Emergency Code Notifications
IWK Health Centre
Halifax, Nova Scotia, Canada
Matthew Campbell, P.Eng., MBA
Director
Planning, Performance & Information Management
Bev Higgins
Manager
Telecommunications & Desktop Support
IWK Health Centre
IWK is an Atlantic Canada hospital that
provides care to over two million residents
of Nova Scotia, New Brunswick, Prince
Edward Island and some sub-specialty
populations from Newfoundland.
– 222 Acute beds
– 25 24/7 Residential beds
Some Impressive Statistics
(2012/2013)
250,000
227,303
4,800
Pediatric Surgeries
200,000
3,265
Gynecology Surgeries
150,000
100,000
371
Breast Health Surgeries
50,000
27,107
126
Life Flight Transfers
0
0
2,000
4,000
6,000
Ambulatory
Visits
ED Visits
IWK Connexall Journey
IWK & Connexall
Partnership
Nurse Call
Patient
Monitors
RFP Pending
New
Implementation
– Stabilizing
Enterprise Suite
Fan Out
Code White
Medical
Initial 3 Implementation
Opportunities
Non-Medical
EOC Activation
Snapshot of
Implementation Status
IWK Connexall Journey
Steering
Committee
Oversight
Committee
Large Membership
Small Membership
Evolution &
Learning
Project & Clinical
Representation
Clinical &
Operational
(Director)
Representation
Implementation
Focused
Strategically
Focused
IWK Connexall Journey
Project
Lead
Technical
Trainer
Core
Team
PM/IE
Technical
Lead
BioMedical
IWK Connexall Journey
Case Study: Implementation of Fan Out Solution
Fan Out Solution
IWK saw an opportunity to apply the Fan Out Application as a
Health Centre wide solution AND to Fan Out to specific teams
of individuals. (Code Teams)
Medical Teams
Non-Medical Teams
• Neonatal Response
• Trauma
• Code Blue
• Obstetrical Response
• Code Red
• Code Brown
• Code Yellow
• Code White
Current State Analysis:
Connexall Team accompanied by IWK Emergency Preparedness /
All Hazards Team conducted a series of drills to identify areas to
improve response times and streamline our workflow
• NICU Workflow
• MSNU Workflow
• Code Red
• Code White
• Code Yellow
• Code Brown
• Neonatal Response Team
• Trauma Team
NICU Workflow Analysis:
Workflow Improvement Opportunities via Fan-out Solution:
Over Communication
Overhead Paging
Nurse ‘Shouting’ for Assistance
Stat Announcements
E-Nurse Carrying Two Pagers
(RT, Beta Team, Neonatal Team)
(Routine & Stat)
Observations
Communication Disconnects
Charge Nurse Unable to Locate Staff Nurse
Pager Voice Component Unclear –
Await Overhead
Pager Infrastructure
Dead Zones?
One Way Communication
Neonatal Response Team
Connexall Team & IWK Core Team Observed Drill - Many Opportunities for Improvement
Staff Call Early Labor
Unit Directly
• Proper
Procedure is to
Call Internal
Emergency
Staff Ultimately
Contact Switchboard
• Identify Code
Blue Team Being
Required
(Incorrect)
• Clarification
Made
• Neonatal Team
Notified via
Pager &
Overhead
NICU Physician
Arrives
• Where is the
Team?
Team Arrives
• ‘Extra’ Staff that
were Not Called
Arrive as Well
• Protection
Services
Required for
Crowd Control
Opportunities for Improvement
Direct
Direct
Activation
Activation
from
from
Workstation
Workstation
Eliminate
Eliminate
Middle
thethe
Middle
Man
Man
Eliminate
Eliminate
Overhead
Overhead
Announcing
Announcing
Eliminate
the Need
for Crowd
Control
Right Person
Right Place
Right Time
Eliminate
Eliminate
Assumptions
Assumptions
Other Medical Codes
Additional Medical Codes were observed to identify opportunities to
streamline workflow and improve response times:
Obstetrical Response Team
Trauma Team
Non Medical Codes (Quick Win!)
Code Brown – Hazardous Substance Spill
Code Yellow – Missing Patient
Code White – Violent Person (Aggression)
Code Red - Fire
Code Green - Evacuation
Code Black – Bomb Threat
Code Grey – External Air Exclusion
Let’s Focus!
Switchboard and Protection Services
Trauma
Team
Code
White
Medical Code
Non-Medical Code
Synopsis:
Synopsis:
Up to 15 Mins for
switchboard to complete
– every second counts.
Workflow design and
process for
implementation to serve
as benchmark for all
non-medical codes.
Code White: Before Connexall
Procedure
Code White
on Unit
Unit Calls
SWB to
Request
Code White
SWB
Transfers
Call to
Protection
Svcs
SWB
Initiates
OHA
Protection
Svs Assesses
& Responds
to Unit
Protection
Svcs Uses 2Way Radio
to Engage
Addt’l
Resources
As Required
Protection
Svcs
Declares “All
Clear”
Protection
Svcs Notifies
SWB to
Initiate OHA
‘All Clear’
Code White: Before Connexall
Reality
Code White
on Unit
Unit MAY
Call SWB to
Request
Code White
OR Call
Protection
Svcs Directly
Protection
Svcs
Dispatches
Officer to
Unit
Protection
Svcs Arrives
on Unit &
Determines
if Addt’l
Resources
Req’d
Protection
Svcs Uses 2Way Radio
to Engage
Addt’l
Resources
As Required
Protection
Svcs MAY
Contact
SWB to
Request
OHA
Protection
Svcs
Declares “All
Clear”
Protection
Svcs MAY
Notify SWB
to Initiate
OHA ‘All
Clear’
Code White – Enter Connexall
Picture
Initiating Clinical Unit, Protection Services OR Switchboard Can Now
Activate Providing Full Detail to Responding Officers.
Code White – Enter Connexall
Picture
Example Notification Received by Protection Services
Fan Out – Where to Next?
Emergency Operations
Committee
Trauma Team Activation
Neonatal
Response
Team
Code Red
Code
Orange - ED
Housekeeping
Connexall & IWK
Looking to the Future
ED
Patient Monitors
Appointment
Reminders
• Code Orange
• Lab Results Notification
• Bed Management
• Continued Stabilization of Initial Implementation
• Identification of Integration Opportunities
• Understanding Work Flow Opportunities
• E-mail/Text Policy Approved
• Great Demand for Functionality – Impact on Patient No-Shows
• Can Connexall be Leveraged?
Oversight Committee Actively Seeks Out Opportunity to Achieve Value &
Efficiency to Better Support Patient Care via Connexall
Closing Thoughts
 Change is Difficult
 As a result, our approach has been one of ‘Incrementalism’
 Enterprise Suite – Tremendous Benefits & Flexibility
 Connexall Support – Cannot Say Enough About How Valuable It Is
Questions & Discussion
Thank You