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Making the change – how a Canadian team changed emergency care at Cluj County Hospital in Cluj, Romania

During the month of October, Dr. Valerie Krym, Sunnybrook emergency staff physician, Dr. Delia Curea, resident physician and Steve Scott RN, traveled to Cluj-Napoca, Romania, to carry out a triage implementation project at the Cluj County Hospital. This is a university-affiliated hospital, providing tertiary care to 350,000 people in the city of Cluj and several million people in the region.

This initiative builds upon the successful completion of a comprehensive assessment of the Cluj Country Hospital emergency department and an education program for the physicians and nurses in October 2005. Hospital and university administration invited the Canadian team to return in 2006 to help set up a triage system. The project as a whole is part of an ongoing collaboration between the Romanian University in Cluj (Universitatea de Medicina si Farmacie) and the University of Toronto, initiated last year.

Triage is the process to assess and prioritize patients’ injuries and illnesses to ensure patients who need care the quickest are seen first.

The project developed throughout 2006. The first step in setting up their triage system was to host two emergency nurses from Cluj County Hospital at Sunnybrook. Kinga Ferenczy and Mihaela Bajko were at Sunnybrook Health Sciences Centre from August 27 to September 26. They received training in emergency care, triage, trauma, and Advanced Cardiac Life Support (ACLS). This nursing exchange was essential prior to the project in Cluj. It allowed the Romanian nurses to gain new knowledge and skills, and enabled them to help us train their Romanian colleagues.

In late September Dr. Krym, Steve Scott and myself returned to Cluj. We established a triage system, reorganized the emergency department, trained Romanian nurses and physicians in triage concepts, created a new emergency department patient chart and provided 24 lectures on selected topics requested by Romanian staff. The two Romanian nurses who were at Sunnybrook were instrumental in making this project possible, because they knew what’s the final purpose and already had the knowledge necessary to help. They participated in training their colleagues and have become leading triage nurses in their emergency department.

This year’s project was very busy because we had to create everything from scratch. We developed a triage area and reorganized the emergency department to accommodate the new triage system and patient flow. It was not an easy thing to do, but it is very rewarding to know that the new system will enhance emergency care for patients in Cluj and will lead to better use of resources, which are already limited. The Romanian physicians and nurses like the new system because patient care is prioritized and staff workload is better organized. The feedback from staff has been very positive, as confirmed by a little survey we did at the end.

Donations were critical to the success of the project. Sunnybrook donated medical supplies worth CAD$10,000 that were taken back to Cluj in September. In addition, donations from Canadian donors, most of them part of the Romanian community in Ontario, allowed the two Romanian nurses to receive training in Toronto, and allowed the purchase of medical equipment and supplies for the new triage system from local vendors, when the Canadian team was in Romania. Essential items such as a “white board” for patient tracking, BP monitors, a glucometer, stethoscopes, infection control equipment, chairs for the waiting room and much more, valued at a total of CD$3500, were supplied for the new system, which wouldn’t have been possible without the generosity of the donors in Toronto.

Sunnybrook nurses and physicians are among the best in their field and they are willing to share their knowledge in patient care and medical education with the Romanian counterparts, and we are really happy to let everybody know about this. Dr. Valerie Krym is spearheading this initiative, and will continue to use her extensive knowledge in international emergency medicine to move things forward.

A new project is underway in 2007, which will include shipping medical supplies to Cluj, and reshaping the educational system for the nurses and physicians in emergency, initiative that will push ahead the new changes and allow down the road the spread of knowledge to other centres.

We’ll share news and details about the future steps with you, as they proceed in the months to come. Until then, allow me to say THANK YOU for your help and ask for your continued support for this important emergency medicine initiative in Romania.

Dr. Delia Curea

* I would like to acknowledge Laura Bristow, Communication Advisor at Sunnybrook Hospital, for her contribution to this article.

Dr. Delia Curea    2/22/2007


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