A new approach to long-term care discharge adopted by The Scarborough Hospital (TSH) and Yee Hong Centre for Geriatric Care (YHC) is going a long way in providing a seamless transfer of patient information between acute care and long-term care facilities.
“It’s the result of an ongoing process whereby we invite our long-term care partners to discuss how we can improve the continuum of care between long-term care and acute care,” explains Nancy Veloso, Manager, Social Work at TSH. “Last February, it became obvious that there was the need to improve communication practices.”
Indeed, a review of the patient transfer process showed the paper flow of discharge summaries were often missing when patients were discharged. “A considerable amount of time was spent by clinicians on the phones at both sites to obtain the necessary clinical data, such as physician orders, medication history, consultation reports, lab, x-ray and special scan results,” explains Teresa Ku, Director of Resident Care at YHC – Scarborough McNicoll. “This information and data are critical to the continuum of care between acute care and long-term care with respect to the patient’s health.”
That’s where information technology comes in. A joint pilot project between TSH and Yee Hong improved the discharge process of long-term care residents admitted to TSH by sharing clinical information with Yee Hong. The project was headed up by TSH’s Sharon MacSween, Applications Manager and Francine McCatty, Applications Analyst of Information Services at The Scarborough Hospital as well as Chris Cheng, Manager of Information Systems from YHC.
“Until now, there has been no mechanism for the hospital to send test results to the nursing home automatically,” MacSween says. “Now, Yee Hong staff can log on themselves to monitor and wait for results.” This allows access to the patient information by Yee Hong staff as soon as patients arrive at the hospital and allows them to continually keep on top of the progress of the patient remotely.
“TSH developed a MedSeek portal solution that allows YHC staff to view patients’ clinical data and information that is critical when the patient returns from the hospital,” Ku adds. “Patient privacy and confidentiality were strictly observed. The portal does not only support timely information accessibility, but enhances communications and service efficiency for both parties.”
By all accounts, Yee Hong lauds the system enhancement. “There has been a noticeable reduction in telephone calls to the hospital, which means more time for nurses at both TSH and YHC to focus on their patients or residents,” says Winnie Wong, Director of Resident Care at YHC Scarborough Finch. “Instead of calling the hospital, nurses at YHC now routinely check the portal for investigation updates and treatment recommendations from specialists whenever a resident transfers to the hospital.”
And the future looks bright for this new approach to long-term care discharge management.
“There are seven long-term care facilities in queue to come online,” MacSween says. “The constant dialogue between long-term care and the hospital, along with IT involvement, can improve the use of technology within the hospital so we can improve the circle of care.”