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Wise resourcing

CHEO Ear, Nose and Throat clinic sees more children and youth than ever before

Seven women and one woman stand shoulder-to-shoulder in two rows in a hospital hallway. They are smiling, laughing and pointing to the woman at the far right of the photograph. 

Nobody feels the demand for services more than the physicians, nurses, health professionals, medical staff and clerks who are dedicated to providing exceptional care. Spurred on by the anticipation of ever increasing demand as the number of children and youth in Ontario continues to grow, the CHEO Ear, Nose and Throat Clinic (ENT) undertook a comprehensive review of everything they do. 

Just over two years ago, in June 2016, ENT launched this initiative. The goal was to ensure as many children and youth as possible are seen in the clinic — not only now, but also for years to come. They challenged the status quo and looked at every aspect of how the clinic was operating. 

Each physician was asked if there was anything that could be changed to make them more efficient. Dr. Jean-Philippe Vaccani, Deputy Chief of Staff and Chief, Division of Otolaryngology finds that he is able to see more children and youth if he schedules returning patients in the morning and first-time patients in the afternoon. No problem. The clerks now book Vaccani’s appointments this way.

Across the clinic, appointment times were standardized: Monday to Friday, 9 a.m. and 4 p.m. This may seem like a small change but standardization makes scheduling appointments easier and more reliable. There are less no-shows which means more children are seen in clinic since every no-show represents an appointment that could have been used by someone. 

To further assist with scheduling, physicians committed to locking themselves into clinic times three months at a time — the doctors must plan their vacations and conference leave well in advance. CHEO’s experience shows that three months in advance is the sweet spot for appointments — much shorter notice and families may have difficulty making arrangements, much longer and appointments are sometimes forgotten. Again, this has resulted in less no-shows and more children and youth being seen. 

ENT nurses call families for an over-the-phone assessment before a clerk books their appointment. Occasionally, it is discovered that an appointment is not required and the care would be better in the hands of their community physician. 

“In all of these calls, the safety of children and youth came first,” says Vaccani. “If a child is moved back into the care of their community physician, that doctor is called to ensure continuity of care and that no child falls through the cracks.”

After two years of innovating and improving, as of July 2018, the CHEO ENT clinic is seeing more children and youth than ever before.

“It has taken a lot of work by all of our clerks, nurses and physicians to become as efficient as we can,” says Ariyan Marvizi, Manager, Ambulatory Care. “It is very satisfying for all of us to know that with no change in resources, we are seeing more patients and we have built a sustainable system so that this will continue for years to come.”

Bringing their respirator from home reduces anxiety for children, you and families

 A head and shoulders photo of Andrea Winters, CHEO’s Professional Practice Leader for Respiratory Therapy.

Respiratory Therapy now allows children and youth to use their own ventilators when they stay at CHEO. This improvement to care has two great benefits — children and youth are more relaxed using a ventilator they are familiar with and, especially during peak season, CHEO is not in danger of running out of machines.

“This initiative is the result of excellent team work to address two factors, current capital restraints and more importantly, patient safety,” says Andrea Winters, Professional Practice Leader for Respiratory Therapy.

When a child or youth is admitted, their personal ventilator is inspected by the respiratory therapist and biomedical engineer to ensure the unit meets all safety requirements for cleanliness and functionality. This eases the anxiety of children and youth (and their parents), knowing that of all the things they must contend with while in hospital, a new new-to-them ventilator is not one of them.

November to March is viral season, an especially busy time of year at CHEO. During these months, Emergency Department (ED) visits go up and there is an unusually high demand on hospital equipment, like ventilators. Allowing children and youth to use their own machine when they are admitted frees the corresponding ventilator for use in the ED.

“There have been times when all of our home ventilation equipment was in use, and loaner units needed to be arranged,” says Andrea. “Allowing someone to use their own ventilator will reduce the chances of this happening.”


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