Holland Bloorview Kids Rehabilitation Hospital

Infinite Possibilities 2007-2012: Strategic Plan

Goal 5: Leading system change and integration and improving access to services

Speeding up the transition
Flo collaborative speeds transfer of children from acute care to rehabilitation

By streamlining the process of how children are transferred from acute care to inpatient rehabilitation, Bloorview Kids Rehab and SickKids have cut medically-unnecessary days, also known as Alternative Level of Care (or ALC days) in SickKids’ brain-injury trauma unit by more than 70 per cent.

Prior to the start of the project in September 2007, children with acquired brain injuries spent on average nine days more than they needed to at SickKids. In 2006, that added up to 273 medically-unnecessary days.

A ‘Flo collaborative’ was struck to bring together teams of managers and frontline staff from each hospital with the goal of “simplifying and speeding up the process,” says Iris Hogan, operations manager of Bloorview’s brain injury rehab team and co-lead on Bloorview’s Flo team.

At the time, the Flo collaborative was part of the Ontario Health Performance Initiative (OHPI) - a joint initiative of the Health System Strategy and Health System Accountability and Performance Divisions of the Ministry of Health and Long-Term Care (MOHLTC) aimed at improving transitions from acute care hospitals to subsequent care destinations for all patients.

A cumbersome referral form was quickly identified as the greatest challenge. “We had a four-page referral that had grown on average into a request for 21 pages of information,” Hogan says. “Four people at SickKids were involved in running around to find the pieces of information and there was a lot of back and forth over the phone that led to delays. In the end, about 50 per cent of our referrals weren’t complete. Sometimes SickKids would fill out 21 pages only to be told that the client didn’t fit our admission criteria and they had done all that work for nothing.”

The Flo groups at both hospitals simplified the referral process by breaking it into two pieces. First, the four-page referral was reduced to a concise, two-page form. What originally took four people up to three days to complete can now be filled out by one person in an hour. The new form ensures that SickKids gets a quick response from Bloorview on whether the client meets its admission criteria.

Second, a six-page form was developed to provide an accurate clinical picture of the client. This form is handed to Bloorview 48 hours before transfer of the client to provide the most up-to-date information.

With the old system, “the clinical picture we got when the form was filled out often didn’t match the child who arrived a couple of weeks later,” Hogan says.
Visual icons that describe steps in the referral process were developed and are posted beside the child’s name on an information board at SickKids. This helps staff identify what stage the child is at and minimizes duplication of tasks.

The improvement process has reduced the number of days to admit a client to Bloorview from 14 to four. With the other process changes in place, they now hover at two to three days. Incomplete referrals have dropped from 50 per cent to less than five per cent.

In addition to speeding up and simplifying the process, Hogan says the project helped staff at both hospitals come to agreement on “what medically stable and rehab-ready is,” so they’re both operating on the same definitions.

Families filled out satisfaction surveys before the changes were put in place. A new crop of families who’ve gone through the streamlined process will be surveyed soon. “We certainly hope the smoother transition will increase family satisfaction,” Hogan says.

Hogan says the project’s success can be attributed to committed team members, supportive senior management at both hospitals and a formal meeting schedule that was set up at the beginning for the full 18 months. This ensured that project time was protected and teams from each hospital met every two weeks.

“Now we want to take what we’ve learned from this project and apply it to our referral processes on other units,” Hogan says.