1 Context The Office of the Chief Coroner (OCC) recommended the - - PowerPoint PPT Presentation
Implementing Life or Limb Policy 1 Context The Office of the Chief Coroner (OCC) recommended the development and implementation of a provincial no refusal policy when critical injuries or conditions of life or limb are involved The
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patients to ensure they receive the right care at the right time at the right clinical setting
life or limb threatened based on the clinical services available at their hospital
nature of the care the patient requires and/or the complexity and severity
between referring physician and most appropriate consulting physician/service
is required and opportunities for system improvements
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Executive Director, CritiCall Ontario
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Network, Primary Percutaneous Coronary Intervention STEMI Program)
communicating to the Call Agent that the case is life or limb and can’t be cared for at their organization
Algorithm and following the escalation process
limb call and for establishing a surge process
regardless of bed status, confirm life or limb status, surge to accept if confirmed and transfer is required (Note: CritiCall Ontario does not provide consultations)
patch referring hospital to Ornge
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Who to Call? The type of consulting physician is determined by
diagnosis provided by the referring physician; or
Where to Call? Patients will be transferred to the closest, appropriate hospital regardless of LHIN boundaries
availability for each hospital
every 10 minutes
throughout the day
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CritiCall Ontario will escalate to CritiCall Ontario Medical Directors for the following reasons:
available bed, the Medical Director will arbitrate discussion with the referring and consulting physicians
due to the lack of an available bed, the Medical Director will contact the hospital Administrator on Call
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CritiCall Ontario Medical Director will follow up directly with the Chief of Staff of hospital(s) via email (copy to Critical Care LHIN Lead) when it has been necessary to contact more than
limb threatening condition
minutes) by CritiCall Ontario
life or limb case
patient transfer
the specialty required
days of the closure of the case
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CritiCall will provide weekly reports to the Critical Care and Emergency Department LHIN Leads, Hospital Chief Executive Officers (CEOs) and Chiefs of Staff (COS) Potential System Performance Indicators:
Potential Hospital Performance Indicators:
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Representative, LHIN Critical Care and Emergency Department Leads, hospital CEO, Chief of Staff and Vice President Clinical Potential Monthly Performance Indicators:
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Sending H-enters patient details in the
CritiCall Ontario) Sending H completes referral form/Discharge Summary - use standard patient transfer forms and pertinent patient information
Patient Repatriation Process
Receiving-H MRP identified through Repatriation Tool and accepts patient. MD to MD conversation occurs The “Status of the Transfer Request” is continuously updated in the Repatriation Tool throughout the patient repatriation process. The “Status” is monitored by the bed managers/flow coordinators Hospitals will ensure current and up to date “gridlock” policies and surge protocols are in place. These policies/protocols will be evoked when patient repatriation is delayed beyond 48 hour timeline.
Receiving hospital identifies bed availability (Repatriation Tool is monitored by all hospitals as per established agreements)
Sending H-MRP determines patient is medically stable and deemed ready for repatriation
No Yes
Can Patient be discharged directly home with CCAC support?
Yes
Sending Hospital and CCAC arrange discharge No appropriate bed Available Sending H-enters patient details in the
appropriate alternate hospital Appropriate bed Available Bed Managers/Flow Coordinators arrange patient transfer Sending hospital arranges for most appropriate mode of transportation e.g., Ornge, EMS, private and patient accompaniment as appropriate Appropriate bed Available Patient transferred LEGEND:
CCAC: Community Care Access Centre H: Hospital MD: Medical Doctor MRP: Most Responsible Physician RN: Registered Nurse
If CCAC has not been involved to date do they need to be contacted?
