IMPROVING TRANSITIONS FROM ACUTE CARE TO REHAB: SPREADING CHANGE ACROSS GTA HOSPITAL SITES FOR PATIENTS POST-HIP FRACTURE GTA Rehab Network Charissa Levy, Sharon Ocampo-Chan, Donna Renzetti October 2016 1
PROBLEM How can we access rehabilitation programs as early as possible to facilitate the recovery of patients following hip fracture across the system? 2
PROJECT AIM To standardize and enhance access to rehabilitation post-surgery for patients post-hip fracture across participating hospitals, with the goal of reducing the acute care length of stay from surgery to discharge (to inpatient rehab program) to an average of 6 days by December 2016. 3
OUR CHANGE STORY. We decided to spread an Early Patient Referral Model and other learnings of the original IDEAS project team* on patient flow for hip fracture * Acknowledgement: Jane Harwood, Michael Garron Hospital Mandy Lau, Providence Healthcare Jackie Eli, Bridgepoint Sinai Health System 4
BARRIERS Why is the rehab application declined? What can rehab programs manage medically? What information is needed in the rehab application? Tools were developed to facilitate referral process improvement. 5
NEEDS ASSESSMENT We asked the Project Leads of acute care and rehab sites to identify their team strengths, current referral practices, needs & mitigation strategies to facilitate implementation of the Early Patient Referral Model. 6
CHANGE IDEAS Acute care: Complete & send rehab application by day 3 after surgery Rehab: Respond within 1 day Consider patient s premorbid functional status 7
OUTCOME MEASURE Average Length of Stay (LOS) from Surgery to Acute Care Discharge Average LOS from admission to surgery Date of admission Date of surgery Average LOS from surgery to sending rehab application Date of surgery Date rehab application sent by acute care Average LOS from sending rehab application to receiving rehab response Date rehab application sent by acute care Date of first response by rehab Average LOS from receiving rehab response to discharge Date of first rehab response Date of acute care discharge 8
PROCESS MEASURES Referrals sent by day 3 following surgery Referrals with 1 day rehab first response time Referrals with Requests for Information. What info requested? Referrals Declined. Why declined? 9
BALANCE MEASURES % patients returning back to acute care from rehab Functional outcome & discharge destinations of patients after rehabilitation Length of stay in rehab programs Patient Experience Questionnaire 10
100% 80% 82% 72% HIGHLIGHT: PROCESS MEASURE Proportion of patients that met the Project AIM of surgery to acute care discharge 6 days (from April 2015 to July 2016) Rehab 63% 60% 51% 48% 40% 42% 34% 20% 0% G (3 months) B (8 months) D (16 months) C (11 months) E (8 months) F (3 months) A (10 months) HOSPITAL 7 acute care hospitals: Credit Valley Hospital Trillium Health Partners (THP), Etobicoke General Hospital William Osler Health System, Humber River Hospital, Mississauga Hospital - THP, North York General Hospital, St. Joseph s Health Centre, The Scarborough Hospital General site 11
Days Days Days Days Hospital 14 A UCL 12 10 8 6 4 2 16 LCL Oct '15 (n=8) Hospital C 14 12 10 8 6 4 2 0 UCL LCL Sept '15 (n=5) Nov '15 (n=5) Oct '15 (n=6) Project Aim 6 Days Dec '15 (n=7) Project Aim 6 Days Nov '15 (n=7) Jan '16 (n=6) Dec '15 (n=7) Jan '16 (n=8) Feb '16 Feb '16 (n=9) Average 8.8 days 14 12 10 8 6 4 2 Project Aim 6 Days UCL Hospital B Mar '16 Apr '16 May '16 Jun '16 Jul '16 LCL 0 (n=6) Across (n=10) 7 acute (n=6) (n=9) care hospitals* (n=15) (and Oct '15 rehab Nov '15 partnerships), Dec '15 Jan '16 (n=7) Feb '16 Mar '16 Apr '16 Jun '16 Mar '16 Apr '16 HIGHLIGHT: PROJECT OUTCOME 319 patients discharged to rehab programs achieved an average of 7.6 days LOS from surgery to discharge since implementation from April 2015 to July 2016. 16 UCL 14 The average first response time across 5 rehab 12 hospitals** was 0.4 days. May '16 Jun '16 (n=9) Average 7.2 days Jul '16 (n=5) 10 8 6 4 2 0-2 -4 LCL Apr '15 May '15 Jun '15 (n=5) Jul '15 Aug '15 Project Aim 6 Days Sep '15 (n=14) Oct '15 Nov '15 Dec '15 (n=5) Jan '16 Feb '16 (n=5) (n=6) Mar '16 Apr '16 May '16 Jun '16 Jul '16 (n=6) Average 5.2 days Hospital D Average 6.7 days *7 acute care hospitals: Credit Valley Hospital Trillium Health Partners (THP), Etobicoke General Hospital William Osler Health System, Humber River Hospital, Mississauga Hospital - THP, North York General Hospital, St. Joseph s Health Centre, The Scarborough Hospital General site **5 rehab hospitals: Baycrest, Providence Healthcare Centre, Runnymede Healthcare Centre, St. John s Rehab SHSC, West Park Healthcare Centre 12
MOST POSITIVE OUTCOME Enhanced communication and collaboration across acute care and rehab partnerships. 13
SUSTAINING IMPROVEMENT Reporting back to project sponsor Continue regular partnership meetings Monitor performance 14
SPREAD To internal rehab programs Lessons learned shared through provincial webinar with IDEAS Alumni Exploring application to other patient groups 15
LESSONS LEARNED celebration of small successes with project teams focus on qualitative benefits observed Engaging project lead/sponsor earlier to obtain a longer baseline performance 16
WHAT S NEXT Continue to support partnerships through quarterly meetings Analyze audit referral process data 17
COST SAVINGS Six of seven hospital sites have achieved or are close to achieving the Project AIM of six days as the average length of stay from surgery to discharge 18
USE OF AWARD FUND Hired an Analyst to help with monthly referral process data analysis across partnerships. 19
Baycrest North York General Hospital Credit Valley Hospital St. Joseph s Health Centre Mississauga Hospital West Park Healthcare Centre GTA Rehab Network Etobicoke General Hospital Runnymede Healthcare Centre Participating Acute Care: Credit Valley Hospital Trillium Health Partners (THP), Etobicoke General Hospital William Osler Health System, Humber River Hospital, Mississauga Hospital - THP, North York General Hospital, St. Joseph s Health Centre, St. Michael s, Sunnybrook Health Sciences Centre, The Scarborough Hospital Participating Rehab: Baycrest, Bridgepoint Sinai Health System, Credit Valley Hospital - THP, Humber River Hospital, Mississauga Hospital - THP, Providence Healthcare, Runnymede Healthcare Centre, St. John s Rehab Sunnybrook, William Osler Health System, West Park Healthcare 20 Centre Other organizations supporting participating sites: Michael Garron Hospital, Mount Sinai Sinai Health System, Toronto Western Hospital UHN, Toronto Rehab - UHN