CritiCall Ontario: Improving access to care through change and innovation

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Lisa Paul was scared.

A year after taking over the helm of CritiCall Ontario, the province’s 24 hour emergency referral service for physicians, Executive Director Kris Bailey reflects on the incredible amount of planning and effort that has gone into improving the organization’s service delivery model during the past year. Kris and CritiCall anticipate the equally daunting, yet exciting work that lies ahead for the organization to be able to meet the growing demand for service. “In just twelve short months we have been able to bring new life to CritiCall Ontario by redefining our core business and developing new business strategies to address the growing demand for service,” says Kris. “We have an aggressive change agenda in place and health-care providers should be pleased by the changes they are seeing and are about to see over the next few months.”

Currently, CritiCall’s home office is located at the Henderson General Hospital site of Hamilton Health Sciences (HHS). While remaining part of the HHS family, in late August, CritiCall will move their core operations to a new, purpose-designed location in Hamilton that will enable them to more than double their current capacity from 5 to 14 call stations. CritiCall’s program managers will remain located in their respective regions of the province.

CritiCall is also front and center in leading several initiatives that are addressing the province’s access to care agenda:

• Dr. Avery Nathens, CritiCall’s Medical Director, Chairs the Telecommunication and Referral Workstream of the province’s Neurosurgical Expert Panel, one of five tracts under the Expert Panel focusing on improving neurosurgical patient referral processes.

• Part of the province’s Critical Care Strategy, Ontario’s Critical Care Information System (CCIS) is now ‘live’ in 116 critical care units across the province. Since implementation began in the spring of 2007, CritiCall program managers have been and are continuing to be the field resource by working directly with individual hospitals to train expert users on how to use the CCIS at each hospital site.

• Earlier this spring, the CCIS’ bed availability tool was mapped to CritiCall’s Bed Registry in 112 critical care units across the province. Every 10 minutes bed availability data from the CCIS is sent to the CritiCall Bed Registry to ensure real-time data is received regarding the number of available beds in the province.

• With an increased focus on patient safety, CritiCall has been working with the Provincial Council for Children’s Health (PCCH) Neonatal Intensive Care Unit Working Group to develop an infection monitoring system for Neonatal Intensive Care Units (NICUs) in Ontario, using CritiCall’s Bed Resource Registry as the foundation for the collection of this new data set. As a result of that important work, the Bed Registry now documents reasons for the closure of a NICU, qualification of infectious agents, and the organizational response to an infectious issue. A manual for use in all perinatal units has also been produced. The new data collection requirements and screens became ‘live’ in June 2008.

A key component of CritiCall’s service offerings is its ability to produce data reports for hospitals, Local Health Integration Networks (LHIN) and the province, based on the critical care data it collects through the call centre. These reports provide valuable information to support planning and resource allocation and the development of best practice. However, until recently CritiCall reports were often too individualized and did not allow for reliable peer comparisons and too cumbersome to translate to a systems level and therefore, less meaningful to the user. CritiCall has revamped the reports based on user feedback and is now providing both uniform discipline-based and system-based data, reflecting activity in all LHINs and all hospitals.

CritiCall recognizes that technology is a key enabler to moving access to care initiatives forward. To that end, CritiCall has partnered with Telus to implement a five-year, $2.3 million integrated patient e-referral service. The e-referral technology solution will provide CritiCall Call Agents with a simplified patient referral process that ensures the right information follows the patient wherever they may have to travel to receive medical attention. The solution also provides CritiCall with advanced reporting capabilities to help decision-makers better understand their operational needs and performance and support business planning.

The solution provided to CritiCall combines TELUS’ CallCentreAnywhere application with the TELUS iScheduler referral and waitlist capabilities, helping to schedule the patient journey by simplifying coordination of resources, facilities, tests and medical equipment across different medical facilities within the community, province, country or world. The Web-based platform uses audio and video features to enable health providers to schedule appointments, book equipment and rooms, and securely share and view electronic health information such as health records, lab results and medical images. This helps health organizations reduce patient wait times by making optimal use of their staff, equipment and facilities. The CallCentreAnywhere is a fully scalable contact centre solution that will enable CritiCall to route calls to contact centre agents internationally, record calls, and deliver improved service by providing agents with a single Web-based browser interface.

“It has been a busy year, to put it mildly,” says Kris. “I’m encouraged by the fact that we’ve made great strides in our ability to assist physicians in caring for people who are critically ill. I’m confident that with the continued support of the Ministry of Health and Long-term Care and health-care providers across the province, we will be able to do much, much more to improve access to, and the quality of care provided to Ontarians in what is perhaps, their greatest hour of need.”

Funded by the Ontario Ministry of Health and Long-Term Care, CritiCall Ontario connects hospital-based physicians to the resources they need to ensure access to the most appropriate care for their critically ill patient. CritiCall’s call volume has increased by 50 per cent since 2003/04.