You have been feeling crummy for a while. Your stomach hurts and after seeing your family doctor once again, she thinks it’s time for you to see a specialist. She makes a call and you are told to head to emergency.

Each day, about 42 patients arrive at Royal University Hospital emergency, not to see an emergency physician, but after being referred by their physician to see a specialist. These visits are called “consults” in health care. And right now, patients receiving consults are triaged, registered and seen in the emergency department.

RUH emergency room exterior

Moving consults out of emergency and into a more appropriate environment is just one piece of streamlining patient flow from the community into the emergency department.

Care providers know it’s important these patients receive care because they have urgent needs, but question if waiting in emergency or sitting in an emergency bed is the best environment to serve them.

“Often, we see patients waiting to see a specialist in an emergency bed or our waiting room and they have to experience the hectic environment that is the reality of emergency medicine,” explains Dr. James Stempien, head of adult emergency medicine. “These patients don’t need assessment by an emergency physician because they have already been referred to a specialist.”

Moving consults out of emergency and into a more appropriate environment is just one piece of the admission process that a team led by Sandra Blevins and Dr. George Pylypchuck are looking at to help streamline the flow from community to emergency.

“Idea sheets we received from physicians, including specialists, indicate many want a more appropriate location, outside of emergency, to see patients needing this consult,” says Sandra Blevins. “During this Better Every Day 14 Day Challenge, we have been trying to determine where that would be. The space needs to work for the type of care and equipment required for the specialists.”

One idea is to support video consults so that patients don’t have to come to emergency to be seen.  But the team is also working on what the consult service should look like and where the right location may be to have this in hospital. This includes mocking up some test areas to see if the service can be supported in a different physical location at Royal University Hospital.

“We know these patients require urgent care, and data tells us 65 per cent of patients who come in for these consultant visits are admitted to hospital,” says Blevins. “The belief is they are better served by not having to wait and be seen in emergency first when they don’t need to be there.”

For more stories and information about the Better Every Day 14 Day Challenge, visit