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Going with the flow reducing the time patients wait for a bed

Group in discussion in front of white board
Toronto Rehab Service Coordinators hold a flow meeting each morning to examine the number of empty beds across programs, which helps transition patients sooner. (Photo: UHN)

Every day at 9:30 a.m., the Toronto Rehab Service Coordinators hold a flow meeting – and it's all about action.

The meeting focuses on getting the right patients to the right places at the right time, and provides transparency, alignment and a structure for better teamwork.

According to Joanne Zee, Senior Clinical Director, Toronto Rehab, the results so far are striking.

"Already we've seen a few same-day transfers," says Joanne. "That would not have happened in the past.

"Accelerating flow means we are utilizing our resources more effectively so patients spend less time on waitlists."

And rehab patients aren't the only ones who benefit.

"We are now able to do a same-day transfer from Toronto General or Toronto Western, whereas in the past it would have been a next-day transfer," says Joanne. "That opens up a bed in acute care earlier, and an admitted patient in the Emergency Department can be moved up to the inpatient unit rather than waiting in a hallway."

Picking up steam

It started slowly, with a weekly call between Service Coordinators, who are responsible for reviewing applications to various specialized programs at Toronto Rehab and determining which patients are most suitable for care and therapy in these areas. Since then it has evolved into a daily face-to-face meeting at the University Centre site, with other Toronto Rehab sites calling in.

"We've worked to identify metrics that allow us to drive action," says Megan Wormald, Service Coordinator on 9 South. "It wasn't easy; some of the data we were tracking, like the number of referrals we declined, didn't help us understand where we needed to focus our attention in order to drive change."

The metrics have evolved – today the team examines the number of empty beds across programs, which helps them transition patients into rehab sooner.

"We've come a long way since we started," says Megan. "More and more people are starting to understand the purpose and relevance of the flow meeting."

A meeting with a purpose

The goals of the flow meeting are posted on the wall:

  • Fill all available empty beds with patients most appropriate for rehab and complex continuing care
  • Provide a mechanism to enable service coordinators to manage flow and make admission barriers transparent and actionable
  • To agree upon and evaluate a daily action plan

The flow meeting facilitates these goals by creating visibility into wait times across all programs. It also provides an opportunity for the service coordinators to learn from one another.

During the meeting, service coordinators review the number of empty beds, the number of referrals accepted and the number of referrals pending.The team updates these metrics and others on a whiteboard every day, making it easy for anyone to see what is happening at a glance.


Team shot in front of white board
(L to R) Joanne Zee, Senior Clinical Director, Brain and Spinal Cord Rehab Program at Toronto Rehab, with Service Coordinators Megan Wormald, Miranda Hong, Karlee Lin and Roshini Sahanandan. (Photo: UHN)

"Sometimes, patients might be suitable for multiple programs," says Megan. "For example, someone referred to the geriatric program might be equally appropriate for the musculoskeletal program.

"In that situation, we might look at the wait time for the geriatric program and potentially redirect that person to a different program where a bed is available so the patient can start rehab earlier."

Service coordinators are assigned to evaluate applications for the highly specialized rehabilitation programs offered at Toronto Rehab. When a rehab application is made on behalf of a patient, a service coordinator reviews it to determine whether the patient is appropriate for the therapy offered by the program and whether they are medically stable enough for the staff at Toronto Rehab to care for them safely.

If the patient meets the admission criteria of the specialized program, an offer is made to the referring hospital and the patient is transferred into a bed at Toronto Rehab. If a bed is not available, the patient is either placed on a waitlist or referred to another program within Toronto Rehab that can provide appropriate care.

Through the flow meeting, service coordinators have developed a better understanding of the nuances of their colleagues' programs, which helps them transition patients into the most appropriate program as soon as possible.

"Everyone is working toward the same goal and with the increased awareness of patients waiting for care, the teamwork is incredible," says Joanne. "The same day admissions wouldn't be possible without support services preparing the room for the next patient in a very short amount of time." ​

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