As Canada's leading research hospital we have a responsibility to work on issues that can improve our publicly funded system. We are all aware that Ontario is facing unprecedented financial challenges and that the government is looking for opportunities to improve healthcare delivery while holding costs stable.

One of the biggest challenges facing our system is managing the care of patients who are "waiting in acute care" for long term care or rehabilitation facilities. These patients are often referred to as "Alternate Level of Care" or ALC. There is no question that these patients- who are often elderly and needing social support as much as medical care- need help. However, once these patients do not require the specialized services available at UHN, we work with a variety of services to move them as quickly as possible in to a setting where the support and resources match their needs.

The Ministry has made a major investment in homecare services to try and reduce the impact of ALC patients on acute care beds. This will assist us in staying on budget and will allow us to respond better to patients who need our services- like patients waiting in our emergency departments.

There is good evidence that many patients currently being referred to long term care facilities can do better at home if they have sufficient supports. The agency responsible for coordinating homecare- the Community Care Access Centers (CCAC)- has started a number of programs- Home First, Waiting at Home- with the idea of taking patients out of our hospital with enhanced community support. CCAC has received the funding to provide this support and we need to change our approach to discharge to make full use of these new services.

Kathy Sabo and Marnie Escaf are leading the approach with CCAC. The changes that we are making include: alignment and integration of the CCAC coordinators to our clinical programs, referral to CCAC coordinators immediately after admission for any patient who may need further services after discharge; encouraging patients and families that we will always consider "home first with support" as the primary discharge destination; recognizing that patients who previously needed to wait in our beds for our treatment facilities can now be cared for at home. These approaches seem to be working- over the past few months we have reduced the numbers of patients waiting for long term care at UHN.

All of us want to ensure that patients have a safe environment when discharged from our beds. However we also need to remember that patients are waiting to get into our programs and acute care beds. Thinking about "Home First" and referring appropriate patients to CCAC coordinators immediately after admission is the best thing we can do at present to improve treatment for all patients waiting for our care.


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