Improving system integration through stakeholder feedback

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By Dr. Andrew McCallum

I started my career moonlighting as an emergency physician in a small town hospital. I loved it. Working with few staff and limited equipment made for a challenging and rewarding environment. However, as the only physician on duty,  I often had to spend time away from the patient making arrangements for transport.  And while caring for patients, I wanted to know that transfer of care and transport to a more appropriate centre could be readily arranged – and quickly.

Thus, when I became CEO of Ornge in 2013, I understood Ornge’s central role in connecting patients with care.  System integration became a key goal in our 2014-2017 Strategic Plan, where we aimed to collaborate with hospitals, paramedic services and other partners to make patient transport easier to arrange and more seamless.  To that end, we have implemented a number of initiatives. I’d like to detail some of these.

We have instituted a Rapid Estimated Time of Arrival (RETA) initiative.  Critically ill or injured patients need to be transferred to definitive care as quickly as possible.  We’ve reduced the amount of information collected for emergent patients. Crews are dispatched virtually immediately, reducing time on the phone.  Thanks to hospitals’ feedback, we are now providing an initial ETA during the hospital’s first phone call to Ornge, updated with a more precise ETA as needed.

Ornge partners with CritiCall Ontario and Central Ambulance Communication Centres (CACCs) on the Ministry of Health and Long-Term Care’s One Number to Call (ONTC) project.  The goal is to enhance access to critical care for inter-facility life or limb patients – transfer to the closest, most appropriate hospital via the most appropriate method of transport. This process removes the onus from the sending hospital to arrange patient transportation.  CritiCall coordinates transport with Ornge or the appropriate Central Ambulance Communications Centre (CACC), monitors ETAs and confirms arrival time at the receiving facility.  This aligns with Ornge’s goal of streamlining inter-facility patient transportation.  Though there’s more to be done, the foregoing represents a significant improvement.

As part of Ornge’s Strategic Plan 2017-2020, we will be introducing an online portal for hospitals to check the status of flights (approximate aircraft ETA, etc.) for same-day urgent and emergency patients, and to electronically book next-day non-urgent patient transports. The portal will improve efficiency for hospital staff, as no phone call to our Operations Control Centre will be needed to book a non-urgent transport.

Ornge is also working with Paramedic Services and CACCs in northern Ontario on a project to speed air ambulance response for time-sensitive cardiac, trauma and stroke patients.   We are working toward direct transportation to regionally-based definitive care for time-sensitive clinical presentations, aimed at improving outcomes.

These and other system improvements are directly related to the feedback we hear from stakeholders. We greatly value this information. We at Ornge know how important our service is to hospitals and patients and are committed to using feedback to continually improve our service to patients.

Dr. Andrew McCallum is President and CEO of Ornge.

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