‘A win for all’: How St. Joseph’s Health Centre is providing rapid care and taking pressure off the Emergency Department
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A new clinic at St. Joseph’s Health Centre is helping patients receive the care they need where and when they need it — while avoiding unnecessary hospital admissions.
The Acute Internal Medicine (AIM) Clinic opened in early January to provide close follow-up for ED patients who need urgent reassessment, but who do not need an immediate hospital stay. ED patients who fit the criteria are referred to the AIM Clinic and see a doctor within 72 hours.
“We are now able to provide rapid specialized Medicine care in an outpatient setting, in an urgent timeframe,” says Giancarla Curto-Correia, Patient Care Manager for 2L Medicine and the AIM Clinic at St. Joseph’s. “Care is coordinated to have patients seen in clinic with testing and/or treatment expedited while being able to go home without waiting in the ED.”
In its first three months, the clinic provided rapid assessment and treatment to 527 patients, diverting admissions for 69 per cent of AIM clinic patients. Hospital escalations, which are situations in which there are more patients than beds available, have decreased significantly since January. This is likely in part due to the slowing of respiratory virus season, and in part thanks to the clinic. It has quickly become a pillar to improving the way patients access care at St. Joseph’s.
“If a patient is not unwell and doesn’t need to be admitted, they don’t want to have to stay here,” says Dr. Heather Fieghen, Division Head of Internal Medicine at St. Joseph’s. “To have the ability to tell them that they can go home and be seen by a physician in the next couple of days, and have all of the investigations done as an outpatient is not only beneficial to the organization, but it’s really the best for patients and important for patient-centred care.”
The idea for the AIM Clinic stemmed from the need to free up space in the ED and Medicine program, while making sure there was a consistent option for rapid assessment. Leadership looked to other hospitals with Urgent Care and General Internal Medicine clinics to see what could be done at St. Joseph’s.
“A similar clinic existed at St. Michael’s, so it was a cross-site collaboration to plan out the AIM Clinic,” Curto-Correia said. “This clinic was designed to provide the best care experiences for St. Joseph’s patient population.”
With different departments like Diagnostic Imaging, Labs, Pharmacy, Procurement, Interprofessional Practice, Environmental Services, Redevelopment, Human Resources, Finance, and physicians involved, the AIM Clinic began to take form.
“It takes a village to open a new clinic,” said Jonathan Fetros, Vice President Clinical, Emergency, Renal, Medicine, Primary & Community Care, & Strategic Partnerships. “Relationships were established early on to make sure patients would get their tests and results quickly.”
The team also decided dedicated staff and space, and proximity to the ED would be important.
“People are working together in the same space, patients are familiar with where they will come back to, and it’s accessible,” said Dr. Orla Smith, Senior Clinical Director of Emergency Care and interim Senior Clinical Program Director of the Medicine Program at Unity Health.
The patient impact has been overwhelmingly positive.
“We have so much good feedback from patients that they didn’t need to spend a night in the ED – they went home, slept in their own beds, came back to our clinic for follow-ups,” said Vladimir Pesevski, Registered Nurse in the AIM Clinic. “As soon as they come in, I take them in for an assessment, then take them to the doctor. We book a follow-up and they go home.”
According to Cole Haya, Administrative Assistant in the clinic, the team can get tests and diagnostics turned around within less than a week.
“A big part of that is the collaboration we have with other departments at St. Joseph’s to get things done as quickly as possible,” he said.
An additional positive effect has been on care teams in both the ED and Medicine, who have a new option for their patients.
“This clinic lets us do the right thing for everyone,” said Dr. Joan Cheng, Chief of the ED at St. Joseph’s. “By referring a patient to AIM, you know they will be looked after soon, so you’re doing the right thing for the patient. You also know there wasn’t an unnecessary admission to the hospital, so you’re doing the right thing for the system.”
The Medicine team echoes this sentiment, Curto-Correia says.
“It’s a win for all.”
By: Ana Gajic