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SIMS Partnership:
Toronto Community Care Access Centre and University Health Network
Emergency Room Notification
System Reduces Patient Overload in Emergency Rooms by Giving Patients Speedy Access to Alternate Services
Background
With an annual operating budget in excess of $1.3 billion, SIMS (Shared Information Management Services) is a partnership of seven healthcare organizations in Toronto that was created to achieve innovation in information management and information technology to support improved care delivery.
The Emergency Room Notification project is a joint initiative between two SIMS partners - the University Health Network (UHN) and the Toronto Community Care Access Centre (TCCAC). UHN encompasses three hospitals, Toronto General, Toronto Western and Princess Margaret, as well as Toronto Medical Laboratories. TCCAC is a community-based, non-profit, operational service agency, funded by the Ministry of Health and Long-Term Care and governed by a provincially appointed board of directors. It provides one-stop access to health and personal support services to help individuals live independently in their homes, or assist them in making the transition to a long-term care facility.
Challenge
Overcrowding in hospital emergency rooms is compounded by a significant number of unnecessary admissions - often of patients who have recently been discharged from the ER who re-present themselves at the ER rather than seeking care from the wide array of alternate healthcare resources available in the community.
Although ER staff attempt to refer appropriate cases to the TCCAC and other community services, the process until recently was a manual one that required ER staff to examine the medical profile and history of each patient presenting at the ER to arrive at a referral decision.
As a result, only the obvious and easy-to-identify cases usually were identified as potential candidates who could return home safely with community support, thus avoiding the need for a hospital admission. In the case of the UHN, this amounted to only 35 emergency patients a month at each site who were referred to the TCCAC.
In addition, those patients admitted to the ER often spent an unnecessarily long time there awaiting a TCCAC assessment. With a "walk-in" visit to the ER costing an average of $175, excluding physician costs, and each day spent there costing an additional $330, excluding physician costs, unnecessary ER visits place a significant financial burden on the healthcare system.
Solution
A new ER Notification system developed by SIMS has automated the patient referral process, enabling rapid TCCAC assessments and reducing the number of ER visits and shortening the length of stay.
When a patient is registered in the hospital information system at the time of admission to a UHN emergency room, the ER Notification system automatically builds a profile of the patient based on information consolidated from a number of other UHN and TCCAC systems, including data on why the patient has presented to the hospital, whether he or she has recently received care at the hospital and whether the patient is currently receiving services from the TCCAC.
The ER Notification system passes this profile through a business rules engine to determine whether the patient is a suitable candidate for TCCAC referral and assessment, in which case a secure e-mail alert is automatically sent to a TCCAC care coordinator's wireless BlackBerry device.
At the same time as the e-mail alert, a corresponding event is sent to the ER whiteboard, which displays a flag informing ER staff that the patient is awaiting a TCCAC assessment. The ER whiteboard, of which there are 15 in each UHN emergency department, is a computerized board that tracks and displays patient status while in the ER. After an assessment, TCCAC care coordinators update the ER whiteboard to reflect that the patient is no longer waiting to speak with the TCCAC.
Results
The ER Notification system has transformed the way patients receive care into a more timely and seamless process. Now, an average of 650 patients a month at each ER site are referred for a wide variety of services, including linking to family physicians, support for managing chronic diseases and other appropriate services to keep them from returning to the ER.
Since January 2006, there has been a 52-per-cent decrease in the number of patients who present at the Toronto General's ER and a 31-per-cent decrease at the Toronto Western Hospital. Patients requiring a complete TCCAC assessment or re-assessment are leaving the ER up to one and a half hours earlier than before, thus freeing up a significant amount of ER bed time.
When the ER Notification system sends a notification for a patient who is already a TCCAC patient, the care coordinator is notified early enough to be able to put a "hold" on any previously scheduled in-home visits. This significantly reduces the number of "patient not found" visits by TCCAC care coordinators to patients' homes.
Although TCCAC staff handling the ER referrals are busier than ever, they report they are more satisfied with the process because they know they are providing better service to more patients. For example, roughly 99 per cent of patients 75 years of age or older are now contacted by TCCAC either during or after their emergency visit, compared with one per cent previously.
Innovative Use of Technology
The ER Notification system is a step toward integrating care across the health sector. It demonstrates innovation through the integration of disparate information systems within the healthcare setting, improving upon existing processes to create a seamless handoff from acute care to community care.
The system was designed to build a full profile about a patient based on data consolidated from several information systems at UHN and TCCAC. As there are no set rules governing which patient information should be used when identifying potential referral candidates, the technology had to be extremely flexible to meet changing project requirements.
The minimal project costs are attributed to innovative integration of existing information and computing resources, application development based on open-source technologies, and effective project and change management.
A 2006 CIPA Winner!
For its exceptional application of information technology to transform its processes and bring benefits to stakeholders, the SIMS Partnership has been awarded a 2006 CIPA Silver Award of Excellence in the Innovation, Not For Profit category.
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