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Accessing the Regional One Number Protocol – User's Guide

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Accessing the Regional One Number Protocol – User's Guide ACCESSING THE REGIONAL ONE NUMBER PROTOCOL South West Local Health Integration Network A USER’S GUIDE CONTENTS Introduction ..................................................................................................................... 3 Section 1 – Overview ...................................................................................................... 4 Section 2 – Inclusion Criteria ........................................................................................... 5 Section 3 – Transfer And Repatriation Guidelines .......................................................... 7 A. Transfer Of Critically Ill Patients ............................................................................ 7 B. Transfer Of Emergent Patients .............................................................................. 9 C. Transfer Of Urgent Care Patients ........................................................................ 11 D. Repatriation ......................................................................................................... 13 INTRODUCTION The User’s Guide has been created to assist clinicians and organizations throughout the South West Local Health Integration Network (LHIN) to understand and effectively fulfill their role in the delivery of timely care to critically ill, emergent and urgent care patients whose immediate clinical needs cannot be met by the hospital in which they are located. This manual is made up of four (4) sections. 1. Overview 2. Inclusion Criteria 3. Transfer and Repatriation Guidelines 4. Roles and Responsibilities for Patient Transfer This manual is intended to be a common reference document and it will be updated on an as needed basis. SECTION 1 – OVERVIEW Timely access to care is a fundamental objective of healthcare organizations, staff and physicians alike. Unfortunately, for a variety of reasons, this objective is challenging to realize. It may be due to lack of human resources; challenges accessing transportation including ambulance services; lack of adequate resources such as hospital beds; or other complicating factors including not having a standard system-wide approach to the referral or transfer of patients. It is this last factor that is the focus of this initiative. The focus of the One Number Protocol is hospital patients who are critically ill or who require emergent or urgent care and whose immediate health care cannot be addressed by the hospital at which the patient is currently located. Operationally these patients have been assessed as: . Life or Limb – requiring in less than four hours, . Emergent – requiring care in four to 24 hours, . Urgent – requiring care in 24-48 hours, and . Non-Urgent – requiring care in over 48 hours. The reason for separating out the patients in this way is that each scenario requires the system to respond with different degrees of urgency – in some cases the speed of response can mean the difference between life and death, the difference between a full recovery and a life-long disability. The level of care that is required but not available at the patient’s current location could include consultation services from a specialist or rapid access to and direct intervention by a specialist at a secondary or tertiary care hospital. The scope of this initiative involves all of the acute care hospitals in the South West LHIN, as well as Bluewater Health and Chatham-Kent Health Alliance (CKHA) in the Erie St. Clair LHIN. This initiative not only involves connecting with medical specialists at the outset but also the return or repatriation of patients back to the originating hospital or community as soon as it is medically warranted. The transfer of patients is a challenging task given the demands on the use of available beds at each hospital. Some hospitals have admitted patients waiting in the emergency department for an inpatient bed to become available. Being able to admit yet another patient in these circumstances is not a simple matter of saying yes. It can be a significant logistical and operational challenge and as such requires the active involvement of skilled and experienced staff with an understanding of the clinical needs of the patient as well as an understanding of current and pending demands for beds. Since the One Number Protocol is a systems solution to a systems problem it requires the full involvement and commitment of everyone and every organization to be successful. The One Number Protocol does not address all of the issues associated with ensuring timely access to care but it does make a difference. Knowing that there is a system in place, knowing that the needs of the these patients will be matched with available resources as quickly as necessary means that much of the guesswork around the current patient transfer processes will be reduced, if not eliminated. SECTION 2 – INCLUSION CRITERIA The following inclusion criteria are to be used to assess patient eligibility: CRITICALLY ILL – requiring transfer in less than four hours A patient with a critical medical problem1 is assessed by a physician and clinical staff as completely and thoroughly as possible and as a result of this assessment it is determined that the patient’s medical condition is such that he/she requires immediate transfer to the nearest appropriate secondary or tertiary centre for follow-up assessment, treatment and admission. Patients who are critically ill would typically include patients with life threatening conditions such as cardiac/respiratory arrest, major trauma especially general trauma, head or neck trauma, shock states or hemodynamically compromised, unconscious patients or altered level of consciousness, severe respiratory distress, head injury, myocardial infarction, overdose and Cerebrovascular accident (CVA). The province of Ontario has developed referral criteria to assist physicians in identifying patient as being in a Life or Limb situation requiring immediate acceptance and transfer. (Life or Limb Policy Implementation Guide) Important Note: Cardiac patients with Percutaneous coronary intervention (PCI), stroke patients and dialysis patients in immediate need of transfer to a specialized dialysis centre have their own region- wide bi-pass protocol in which patients are transferred directly to the service they need. EMERGENT – requiring care in greater than four and less than 24 hours A patient with a serious medical problem is assessed by a physician and clinical staff as completely and thoroughly as possible and as a result of this assessment it is determined that the patient’s medical condition is such that he/she requires transfer to the nearest appropriate secondary or tertiary care centre for follow-up assessment, treatment and admission if appropriate, in the next 4-24 hours. URGENT CARE – between 24 and 48 hours A patient with a serious medical problem is assessed by a physician and clinical staff as completely and thoroughly as possible and as a result of this assessment it is determined that the patient’s medical condition is such that he/she requires transfer to the nearest appropriate secondary or tertiary care centre for follow-up assessment, treatment and admission if appropriate in the next 24-48 hours. 1 Children and adults with acute psychiatric problems are excluded from this protocol. REPATRIATION There are a number of circumstances that trigger the need for a patient to be repatriated that is, returned for care at the hospital from which they were sent or return to the community in which he/she lives. Not all patients need to be repatriated and the first option is to return the patient to his/her home with community services. If a patient does require follow-up hospital services, this could include transfer to a specialized service (for inpatient rehabilitation for example). The focus here is on patients who need additional acute care, but not at the level that required them being transferred in the first place. The following four repatriation scenarios have been developed as part of this project. 1. Taking patients back who have been transferred to another hospital for care 2. Taking patients back who were critically ill, emergent or required urgent care when admitted to another hospital but who did not originate from their community or home hospital (e.g. motor vehicle accident and stroke patients) 3. Taking a patient back in exchange for the other hospital accepting a patient who is critically ill, emergent or requires urgent care - happens when all beds are occupied (Swapping Scenario) 4. When a patient cannot be returned to their home community hospital due to all available beds being full and swapping not being possible, but there is capacity at a nearby hospital that might provide an opportunity to return the patient to a comparable, nearby hospital, closer to family etc. This option would only be considered when the ability to serve patients who are critically ill and who require emergent care is being compromised. (Almost Home Scenario) SECTION 3 – TRANSFER AND REPATRIATION GUIDELINES The transfer and repatriation guidelines are divided into five sub-sections. A. Transfer of Critically Ill Patients B. Transfer of Emergent Patients C. Transfer of Urgent Care Patients D. Repatriation of Patients E. Roles and Responsibilities for Patient Transfer A. TRANSFER OF CRITICALLY ILL PATIENTS Patient with a critical medical problem is assessed by a physician and clinical staff as completely and thoroughly as possible and as a result of this assessment it is determined that the patient’s medical condition
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