CONNECTING C A R E, P E O P L E AND IDEAS
VOL 2 • NO. 1 FEBRUARY 5, 2018
Partnership leads to better patient care, better results A message from Maggie Bruneau, vice-president, Clinical Programs and chief nursing executive and Dr. Peter Nord, vice-president, Clinical Programs and chief medical officer
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ince the start of the new year, we have seen the rapid spread of flu and respiratory illness in the community, with many outbreaks occurring across the city and within our own network. As we’ve been operating in surge protocol since January, patient access and flow is a top priority across the network, and our six clinical site leads are collaborating on strategies to help mitigate Alternate Level of Care (ALC) numbers at our hospitals and make sure patients are receiving the right level of care they need in the right place. One of the newer strategies at play is the opportunity to admit patients to Providence Healthcare directly from emergency departments of our acute-care partners. This admission pathway opens up a more seamless and timely flow for patients who do not require care in an acute setting, but may benefit from a short admission to rehabilitation.
Alternate Level of Care
Let’s look at an example of a woman who arrives at St. Michael’s Emergency Department (ED) with a fractured pelvis. The most appropriate care setting for her may be a rehab hospital, like Providence, where she would be medically cared for, have her pain managed, and begin a suitable rehab program as quickly as possible.
ALC refers to a patient occupying a bed in a hospital but does not require the intensity of resources or services provided in that setting. ALC poses a system-level problem as it affects a hospital’s ability to care for acutely ill patients. 1
Until recently, Providence would have only been able to admit this patient from a bed at St. Michael’s, meaning she would have moved from the ED to an inpatient unit to wait for her care team to initiate a referral to Providence. This process could take several days, creating an ALC concern at St. Michael’s and delaying the start of her active rehab. ALC continued on page 2
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NEW PATHWAY TO PROVIDENCE
ALC AT A GLANCE
WORKING TOGETHER
NEWS BRIEFS
OUR SHARED PURPOSE • VOL. 2 • NO. 1 • FEBRUARY 5, 2018 • page 1
AT ST. MICHAEL’S Alternate Level of Care rounds
Like most units at St. Michael’s, Trauma and Neurosurgery has a lot to cover during its daily and weekly rounds. Many of its patients have complex injuries and illnesses and most require continued care after they leave the hospital. A special characteristic of one of the rounds – the weekly ALC rounds – is that in addition to case managers, social workers and nurse practitioners, they are attended by the same two LHIN home-care co-ordinators every week. The result is improved communication and understanding between the unit and home care and a faster transition for patients who are ready to recover at home or elsewhere in the community. The purpose of this collaboration is to ensure that patients are transitioned home safely with the support they require and to create capacity within Trauma and Neurosurgery unit.
OUR NETWORK Under the new scenario, the St. Michael’s ED team can quickly identify patients who do not need acute admission but need rehab and support post injury or illness (typically, our Geriatric Medicine or Orthopaedic Rehab are the most suitable programs for these admissions). The ED team now liaises directly with Providence’s patient flow team to jump-start the process to bring her to Providence. Alternate Level of Care continued from page 1 1
Health Quality Ontario’s Quality Compass, December 2016
The end results are fewer inpatient admissions at St. Michael’s, ALC avoidance, and – most importantly - a better health outcome for the patient. While Providence can also admit patients directly from St. Joseph’s Health Centre’s ED, there hasn’t been the same volume of patients because of our geographic distance - most patients like to be treated locally. Our teams are continuing to discuss ways to make this admission pathway more viable.
AT ST. JOSEPH’S Early discharge planning The healthiest place for most people to be is in their own home. That’s why as soon as a patient is admitted to St. Joseph’s Health Centre, our teams are planning for their discharge – we want them to get back to an environment where they’re comfortable and functional as quickly as possible. To help make that happen, an interprofessional team in our Emergency Department (ED) works with the medical team to help patients get the care they need and then move to the appropriate next level of care. This team includes a transition planner, occupational therapist and a geriatric emergency medicine (GEM) nurse. If the patient doesn’t need to be admitted, this means helping them to be discharged straight from the ED, and if they do require further care, it means starting the planning of where they’re going to go after their hospital stay before they’re even admitted. When a patient moves on to a unit, conversations about discharge happen with physicians, members of the patient’s care team, along with their family so everyone is aware of the plan and can help provide support.
How we’re working to ensure better patient care Thank you! Creating strategies that provide patients with the right care, in the right place at the right time has positive impacts on flow and the experience our patients and families have while in our care. The above highlights a few things our teams are doing to create those seamless transitions of care.
Thank you for your continued commitment to caring for people during a very difficult flu season, and for being mindful of the many ways in which our network can collaborate to enhance patient care and positively impact the larger health care system in Toronto.
Providence Healthcare Floating office makes the rounds
You might not think much at first about the impact of a cart on wheels, a laptop and a fake plant to improve patient care, but Providence Healthcare’s collaborative learning specialist, Melissa Goddard, is seeing the positive effect of her ‘floating office’ on both staff engagement and patient safety. With her miniature cubicle on wheels, Melissa takes her work ‘on the road’ in clinical areas to promote collaborative learning opportunities. The results? Patients and families engage and smile; clinicians share their education goals; and staff express patient safety concerns, which Melissa brings forward, with permission, to the patient safety manager. As Melissa says, “the floating office is like a watercooler stop for staff to comfortably speak, in the moment, about what matters to them. I also hear the patient/family voice, and it grounds my work.”
St. Joseph’s Health Centre A new path of care for heart failure patients
Heart failure (HF) is a condition that as many as 600,000 Canadians are living with every day, and last year, approximately 570 patients with HF were seen through St. Joseph’s Emergency Department (ED). As part of a UHN-led research study, St. Joseph’s has launched a Rapid Heart Failure clinic, receiving referrals from doctors in the ED and providing quick follow up with patients within 48-72 hours of discharge. The clinic is a partnership between the ED, Cardiology, Ambulatory Care Centre, Medical Diagnostics and Research teams, and the Health Centre is one of ten sites participating in the study over the next two years.
St. Michael’s Hospital Doug Sinclair to step down
After more than eight years as chief medical officer and vice-president of Programs at St. Michael’s Hospital, Dr. Douglas Sinclair will be stepping down at the end of March. Dr. Sinclair has been a leader on many fronts, including on clinical programs, a champion of physician practice and a strong voice at many provincial health-care tables. Moreover, he has been a thoughtful patient advocate consistently ensuring that quality and compassionate patient care are delivered throughout the hospital and in our family health teams. He’ll continue to keep some clinical hours in the St. Michael’s ED, staying close to the work with patients that he loves.
oursharedpurpose.com Our Shared Purpose is an internal newsletter intended to keep staff at all three sites informed about our integration and transition plans, as well as highlight key achievements and activities at each of the sites. Our Shared Purpose is published monthly by the Communications teams at Providence, St. Joseph’s and St. Michael’s. If you have any questions about any of the articles, please visit oursharedpurpose.com to submit your inquiry. OUR SHARED PURPOSE • VOL. 2 • NO. 1 • FEBRUARY 5, 2018 • page 4