Sending H to Receiving H Nurse-to-Nurse Transfer of Accountability occurs
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“all patients, irrespective of if they are life or limb cases, will be repatriated within 48 hours once deemed medically stable and suitable for transfer”
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Authority (usernames and passwords) and respond to user questions regarding technology
the tool
Note:
hospitals
CritiCall Ontario
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LHINs Role:
hospitals
hospitals
Please note: the tool does not replace the need for hospitals to verbally confirm requests and transfer arrangements LHINs/specialty groups are responsible for creating the terms of utilization for acute care hospitals within the LHIN or group and monitoring compliance
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Hospitals will need to:
are made
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Click to access the Repatriation Tool
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Patient Access & Flow “One Number” Access protocol Life or Limb – No Refusal Classification – Right Patient ExACCRT Call Management – Right People Decision Support – Right Outcome
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and transfer to high levels of care – the processes and mechanisms for communication are critical for effective implementation and the partnership with CritiCall Ontario is essential
project was funded to improve acceptance and communication mechanisms for life or limb calls – Adult Extramural CCRT physicians take life or limb calls that resulted in decreased acceptance times and better consultative support to small sites across the region
through the policy a number of critical conversations have been driven to improve these circumstance
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Critical Care LHIN Lead South West LHIN Michael.sharpe@lhsc.on.ca
System Design and Integration Lead South West LHIN Carrie.jeffreys@lhins.on.ca
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Critical Care LHIN Lead North East LHIN dmanchuk@nosm.ca
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i. Understand the Life or Limb Policy ii. Ensure Institutional Leadership iii. Identify Implementation Challenges and Discuss Mitigation Strategies iv. Develop Policies and Agreements to Support the Life or Limb Policy v. Communication and Engagement vi. Ongoing Monitoring
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aware of and have committed to adopting the Life or Limb Policy at their hospital
by all hospital CEOs
Emergency Department LHIN Leaders are instrumental to supporting implementation, specifically in reviewing reports from CritiCall Ontario to identify on-going system level challenges
Chiefs of Staff and Critical Care and Emergency Department LHIN Leaders to review system challenges
leadership and will support local implementation of the Life or Limb Policy
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Challenges Support Available Repatriation
Process Guide
Transport time
support for Life or Limb Policy and discuss
serve as an impetus for timelier service if necessary Lack of centralized knowledge about site resource availability and capability CritiCall Ontario’s PHRS provides up-to-date information
informed by hospitals) Attaining support from hospitals and physicians that do not normally provide consultations/care via CritiCall Ontario
monitoring process will support accountability and further education
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procedures and/or Bed Capacity Management Protocols to ensure the responsibilities related to acceptance of life or limb patients are well-supported throughout the hospital
CritiCall Ontario directly
respond to pages from CritiCall Ontario within 10 minutes
Critical Care Surge Capacity Management Plan and that administrators and clinical staff are aware of this protocol
limb threatening conditions
specialties that cannot be covered within the LHIN
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understanding of the Life or Limb Policy, and the message that ‘this matters’
responsibilities for those involved, and changes to hospital processes and clinical practice
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performance
correct
status reporting
data and encompasses LHIN and hospital administrators and clinical leadership in this process
establish a process for ongoing review of data received in order to monitor hospital performance and support integration of the Life or Limb Policy into hospital culture
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Scenario Source Process Cases in which CritiCall Ontario contacts more than one hospital with the clinical services available to provide care to patients with life or limb threatening conditions CritiCall Ontario’s Case Records i. CritiCall Ontario’s Medical Director will follow-up with the Chief of Staff at the involved hospital(s) within two business days to discuss the life or limb case and barriers to care. The Critical Care LHIN Leader(s) from the involved LHIN(s) will be copied on this communication ii. Chief of Staff is required to follow-up with the involved physician(s) within their hospital to discuss the life or limb case, course of action, and areas for improvement iii. Chief of Staff will submit a response summarizing the outcomes of the follow- up to CritiCall Ontario’s Medical Director and the Critical Care LHIN Leader within five business days
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Scenario Source Process Delays in access to acute care services (Greater than 4 hours) System inefficiencies that unnecessarily prolong access to acute care services (Within 4 hours) CritiCall Ontario’s Weekly Life or Limb Hospital and System Response Report i. Weekly Life or Limb Hospital and System Response Report to: Critical Care LHIN Leader, Emergency Department LHIN Leader (for each LHIN), Hospital Chief Executive Officer, Vice President of Clinical Services (or equivalent) and Chief of Staff at the involved hospital(s)
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Scenario Source Process Ongoing system challenges related to the implementation of Life or Limb Policy CritiCall Ontario’s Monthly Life or Limb Summary Data Report i. Life or Limb Summary Data Report to: LHIN Chief Executive Officer, Life or Limb Policy LHIN Representative, Critical Care LHIN Leader, Emergency Department LHIN Leader (for each LHIN) and Hospital Chief Executive Officer ii. Life or Limb Policy LHIN Representative is required to review Life or Limb Summary Data Report to monitor hospital responsibility as detailed in the Life or Limb Policy iii. Life or Limb Policy LHIN Representative will meet with Critical Care LHIN Leader and Emergency Department LHIN Leader to discuss system challenges requiring further discussion with the LHIN Chief Executive Officer and when necessary, hospital Chief Executive Officer
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Minor Surge
beyond the normal capacity (<115%), where response is localized to an individual hospital Moderate Surge
LHIN level (≥ 115% ) , wher e an
gani zed r esponse at t he LHIN/regional network level is required Major Surge
care resources of individual hospitals and regions for an extended period of time, where an organized response at the provincial or national level is required
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Minor Surge Activation
CritiCall
and Index Hospital’s CEO, Medical and Nursing Directors
necessary to declare a Moderate Surge
Moderate Surge Response
hospitals, and all other partners (ORNGE, MOHLTC) of situation
Moderate Surge Event
When internal resources have been exhausted and capacity > 115% – trigger Moderate Surge
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