely full, they will wait on stretchers.
Note: If patient is stable and does not require a bed, they may be
brought to the waiting room until a room is available.
30
~FYI~
The factors listed above may result in a patient being “bumped” up or
down the wait list.
CTAS 1-2 patients will typically be bumped-up the list.
CTAS 4-5 patients can be bumped-down the list.
However, the length of time a patient has waited also factors in.
Example: A CTAS 4 patient who has been waiting for four hours may get a
room before a CTAS 3 patient who recently presented.
3. Number of patients in the ED waiting for a bed on the medical
floors
4. Availability of rooms on inpatient units to receive patients
from ED. This is affected by the number of patients on
inpatient units, how many of them are being discharged and
what time discharge occurs. This is also impacted by the
availability of care for the patient post discharge whether that
be going home, or moving to other care such as Shaver
Rehabilitation, Long Term Care, Hospice and other facilities
where there can also be wait times for admission.
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Infection Control Procedures
1. Contact Precaution Signs
• Familiarize yourself with IPAC signs
• Understand differences between the signs
2. Personal Protective Equipment (PPE)
• Be comfortable with proper wear and disposal of PPE and
ask nurse to review if unsure
• Reference Donning and Doffing (Page 22)
• Ensure diligent hand washing practices
3. Other Information
• Kindly educate family members and/or patients
seen walking outside of a room with PPE
• Always check for contact precaution signs before
entering a room...if unsure, ASK!
32
Volunteers are permitted to enter rooms to provide comfort measures to
patients with signs for Contact Precautions and Droplet/Contact
Precautions. Be sure to read signs and wear the appropriate PPE. Providing
care in these rooms is not mandatory and each Volunteer will make his/her
own decision.
Volunteers are asked NOT
to enter rooms or provide
care to patients in rooms
marked with Airborne
Precautions Signs.
33
New Volunteer Orientation &
Training Process
NHS
Volunteer
Orientation
Department
Shadow
Shift #1
Start
Regular
Shifts
Department
Shadow
Shift #2
NHS Volunteer Orientation
Aim: Educate new volunteers on the mandate of volunteer
resources, the policies in place to maintain safety, confidentiality,
and professional conduct.
Department Shadow Shift
Aim: To develop a strong understanding of the department specific
role, way-finding throughout the department, how volunteers
communicate with patients, families and staff. Preparation of the
new volunteer to commence regular shifts.
34
Shadow Shift #1
Department Orientation
Where am I going during a shift in this department?
Focus:





Orientating the volunteer to the department’s overall layout
Orientating the volunteer to department processes (Triage
process, Nurse-to-patient assignment, etc.)
Orientating the volunteer to policies and procedures
commonly encountered (Infection control, confidentiality,
NPO-food/drink restrictions, etc.)
Introduction to volunteer’s role in patient care
Evaluate volunteer’s understanding of material covered
Shadow Shift #2
Role Orientation
What is my role and how do I fulfill it?
Focus:





Orientating the volunteer to their role within the department
Actively engage in patient and family interaction
Orientating volunteer on various tasks commonly—and
uncommonly—encountered during a shift
Confirm volunteer’s understanding of policies and
procedures (Especially: infection control and confidentiality)
Evaluate volunteer’s understanding of material covered and
comfort with the role
35
Interested in Leadership?
Consider becoming a Trainer!
At the foundation of the Emergency Department Volunteer team is a
small but mighty group of individuals who provide orientation and
training to new volunteers in the Emergency Department.
ED Trainers have





Minimum One Year experience in the Emergency
Department
Demonstrate success as an ED Volunteer
Consistently meet commitment for weekly shifts
Have a knack for teaching, role modeling, coaching
Good communication and Leadership skills
Please contact me at danderson@niagarahealth.on.ca for more
information if you are interested in knowing more about this
opportunity.
36
QUESTIONS???
Please seek out answers to any questions you may have:
Rob Smith – ED Volunteer Team Lead
Robert.Smith@niagarahealth.on.ca
Debbie Anderson – Coordinator, Volunteer Resources
danderson@niagarahealth.on.ca
or…
Speaking with the Charge Nurse on Duty, the Triage Nurse or
Emergency Department Manager Lisa Hildebrand
Thank you!
Thanks for taking the time to review this important information and
taking action on new initiatives to improve the experience for
patients and their loved ones in the Emergency Department. We
hope the information in this Handbook is valuable to you and helps
you make the most of your experience as an Emergency Department
Volunteer.
37