A STAR is born Collaborative Strategy that works! Objective - - PowerPoint PPT Presentation

A STAR is born…

Collaborative Strategy that works!

Objective Objective

• Demonstrate the importance of

developing and nurturing partnerships in achieving quality outcomes, providing the right care at the right place at the right time

• St. John
• St. John’

’s Rehab s Rehab

• The only hospital in Ontario solely dedicated to

specialized rehabilitation

• Serve patients from throughout GTA and the

province

• 160 beds in north Toronto (Central LHIN)
• Founded in 1937 by the Sisterhood of St. John the

Divine

• 2,400+ inpatients per year (Average length of stay

from 1 week to 3 months)

• More than 40,000 outpatient visits per year

Our programs Our programs

• We provide specialized rehab care for adults

recovering from:

– amputations – burn injuries (unique in Ontario) – cancer (unique in Ontario) – cardiovascular surgery – organ transplants (unique in Canada) – orthopaedic conditions – strokes and neurological conditions – traumatic injuries – complex medical conditions/procedures (STAR program)

Referrals by Hospital (April 2009 - February 2010)

0% 5% 10% 15% 20% 25% 30% 35% 40% Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 NYGH Sunnybrook UHN

• St. Mike's

Southlake Markham Stouffville

North York General North York General

• 400 bed acute care facility
• 194 bed long term care facility
• 12 hour urgent care centre
• Serves 450,000 residents in North /

Central Toronto

• 3,100 Staff/ 900 Physicians

Rationale Rationale

• f partnerships
• f partnerships
• Collaborate and focus on the strengths
• f the respective organizations to

improve efficiencies and enhance patient outcomes

Partnerships Partnerships

• 1. Reduced Wait Time for Inpatient Rehab

Pilot Project

–

To improve the continuum of care for patients requiring rehab

–

To maximize appropriate and timely admissions to SJRH

Partnerships Partnerships

Referrals / Patient Flow Coordinator

• Collaborates with teams at SJRH and NYGH to

assess and identify patients early in the acute phase of their hospitalization who may candidates for rehabilitation

• Liaises with teams at SJRH and NYGH to

facilitate efficient and timely patient admissions to rehabilitation.

Partnerships Partnerships

Referrals / Patient Flow Coordinator

• Provides operational support in the

coordination of referrals from NYGH to SJRH

• Provides operational support with a focus on

implementing new processes, improving on existing ones and enhancing communication

Partnerships Partnerships

• 2. SJRH / NYGH Integration Initiative

–

Transfer of rehab program from NYGH to SJRH

–

First major integration initiative of the Central LHIN

Partnerships Partnerships

Benefits:

• More focused rehab care for patients at SJRH
• Additional resources at SJRH for clinical

enhancements

• Frees up resources at NYGH for acute care
• Focuses on Alternative Level of Care Issues

STAR Program STAR Program

• Development of Short Term Active

Reconditioning (STAR) Program

– The need for a reconditioning program was identified through communications with and referrals from NYGH and other hospitals – Involvement of NYGH representatives in identifying admission criteria for program

STAR Program STAR Program

Admission Criteria:

• Medically stable
• Demonstrates motivation to engage in active rehab and has

measurable, attainable rehab goals

• Safe and appropriate post rehab discharge destination plan

should be identified

• Can tolerate at least 30 minutes of continuous daily therapy

1 – 2 times a day

• Able to sit unsupported for 15 – 20 minutes
• Able to transfer (assist x 1 is accepted)
• Has behavioural and cognitive abilities that will support

participation in active rehab

• Demonstrates potential to perform ADL activities
• Special needs are considered on a case-by-case basis

Key Components Key Components

• Focus on:

– pull strategy – the needs of the patients – the strengths and expertise of each partner – win-win partnership – communication & relationship building

Pull Strategy Pull Strategy

• Focus on using a pull system rather

than the traditional push system

– Push - patient is ready for discharge from acute care and will be sent to rehab – Pull – patient is a good candidate to benefit from rehab and will be sent to rehab after discharge from acute care

Patient Needs Patient Needs

• Focus on the patient’s need for the

right care at the right time at the right place

– Smooth transition across the continuum

• No unnecessary waiting
• Discharge from acute care to rehab as soon

as ready

Strengths & Expertise Strengths & Expertise

• Focus on the strengths and expertise of

each organization

– NYGH  acute care – SJRH  rehabilitation care

• Patients can receive the most

appropriate care by the most appropriate provider

Win Win-

• Win Partnership

Win Partnership

• Focus on creating a partnership

where all parties involved can benefit:

– Patients – right care at the right time at the right place – NYGH – freed up resources to better meet needs of ALC patients – SJRH – more efficient use of available capacity

Communication & Communication & Relationship Building Relationship Building

• Focus on clear / open communication

and enhancing working relationship between partners

– Information sessions – Planning / Implementation sessions – Feedback sessions – Have point person who can help solve issues identified

CLHIN Priorities CLHIN Priorities

• The initiatives are aligned with the

Central LHIN priorities under IHSP :

– Access – Coordination – Quality – Efficiency

CLHIN Priorities CLHIN Priorities

• Access:

– Improve access to specialized rehab services for patients, enabling them to get the most appropriate care in the right place at the right time – Improve access to acute care services for patients by increasing bed capacity for ALC patients at NYGH – Improve access to emergency services by decreasing the number of ALC patients in acute care beds

CLHIN Priorities CLHIN Priorities

• Coordination:

– Improve the continuum of care for medical patients at NYGH that require rehabilitation services – Improve the referral process between SJRH and NYGH through the use of the Referrals / Patient Flow Coordinator that can identify and assess patients early in their stay at NYGH who may be candidates for services at SJRH

CLHIN Priorities CLHIN Priorities

• Quality:

– Increase quality of care for rehab patients receiving care at a specialized rehabilitation hospital – Increase quality of care for ALC patients being consolidated on a single unit with specialized care by the right providers

CLHIN Priorities CLHIN Priorities

• Efficiency:

– Improve patient flow by using a specialized ALC unit to transfer patients out of the medical inpatient units – Improve cost per patient day for rehab patients, by transferring them more quickly to a specialized rehab hospital

Outcome Indicators Outcome Indicators

• Performance Measurement:

– Application rejection rate

NYGH Other Hospitals 11.80% 27.40%

Outcome Indicators Outcome Indicators

• Performance Measurement:

– Time from application from NYGH to time of admission to SJRH

NYGH Other Hospitals 2.3 days 3.3 days

Other Indicators Other Indicators

• For monitoring purposes, the

following indicators are monitored to make sure there are no un-intended

• utcomes:

– Average Length of Stay – Function Score Change – Discharge Destination – Patient Satisfaction

Challenges Challenges

• Communication
• Clarifying Expectations
• Balancing existing patient population

and new needs identified

Key Messages Key Messages

• Identify opportunities for win-win

partnerships

• Communication is key
• Role of liaison is integral for success of

partnership

• Need clear metrics and targets to evaluate

initiatives

• Clear plan and strategy to manage change

Questions Questions