When Elsa* dials 911, not only does she know that help is on its way, but she knows where the Toronto Emergency Medical Services (EMS) Paramedics will take her and that her primary care doctor and Toronto Central CCAC care coordinator will be notified immediately.
Elsa is part of an initiative created by Toronto Central CCAC and Toronto EMS that also involves acute and primary care. The Emergency Department (ED) Transfer Package and Community Agency Notification (CAN) Program places patient safety front and centre, and ensures that individuals with multiple complex health conditions are supported and their needs communicated accurately as they transition through the health care system.
Research increasingly indicates that patients are at higher risk of medical errors and other adverse events during situations in which responsibility for care is being transferred from one care provider to another. These risks can be reduced through better coordination of care and increasing access to patient information for the provider who is taking over care of the patient. A medical transfer package is one example of how to ensure that necessary patient information follows the patient.
Elsa has Chronic Obstructive Pulmonary Disease (COPD) and diabetes, and lives with her husband who also has multiple health concerns. Previously, during an acute episode, she would be taken to the first available hospital. It meant different hospitals and doctors, answering many questions on each occasion, increasing her anxiety and disorientation. Sometimes her family doctor and Toronto Central CCAC care coordinator didn’t even know she’d been to hospital.
But this new partnership has changed all that. Elsa and her husband are assigned to one nearby hospital, and the ED Transfer Package includes the important information EMS Paramedics and emergency department staff need in the first two hours of caring for a patient. The Community Agency Notification (CAN) program ensures that one phone call by a Paramedic will automatically inform the client’s care team members whether or not the patient is transferred to hospital.
The heart of the ED Transfer Package is a single Patient Information Sheet, which includes important medical information, medications, ‘Do Not Resuscitate’ (DNR) status, cognitive status, communication and behavioural considerations, and special devices used by the patient. The information sheet was developed by Toronto EMS and Toronto Central CCAC in consultation with emergency department staff, pharmacists, patients and caregivers.
The information sheet is kept in a clear plastic bag with DNR orders, if any. Patients are encouraged to keep their medications in the bag too, so that Paramedics will have everything easily accessible if they need to transfer the patient to hospital. Paramedics are trained to look for the transfer package inside the front door or on the refrigerator.
Elsa and her husband keep their transfer packages on the fridge. A large sticker on their front door alerts EMS to look for the packages. Bright stickers on their health cards also alert paramedics or hospital staff (if they were to make their own way to hospital) to their participation in the program.
The second crucial part of the program, the Community Agency Notification (CAN) program, requires one phone call to be made by the EMS Paramedics or hospital staff. They leave a message on the CAN hotline with the patient’s name, CAN ID number, and the hospital receiving the patient. If the patient is not being taken to hospital, the reason is given.
The notification line automatically forwards the message via email or phone to everyone on the patient’s contact list, including the Toronto Central CCAC care coordinator, the Toronto EMS project coordinator, and the patient’s primary care provider. This allows them to follow up and even consult directly with hospital staff.
The ED Transfer Package and CAN Program demonstrate the benefits of integrated care to both patients and our health care system. Improved communication ensures accurate information is passed on in a timely way, improving patient safety and quality of life. Patients (and families) are more comfortable staying at home longer, delaying the need for long-term care. Calls to EMS and demand on emergency departments are reduced. * (not her real name)