Effective collaboration helps launch eReferral

By Stephanie Saull-McCaig and Christina Tang

Stephanie Saull-McCaigTORONTO – The Toronto Central LHIN has implemented a Resource Matching and Referral system (RM&R) to translate the paper Palliative Care Common Referral Form to an electronic format. The system enables the organization to send and receive adult inpatient palliative care bed referrals.

The intent of the project was to deliver on 5 key areas:

• Provide patients with more timely and equitable access to palliative care beds.

• Create a more efficient referral process as patients move across the continuum of care.

• Allow clinicians to respond to referral requests in real-time and expedite the accept/admit process.

• Provide clinicians with an easy method to view a patient’s status and make timely decisions on when to provide palliative care services.

• Centralize communication between sending and receiving organizations, removing a reliance on faxes, telephone calls or emails to refer a palliative patient in Toronto.

While the implementation of RM&R in Toronto Central was successful, there were several challenges to overcome. Developing a common workflow among 14 organizations was a significant challenge.

Drawing on lessons learned from previous projects, the team solved the challenge by working collaboratively with clinical champions. The first step was charting how all 14 organizations either send or receive palliative referrals.

In the second step, the teams analyzed all organizational workflows and built one standardized workflow. Finally, the standardized workflow was presented to clinical champions and subject matter experts in a collective forum.

Facilitated by the implementation teams, the discussion allowed stakeholders to voice concerns and amend the standardized workflow to meet every organization’s minimum business requirements.

Involving clinical champions throughout the project was a key factor for success. It allowed the team to understand organizational nuances captured during the planning and design phase, which assisted with adoption during implementation. Moreover, as questions arose during implementation or post go-live, the clinical champions were able to give constructive answers to assist the team.

Scheduling weekly touch bases with all 14 participating organizations also proved to be highly important and productive. The implementation teams were better able to understand organizational differences and routinely identified issues that could blossom into risks.

The teams also regularly liaised with the project’s executive sponsors, Toronto Central LHIN, to escalate urgent issues. The intra-facility palliative referral issue was identified at an early enough stage to prompt discussion with the acute care facility’s leadership and clinicians.

All stakeholders worked collaboratively to understand the issue’s context and develop a solution without compromising the project’s scope and timelines.

An additional outcome of RM&R is the ability to track referral pattern data. Since October 2014, 942 palliative referrals have been sent. Of the 942 referrals sent, 839 referrals (89%) have been accepted by receiving organizations. Only 313 (33%) referrals were sent back for more information.

The data showcases not only the successful adoption of RM&R by clinicians, but also displays the effectiveness of the implementation teams’ project and change management strategy. The high accept volume is, in part, due to the active collaboration between all stakeholders.

Sheila Deans-Buchan, Nurse Practitioner from St. Michael’s Hospital noted that, “The (RM&R) project has improved communication and workflows within our Palliative Care Unit (PCU) team. It has been a very smooth transition since go-live. Overall, RM&R has had a positive impact in our PCU.”

While the project successfully met its objectives, and was accomplished by staying within the original budget, clinician champions want additional functionality to improve palliative referrals in Toronto.

As an example, the implementation teams are now working to develop a bed-level registry that will offer increased transparency and facilitate faster referrals and expansion to include community-based palliative care referrals.

Stephanie Saull-McCaig (pictured) is Director, Resource Matching & Referral Program – Toronto Central LHIN. Christina Tang is Sr. Project Manager, Resource Matching & Referral Program – Toronto Central LHIN.

About Strata Health Solutions
Strata Health leverages technology to achieve dramatic patient flow improvement within health systems. Since 2001, over 1.1 Million referrals have been completed within the existing 35 care streams (referrals paths) demonstrating powerful results across the entire care continuum. Strata Health is based in Canada (Calgary Vancouver, Toronto, Montreal, Quebec,), in the UK (Dartford, Kent) and in France (Paris). For more information, visit

About University Health Network
University Health Network consists of Toronto General, Toronto Western, Princess Margaret Hospitals and Toronto Rehabilitation Institute. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in transplantation, cardiology, neurosciences, oncology, surgical innovation, infectious diseases, and genomic medicine. University Health Network is a research hospital affiliated with the University of Toronto.

About Shared Information Management Services
Shared Information Management Services (SIMS) is the enterprise information management and technology department at University Health Network. It also partners with other organizations to develop regional and provincial healthcare information management and technology solutions.

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