Stopping the ripple effect and improving patient flow

When a hospital has a high number of patients who have finished the acute care phase of their treatment yet remain in an acute care bed, bottlenecks begin happen, making it difficult for staff to admit patients from emergency departments (EDs) to the hospital. Many patients in an acute care bed are often candidates for home care or rehabilitation, but cannot be discharged because the appropriate level of care is not available.

In February 2008, University Health Network (UHN) launched the start of a 15-month Alternate Level of Care (ALC) project, looking at ways to improve patient flow through the hospitals’ EDs and ultimately ensuring equitable access to services.

As part of the initiative, a multidisciplinary team of clinical leaders and staff from UHN as well as project management experts and technical specialists from Shared Information Management Services (SIMS) worked with multiple external stakeholders to build community partnerships in the interest of patient-centred care.

Building on a long-standing referral relationship, UHN worked collaboratively with the Toronto Central Community Care Access Centre (CCAC) to transfer patients safely and more efficiently back into their home communities with CCAC supports. By working alongside social workers, physicians and nurses in EDs, CCAC Care Coordinators can identify suitable clients more quickly, which can mean fewer unwarranted hospital admissions and shorter stays in the ED for those needing care.

Gayle Seddon, a Client Services Manager for the Toronto Central CCAC describes the ALC situation being faced by hospitals as a “ripple effect.” “One person sitting in a bed where they don’t need that level of care totally blocks the system for the person who is coming in through the ED who needs acute medical care,” explains Seddon. “As a result, the client in the ED now has to wait longer before he/she can be moved into the hospital to continue treatment.”

More than just moving one person out of a bed, ALC is about the impact of patient/client care allocation on the entire health-care system.

UHN’s Surgeon-in-Chief, Dr. Bryce Taylor considers community partnerships crucial to the long-term success of the project. “Relationships with referring organizations are the key,” says Dr. Taylor. “Whereas, the collection of data is the first step, the next steps and the most important ones are those relationships, those collaborations that we develop with other organizations so that we can get the patient into the right place.”