Moments after Hamilton Health Sciences’ (HHS) new digital records system went live on June 4, an air ambulance helicopter landed on the roof of HHS Hamilton General Hospital, carrying a trauma patient and then a stroke patient in need of from immediate intervention, arrived by ambulance.
The simulations helped prepare Hamilton General Hospital’s emergency department for the launch of Epic.
It was a trial by fire for the emergency department (ED) team, which had just accessed the new Epic hospital information system for the first time, when these two patients walked through their doors.
“We didn’t expect perfection when we launched Epic, but our team was well trained and ready.” — Dr. David Quinlan
With the flick of a switch, around 5:30 a.m., Epic replaced dozens of electronic and paper systems, making every patient’s medical information available in one secure place online. In an instant, long-established medical and administrative workflows changed dramatically.
Dr. David Quinlan, emergency room physician and trauma team leader at HHS Hamilton General Hospital
Epic’s many benefits include improved communication between HHS doctors, nurses and other health care providers, faster access to patient information, including test results, and improved patient safety.
Pre-practice pays off
The ED team was well prepared for the transition thanks to months of prior practice using Epic’s training tools. But there was a learning curve once the new system went live.
“We didn’t expect perfection when we launched Epic, but our team was well trained and ready,” said Dr. David Quinlan, ED physician and trauma team leader at HHS Hamilton General Hospital.
The training involved practicing nine simulations in the weeks leading up to the launch – three blue codes, meaning no vital signs; simulation of a single stroke in which the patient requires clot-busting therapy; and five trauma simulations, including an air ambulance scenario.
“The stroke and air ambulance simulations were very similar to what the EMS team experienced on launch day,” says Quinlan. “As a result of all their practice and preparation, including these simulations, our patient-centered goals and treatment were not delayed. At the end of the day, that’s what matters.”
Sarah Hayow, ED Clinical Educator at HHS Hamilton General Hospital
The simulations were prepared by a focus group including Quinlan and ED clinical educator Sarah Hayow. They were released into trauma units during quiet moments, with mannequins posing as patients. Everyone involved in ED care participated, including physicians and staff from radiology, surgery, transfusion medicine, and allied health care, 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 requiring a blood transfusion, we used dummy blood products to represent real blood. This included ordering blood products through the practical tools of the Epic system. These dummy blood products were placed in a cooler and collected by a porter who delivered them to the trauma unit. The units of blood were then checked and suspended over the transfusion manikin.’
Meeting the challenge
Hayow contributed to the joint implementation of the simulations with Quinlan. “Our team really had the opportunity to practice,” says Hayhoe, who was working the morning Epic went live to help troubleshoot issues.
“Our team members kept calm, dug in, and quickly got our patients the help they needed because that’s the emergency way.” – Sarah Hayow, ED Clinical Educator
“We had just turned on the Epic system when the air ambulance arrived, followed about five minutes later by the stroke patient,” Hayhow recalls. “Every nurse was trying 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, dug in and quickly got our patients the help they needed because that’s the emergency way.”
Although there were some issues on the launch day, the team managed to overcome them effectively.
“For example, there were difficulties in printing blood labels, but we were prepared with a back-up plan,” Hayhow says.
Since launch, ED team members have continued to work on smaller challenges, such as adapting to new workflows and processes.
“Everything has changed, from the way we document, to the way we take blood tests, to the way we administer medication,” Hayhow says. “Every day we learn more through hands-on experience about how everything works and looks in an ED environment. And every week it gets easier.
A change for the better
While change is never easy, in Epic’s case it is welcome.
Epic is considered one of the best systems in the world and is used internationally by many high-profile hospitals. Hamilton Health Sciences is among the first hospitals in Canada to implement Epic’s newest and fully electronic system.
Dr. Barry Lumb, executive leader 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 to provide the best possible care for our patients,” said Dr. Barry Lumb, executive director of system implementation at HHS.
Michelle Leafloor, vice president of health information and technology services and chief information officer for HHS, calls Epic the future of healthcare.
“With Epic, not only will we be able to do even more to improve the health outcomes of our patients,” says Leafloor, “we will also be able to contribute to research that will change the lives of countless patients outside of our own community.”
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