TDMH emergency department enhanced by nurse practitioner

Nurse Practitioner Krista Wright heads up the Rapid Assessment Fast Track program in Tillsonburg District Memorial Hospital’s Emergency Department. The program has been successful in relieving pressure off the ED. (Jeff Helsdon photo)

Jeff Helsdon, Editor

Nurse Practitioner’s Week had an extra special meaning at Tillsonburg District Memorial Hospital (TDMH) with the success of a year of the Rapid Assessment Fast Track (RAFT) program under Nurse Practitioner (NP), Krista Wright.

Nurse Practitioner’s Week is November 10 to 14, a little more than a year after RAFT program was launched at TDMH in September 2024. The aim of the RAFT program was to reduce wait times, optimize team members satisfaction, optimize space utilization, and significantly improve overall patient flow, efficiency, and experience. It has checked the boxes in these areas to date.

The TDMH emergency department operates on a one-physician model, with the dedicated local doctors covering shifts and shifts filled from Health Force Ontario doctors. The ED does see a large number of patients with less acute conditions; these overall contribute to longer wait times for everyone that visits the ED. The introduction of the NP as part of the RAFT program has improved the wait time of patients with less acute conditions; and thus improved overall ED wait times.

Ministry of Health, Pay for Results program funding allowed the RAFT program concept to move forward at TDMH. April Mullen, Chief Nursing Executive & Vice President Clinical Services, explained a time and motion study of ED visits was completed prior to the program launch to inform the service.

“Based on our data, we thought that if we could have the RAFT program operating when the highest volume occurred, then we would have an effective program ,” Mullen said.

The RAFT program operates Monday to Thursday from 10 a.m. to 6 p.m., and Friday from 10 a.m. to 2 p.m.

Wright, who is from Windsor, worked 10 years as a Registered Nurse (RN) in London before returning to school to complete her Masters and Nurse Practitioner course. Her preceptor for her placement was Dr. Carroll Harder, who is now TDMH’s Chief of the ED. Wright worked for a year as a nurse practitioner in London before seeing the opening in Tillsonburg.

“I come from a fast-paced background,” she said. “Intensive care is fast paced. I liked the idea of having autonomy and still having back up.”

The system was set up for the RAFT program to see 10 to 12 patients per day. Wright usually sees 15 to 20.

“As we celebrate Nurse Practitioners Week, I want to express my appreciation for the incredible work our NP does every day, said Dr. Carroll Harder, ED Chief. “Our RAFT program has been an outstanding success this past year — improving patient flow, reducing wait times, and ensuring high-quality, compassionate care for every patient who comes through our doors. Krista’s leadership, expertise, and dedication have set a remarkable standard for our department. I’m truly proud of what we’ve accomplished together and excited to see how we can continue to provide excellent care for our community.”

The model used in Tillsonburg is unique. Wright only knows of nurse practitioners working in EDs in Windsor, Sarnia, and Goderich in Southwestern Ontario.

When a patient comes into the TDMH ED, they register and are triaged. At this point, they are given a Canadian Triage Assessment Score (CTAS) score. Wright only sees patients with a low to moderate acuity triage score.

“I look at the patient list and see what might be appropriate for the RAFT,” she said, adding she looks at it several times through the day.

NP have an extended scope of practice that includes diagnosing prescribing medication, and ordering diagnostic tests. Examples of medical concerns Krista may care for include sore throats, stitches, applying a cast, upper respiratory conditions, ordering tests, prescribing antibiotics, ear infections, measles and gastro-intestinal conditions.

“If they’re more complicated, I consult with the ED physician and we go from there,” she said.

Patients entering the RAFT area will notice it looks different than the remainder of the ED department. Along with the two beds, there are three chairs.

“We have included chairs so I can see more people,” she said, explaining people with low to moderate acuity issues don’t always need to lie in a bed.

That doesn’t mean that she hasn’t found some serious health issues in the last year. She has found people who came for other issues who had cancer and heart conditions, and has had to support admitting people.

The RAFT program is not to provide care for ongoing conditions, or to renew prescriptions. Wright said those people should visit their family doctor or the clinic for unattached patients led by the Ingersoll NP led clinic located in the Roulston’s Pharmacy

So how do patients like the new care model in the Tillsonburg ED? Mullen said they have results from patient experience surveys, and “They’re glowing, people love Krista. They love the time spent with Krista and they leave understanding their condition and next steps in care.”

The numbers also tell a positive tale. The year before the RAFT system was implemented, the average wait time to be seen by a physician over the entire year was 2.3 to 2.8 hours. Since RAFT has been in placethis time has been reduced to 1.7 to 2.4 hours.

“These achievements are a direct reflection of the dedication and collaboration of the ED team, who embraced this innovative model to serve patients and families better,” Mullen said. “The past year clearly demonstrates how innovation, teamwork, and a commitment to excellence can drive meaningful impact in emergency care.”