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ED iCARE and a Quick Response Team:A Community Pull Strategy

Quality Forum

February 20, 2015

Shannon Hopkins, Director of Operations, Home Health & Transition Services, VancouverSusan Seeman, Director, Strategic Initiatives, Care Management Program, Vancouver

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13

2014/15 6,897 6,917 6,941 7,231 7,086 7,182

2013/14 6,578 6,572 6,732 7,069 6,953 6,784 6,692 6,354 6,329 6,643 6,824 6,671 6,836

2012/13 6,426 6,486 6,436 6,548 6,600 6,687 6,414 6,457 6,310 6,481 6,223 6,378 6,617

5,600

5,800

6,000

6,200

6,400

6,600

6,800

7,000

7,200

7,400

VGH Emergency Visits - 2012/13, 2013/14, 2014/15

Ongoing growth averaging 4% per year

Call to Action

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1 2 3 4 5 6 7 8 9 10 11 12 13

2012/13 659 670 658 643 610 658 673 697 672 635 688 686 692

2013/14 687 683 674 684 668 668 689 686 702 655 698 693 676

2014/15 643 669 659 639 655 649

600

620

640

660

680

700

720

Avg # of beds occupied

Period

VGH (excl MH) Average Number of Beds Occupied

Vancouver’s True North Goals &Strategic Priorities

Providing best care is at the heart of our True North goals and central to what we want to achieve.

Home is Best• With the appropriate

supports, home is usually the best place for frail, elderly patients to recover and manage chronic conditions.

• In the comfort of familiar surroundings, patients have the best chance to regain their strength and independence.

• It’s best for the patient, frees beds for patients in need of in-hospital care and eases ED congestion. It’s providing best care.

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iCARE and QRT Partnership in Emergency

• iCARE daily inter-professional care and discharge planning methodology helps the ED and community teams identify and support priority clients in an effort to prevent unnecessary admissions and create sustainable transition plans for the > 70 year old population

ED iCARE Team• Care Management Leader (CML)

• Screens > 70 yrs. old population to identify mod to high risk for readmission patients

• Ensures medical/functional stability for discharge • Facilitates completion of ‘My Discharge Plan’

• Sets up post discharge GP appointments within 48-72 hrs of discharge

• Transition Services Team (TST)• Brings HH historical information to planning process• Links with HH team to ensure ongoing care

• Assigns QRT if HH not available for quick response

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ED iCARE Team• Quick Response Team (QRT)

• comprised of 2 nurses, 1 OT and a GP as part of ED iCARE team – collaborates with HH teams

• Physician bridges primary care between ED and community

• Available to support discharges when a same day/next day visit is req’d. Can support client for up to 2 weeks following ER visit

• Will often meet the client in the ER to initiate the ‘warm’ handover to the community

• Their approach is address any challenges that the client may have that impacts their ability to safely remain in their home

• Typically they will assist with pain management, mobility challenges and help client settle back into home environment

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P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13

2014/15 6,897 6,917 6,941 7,231 7,086 7,182 6,797 6,860 6,527 6,884

2013/14 6,578 6,572 6,732 7,069 6,953 6,784 6,692 6,354 6,329 6,643 6,824 6,671 6,836

2012/13 6,426 6,486 6,436 6,548 6,600 6,687 6,414 6,457 6,310 6,481 6,223 6,378 6,617

5,600

5,800

6,000

6,200

6,400

6,600

6,800

7,000

7,200

7,400

VGH Emergency Visits - 2012/13, 2013/14, 2014/15

We continue to see an increasing number of visits to the ED

How are We Doing?

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13

2014/15 20.62%20.34%20.26%19.08%19.86%20.63%21.27%21.09%22.51%21.24%

2013/14* 23.00%22.41%22.13%21.28%22.03%21.40%23.16%23.06%23.19%22.26%22.85%21.30%21.16%

2012/13* 23.03%23.23%22.50%21.43%21.80%21.62%22.36%21.70%22.63%23.01%23.40%22.56%21.40%

17%

18%

19%

20%

21%

22%

23%

24%

25% VGH Emergency Admission Rate - 2012/13, 2013/14, 2014/15

*ED admits adjusted for DTU

VGH YTD 14/15 ED Admit rate 20.7% - data back to 2003/4 indicates this is the lowest rate achieved (records not available prior to 2003/4).

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Success Factors

• Strategic Priority – ‘One Vancouver’

• Shared Vision by entire team

• Visible Leadership

• Ongoing coaching and mentorship

• Standard Work

• Collaborative Practice

• Ongoing Evaluation

• Can’t let up!

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