When working at St. Joseph's you will need to be familiar with the procedures for access that ensure patients, physicians, dentists, midwives and employees can access the building after hours if required.
Entrance 2200 to 0800 hours
Patients arriving between 2200 and 0800 hours will enter via the Grosvenor Street Outpatient and Admitting Entrance. This door will be unlocked and security will be present to assist. Ambulance stretchers and transport isolettes will fit comfortably through this entrance.
Ambulances 2200-0800 hours
The only patients arriving by ambulance between the above hours are those who meet the following criteria:
Pregnant woman greater than 20 weeks gestation who are medically stable but who will likely require the NICU;
Pregnant women who are currently under the care of a St. Joseph's Obstetrician;
Surgical patients who have been triaged at another Emergency Department (LHSC or local community) and have been accepted for care at St. Joseph's; and
Medicine/Family Medicine patients who are a direct admission from LHSC or a prearranged admission from Family Practice for palliative care.
Sexual assault & domestic violence patients requiring an ambulance will go to an Emergency Department.
Process for Accepting Patients after 2200 hours
Surgical Access
If you are contacted by a post-operative patient or physician from another location, collect key medical information to determine if the patient meets the criteria for care at St. Joseph's.
If yes, and you wish to accept this patient, please contact the Resource Nurse (pager 16999) to ensure that resources are available to accept this patient at this time. Please notify the referring physician or facility of the decision to accept/refuse care.
The Resource Nurse may facilitate the process by contacting the patient or the referring physician, if requested. The Resource Nurse will link with the Security Officer located at the Grosvenor Street Outpatient and Admitting Entrance to ensure smooth access. Security will notify Admitting.
An essential aspect of the surgical access to care is to have a dialogue with the Resource Nurse so that a smooth process can be assured for the patient and the physician and that capacity is available.
Orders are to be received within 15 minutes after arrival of the patient in order for the Resource Nurse to institute care.
Obstetrical Access
Term pregnant patients coming to the hospital in labour will access obstetrical triage after hours without speaking with a physician. Pregnant women greater than 20 weeks gestation who arrive by ambulance due to a pregnancy related problem will be accepted directly to Obstetrical Triage.
If you are contacted by a patient or physician from another location between 2200 and 0800 hours collect key medical information and determine if this is a medically appropriate patient to accept at St. Joseph's Hospital.
If this is a medically appropriate patient and you wish to accept this patient, please contact the Triage Nurse (extension 64714) to ensure that resources are available to accept this patient at this time. Please notify the referring physician or facility of the decision to accept/refuse care.
The Triage Nurse may facilitate the process by contacting the patient or the referring physician, if requested. The Triage Nurse will link with the Security Officer located at the Grosvenor Street Outpatient and Admitting Entrance to ensure smooth access. Security will notify Admitting.
An essential aspect of the obstetrical access to care is to have a dialogue with the Triage Nurse (Obstetrics) so that a smooth process can be assured for the patient and physician and that capacity is available.
Orders are to be received within 15 minutes after arrival of the patient in order for the Triage Nurse to institute care.
Risk Factor and Co-morbidity Screening
Considerations related to risk factors and co-morbidities when accepting a patient after hours include:
Post -operative procedures that:
Routinely require post operative intensive care admission
Require major or prolonged invasion of abdominal or thoracic cavities
NOTE: Minimally invasive procedures of the abdomen are acceptable
Are life threatening in nature
Routinely have an expected length of stay greater than 72 hours (post Milestone 2) due to extensive co-morbidities
Co-morbid disease producing high risk of serious perioperative complication will lead to exclusion. Conditions recommended for non-consideration include:
Severe latex allergy
Moderate to severe sleep apnea with co-morbid conditions
Unstable cardiac disease
Advanced respiratory disease (severe activity limitation, or requiring home O2)
Resource Nurse Role
The role of the Resource Nurse at St. Joseph's Hospital is to facilitate patient access and provide care between the hours of 2400 and 0800. An Urgent Care Nurse will respond to this pager between 2200 and 2400 hours. Nurses in this role will be aware of anticipated patient arrivals, bed availability, and the Operating Room schedule. This information is essential for a smooth process of patient access.
Physician On-Call Guidelines
On-Call Professional Staff Members are expected to respond to a request for their services from St. Joseph's or LHSC:
By telephone: within a maximum of 15 minutes
In person: within a maximum of 30 minutes if the clinical situation arises.
The on-call response time is defined as the amount of time elapsing between the first successful notification of an on-call physician (verbally or by pager) of the need for his/her services.
Each Department will develop guidelines to be followed should the on-call Professional Staff Member not be available in a timely manner. It is the responsibility of each Department to distribute the guidelines to appropriate key stakeholders (ie. Switchboard).
It is recognized that these are maximum times for on-call Professional Staff Members throughout the institution. Individual departments may set out their own guidelines that fall within these maximums. It is further recognized that there may be a rare and unusual circumstance in which the on-call Professional Staff Member may be unable to respond within the times set out by these guidelines.
These guidelines will be suspended in the case of unusual and acute short-term patient volume increases such as those experienced in a disaster response situation. The Integrated Vice-President of Medical Education & Medical Affairs, Chair of the Medical Advisory Committee or the Chief of Staff (or their delegates) may suspend these guidelines.
