Bruyère Continuing Care (ON)

  • Kathy Greene, Director, Department of Decision Support, Bruyère Continuing Care, Ottawa, Ontario 

Organizational Changes to Patient Flow Using a Centralized Evidence Based Referral and Triage System for Hospice Palliative Care Services

The healthcare system in Ontario is comprised of multiple vertically integrated care continuums that lack the intrinsic capacity to transition patients in a timely coordinated manner between settings. A lack of system integration creates situations where patients experience difficulty accessing timely care in the most appropriate setting. This can result for example in costly acute care beds being occupied by patients who could be more appropriately cared for in less costly sub-acute care settings. Optimizing patient flow between settings requires not only care providers to work collaboratively to remove access barriers, but also leveraging the use of technology aids such as the e-referral tools to facilitate efficient and coordinated access to care.

Creating an integrated hospice palliative care continuum is an identified priority of the Champlain Local Health Integration Network as a means to increase access for patients and their families to appropriate hospice palliative care services for end of life or symptom management care. One piece needed to support improved access to care is the addition of residential hospice beds to complement existing services at Bruyère Continuing Care and Ottawa Hospice Services. Funding for one new residential hospice was secured with its operation starting in 2013.  

This intervention project was designed to improve integration and coordination within the hospice palliative care continuum through the creation of a system of centralized referral and triage using e-referral technology. Before embarking on the development of an e-referral tool, a central referral and triage working group comprising stakeholders from Ottawa Hospice Services, Bruyère Continuing Care and the Community Care Access Centre developed evidence based admission criteria as well as a revised referral application to guide whether  patients are triaged to either a residential hospice or an inpatient palliative care unit. Having all hospice palliative care applications centrally triaged permits patients to be admitted to the most appropriate care setting, either to a home like residential hospice or to a specialized inpatient palliative care unit based on their needs. To assist in developing the e-referral tool, funding from two sources was secured to facilitate the launch of the SMART project: A System to Manage Access, Referrals and Triage of Patients to Palliative Care Units, Services and Hospices in Ottawa.

One objective of the SMART project is to create and launch a centralized e-referral system for existing hospice palliative care facilities with a plan to expand into future hospices that come into operation. Investigation of existing e-referral systems led to a decision to utilize two existing applications available at no cost through the Champlain Local Health Integrated Network and the Community Care Access Centre. Work is underway to develop background system architecture so e-referrals can flow between the two systems into one central portal, permitting all applications to be triaged according to established criteria. A launch date to pilot this e-referral system is projected to be the summer of 2013.

Increasing partnership between care providers and the clinicians who refer patients into this care continuum has the goal of improving patient flow by efficiently using available resources so patients and families can access specialized care in an organized and predictable manner. It is anticipated the SMART project will support an integrated hospice palliative care continuum by facilitating timely access to care, care coordination, seamless linkages between care providers as well as use of a common assessment and electronic documentation system. The SMART project’s e-referral system will permit the tracking of waitlist information as well as metrics such as wait times for admission so impacts of this e-referral system can be measured on an ongoing basis by the Central Referral and Triage Working Group.