A new technology that hoped to stop unnecessary repeat visits to
the emergency room (ER) has proved successful in its first few
months.
The electronic notification system is used to alert Community Care Access Centre
(CCAC) staff if someone admitted to the ER at Toronto General
Hospital or Toronto Western Hospital is a candidate for their
services.
The CCAC provides, amongst other things, home nursing,
homemaking and nutrition counseling.
"The objective is to decrease repeat visits to the emergency
department," said Tracey MacArthur, director, Community Care
Information Management, Shared Information Management Services
(SIMS). "We make sure that we identify all patients that come into ERs that
may need some kind of homecare service that doesn't necessarily
have it."
When a patient that meets the criteria is entered into the
system, the system flags the patient, said MacArthur. An alert is
then sent to a CCAC coordinator on their BlackBerry who then goes
to the ER and assesses the patient.
"Using (handheld digital devices) was essential because the CCAC
coordinators are always walking around the hospital," she said.
"Since they don't staff the hospital 24-hours a day, the
coordinator follows up with night referrals the next day by
phone."
The flagging criteria are based on age and what the complaint
upon arrival at the ER is, for example, all patients over 75 are
automatically flagged for assessment, according to MacArthur.
The criteria had to be established and then narrowed down so the
system would be effective, said Debra Davies, nurse manager,
Toronto General ER.
"We had to make sure the poor CCAC rep wasn't being paged with
every single patient that came through," she said. "We actually
honed it down to something that was really valuable."
Davies said another advantage is that the CCAC coordinator
becomes part of the ER team and other members of that team get to
know the coordinator as an individual.
The criteria being used have produced positive outcomes,
MacArthur said.
"We've seen that requests for assessment almost triple," she
said. "We've also seen that almost 80 per cent of those requests
for assessment have actually resulted in some kind of a service
that was needed."
Automatic, electronic referrals take the guesswork out of
whether a patient should be assessed, so ER staff don't have to
make a judgment call about every patient, but staff can still refer
a patient manually, said MacArthur.
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