Jake Tran, President & CEO of the Toronto Grace Health Centre, talks to contributing writer Gerry Condotta about how the Grace’s highly successful Remote Care Monitoring (RCM) program is helping to solve the problem of hospital overcrowding.
Jake Tran, President & CEO
Why is there such a problem with overcrowding in hospitals?
Jake: That’s a big question. There are many causes; one of the biggest is the very high number of patients who are in acute care hospitals who don’t need to be there. We call them alternate level of care (ALC) patients. Simply, these are patients who occupy a bed in an acute care hospital when they no longer require the intensity of services provided there. This happens because treatment in more appropriate environment isn’t available. So, they stay in hospital. And the hospitals become overcrowded.
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So, to reduce hospital overcrowding, you need to find a better way to transfer out the patients who don’t need to be in acute care hospitals to a more appropriate environment?
Jake: Exactly. The ALC problem has been increasing for years, causing serious bottlenecking at acute care facilities. We were looking for a way to transition patients out of acute care into post-acute care earlier. Our robust Recover program helps to achieve that goal by ensuring that post-ICU patients and their family caregivers enjoy integrated care across the healthcare continuum. But we realized that bottlenecking could also occur downstream, at rehabilitation. So, in 2018 the Toronto Grace created its Integrated Transitional Care (ITC) program at the Salvation Army Toronto Harbour Light site. The program provided support for medically stable ALC patients with either bariatric requirements or mental health and addiction requirements who had acquired a level of independence, but who continued to require a level of support before they could transition into the community.
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How does the RCM program work within the ITC program?
Jake: The Toronto Grace has been working on an integrated transitional-care model for quite some time — we have information on that on our website and in our annual reports — and the RCM program is a major component of it. Without going into too much detail, the ITC model not only helps patients transition more quickly and easily from acute care settings to the Grace’s post-acute care rehabilitation program, it also helps patients transition more quickly from the Grace to their homes or back to the community. The RCM program is part of the larger ITC program that specifically helps patients transition from the Grace and other healthcare facilities to more appropriate care settings — their home or a more supportive setting. As well, the program accepts referrals for patients already at home who perhaps because of a decline in overall health or aging need additional care to help them avoid readmission to an acute care hospital.
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In a nutshell, then, the RCM program is designed to help with the transitioning of patients to the community. How does it do that?
Jake: The RCM program is the framework — the support structure, the backbone — of our integrated transitional care model. We use technology as a tool to create integration that improves the transfer of patients to their appropriate care setting. We’re increasing the flow of patients while decreasing ALC designations and rehospitalization.
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So, the RCM program’s objective is to improve patient flow, which will help prevent hospital overcrowding. ALC patients will be able to transition from acute care settings to the community more quickly and easily, and there will be a reduction in the number of patients already receiving care in the community requiring rehospitalization. Is that correct?
Jake: Yes. The objective for building an integrated transitional care model that includes an RCM program can be summed up in one word: FLOW. Improving flow is critical. When patients are able to transition more quickly to appropriate health care settings, they experience better health outcomes. Along the continuum of care in our healthcare system, there are transitional gaps, which increase a patient’s risk of being re-admitted to an acute care facility before they can return home. This causes an increase in ALC rates. Our integrated transitional care model addresses those gaps and improves patient flow. No matter what form of care is being provided — acute-care, post-acute care, complex continuing care, rehabilitation, transitional care, or long-term care — the RCM program can help to improve flow and prevent people from being institutionalized (remaining in a health care environment they no longer need). By providing patients at home with a combination of in-person and virtual care, coupled with 24/7 medical and non-medical monitoring that utilizes technological advancements, we’re helping them avoid returning to an acute care facility. And of course, if there are fewer ALC patients in those facilities, the acute care hospitals will be able to provide better care for those patients who do need the level of care that they provide. There will be less overcrowding.
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The Premier’s Council put out a report in 2019: “Improving Healthcare and Ending Hallway Medicine.” The report concluded that there was a potential to integrate health care and introduce technology solutions to build strong and efficient community and hospital services, support better outcomes for patients, and fix the problem of hallway health care. The Toronto Grace began working on an integrated transitional care model as early as 2018, using technology to improve integration. Would you say the Toronto Grace was a pioneer in integrated health care?
Jake: Well, we began working on an integrated care model slightly earlier than 2018. Back then, we embarked on building a model that could help reduce the problem of elevated ALC days. If that makes the Grace a pioneer, then, sure, I’ll accept it under the widest of definitions. But remember, the concept of integrated care was around in different forms long before 2018. In fact, other countries have been practising integrated transitional care for quite some time.
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In the report’s Opportunities for Improvement section, it’s stated that the government was looking for innovative solutions to support leaders and pioneers in integrated health care and would consider proposals for scaling up these initiatives so that everyone can benefit from co-ordinated care. At the end of 2019, the government announced the first cohort of Ontario Health Teams. These teams were created to provide better integrated health care by styling a seamless experience for patients moving between different healthcare services, providers, and settings. It seems that the RCM program is an innovative solution to the problem of downstream transitioning. Has the government reached out to Toronto Grace about its integrated transitional care model and the RCM program’s use of technology to limited ALC designations and rehospitalization?
Jake: Yes, the Toronto Grace has been invited to work with several Ontario Health Teams (OHT). Our integrated transitional care model dovetails with the OHT’s integrated care, and the technology we use in RCM’s program provides data to experts in other cities. The data we provide to healthcare providers in other communities helps them deliver the appropriate care for their patients, which helps avoid the need for readmitting them to an acute care facility.
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I think we have a good sense of the rationale for the creation of the RCM program; I believe I will be speaking with your RCM program manager, Danielle Kilby-Lechman, who will provide me with a more in-depth explanation of how it works.
Jake: That’s right. She can tell you how she and her team have created and run the program. They deserve huge kudos — in only three years, the program has expanded its ability to care for patients enormously. We started with only two patients and today we have upward of eight thousand five hundred patients. She can tell you all about that and about our collaboration with other OHTs.
That’s really impressive. I look forward to learning more from her. Thank you.