Southlake participates in new program to reduce patient wait times

For many families, transitioning a loved one from the hospital to an alternate care provider, such as a long-term care facility, can be an overwhelming and challenging experience.

This experience is further stressed when the family is required to make decisions quickly, as the acute care bed their loved one is occupying is urgently needed by another patient who requires hospital admission. In order to help improve this transition process, Southlake Regional Health Centre has pledged its support to a provincial quality improvement program aimed at making the transition from acute hospital care to alternative levels of care in the community a more effective and efficient process.

"At any given time, it is not uncommon for Southlake to have more than 40 acute care beds occupied by patients who may no longer need the level of care we provide," commented Peter Finkle, chief operating officer. "This high number significantly affects our ability to provide timely care to other patients who may require hospital admission."

The Flo Collaborative is a provincially (Ministry of Health and Long Term Care) run program that brings together hospitals, Community Care Access Centres (CCACs), Local Health Integration Networks (LHINs) and other sectors, such as complex continuing care, rehabilitation, and longterm care facilities across Ontario, to reduce the number of ALC (Alternative Level-of- Care) days that a patient spends in the hospitals - days when a patient is occupying an acute care bed when he or she does not need one.

Southlake is one of 29 participating hospitals in the province involved in the 18- month program, which includes specialized training in quality and process improvements focused on identifying efficiencies to help advance ALC patients through the process and into the appropriate care to meet their needs more quickly.

"Like any complex problem, reducing ALC days has many contributing factors," Finkle commented. "The Flo Collaborative allows us to focus on those factors stemming from the process of care delivery. We want to ensure our patients are receiving the right care, at the right time, and in the right place. Everything is examined from the patient's perspective as to what works well to make their stay appropriate to their needs. The elimination of unnecessary steps and processes is at the heart of the Flo Collaborative."

For Southlake, this provincial initiative could be the answer to an increasing acute care bed shortage that consistently affects the hospital. Presently, York Region is experiencing unprecedented growth. In fact, for the past five years, the Region has grown by 36,000 new residents per year and acute inpatient volumes at Southlake have increased by nine per cent per year, an unprecedented situation not seen anywhere else in the province.

York residents in the age bracket of 65 and older are increasing in the GTA/905 at almost three times the provincial rate and four times the Toronto rate. Increasingly, Southlake struggles to have enough beds readily available to keep patients that no longer require acute care but must remain in hospital until a bed becomes available in a long-term care facility or home care services can be arranged. This situation often results in emergency patients waiting unnecessarily for hours before being admitted to an acute care bed, and frustrations for other patients and paramedics arriving in the ER who have to wait hours before a stretcher becomes available. At its worst, a lack of available acute care beds can result in the cancellation of scheduled surgeries due to a lack of available beds for patients requiring admission following their procedure.

"Currently, the efficiency of our hospital processes is likely less than optimal- a fact that has a direct impact on our ability to address fully the needs of our community," Finkle remarked. "All of us - physicians, staff, management - must work together to develop strategies to improve patient flow."

Participating in the Flo Collaborative will help Southlake to address efficiency at every point of patient contact. The result is improved patient flow and bed availability, as well as the ability to keep better pace with the growing demands from the York Region and South Simcoe communities for healthcare services.

Other steps that Southlake has taken in order to keep pace with demand for service include: • Expanding its facility by adding more inpatient beds and additional diagnostic imaging clinics. • Hiring more nurses enabling the hospital to keep available beds open. • Recruiting more physicians (such as orthopedic surgeons, hospitalists, etc.) to perform additional surgeries, thereby reducing wait times for many patients. • Purchasing new equipment (a new MRI, two new Cat Scanners, three digital mammography machines, etc. were recently installed at Southlake). In addition to improving the quality of diagnostic images, this state-of-the-art equipment is reducing wait times and increasing capacity by more than 140 per cent. • Extending hours of operation (appointments for many diagnostic procedures are now available evenings and weekends). • Working with community partners to make home care available more quickly. • Open a pre-admission and discharge lounge for busy days where patients who are discharged in the morning can wait until such time as a family member or friend can pick them up. • Introducing new surge capacity protocol. As a way to reduce wait times in the ER, this four-stage protocol allows Southlake to respond to higher demand peeks in an effective, coordinated and predetermined fashion while preserving access to necessary scheduled services. • Introducing clinical resource reviewers to examine all patient chart information against widely accepted clinical criteria to determine concurrently patients' service requirements and identify areas for improvement.

The province has put a human face to the project through the use of an analogy of an 85-year-old woman named Flo who is admitted to the hospital with several medical conditions. The analogy chronicles Flo as she leaves the hospital and needs quality care in the right setting and the system needed to support her and her family in getting her there.

The Flo Collaborative is an Ontario Health Performance Initiative and is cosponsored by the Health System Strategy Division and the Health System Accountability and Performance Division of the Ministry of Health and Long-Term Care.