Toronto Grace Health Centre emerges as a virtual care powerhouse

The Toronto Grace Health Centre, an urban hospital specializing in complex, continuing care and post-surgical rehab, has large ambitions when it comes to telehealth.

The organization has built an effective remote patient monitoring system – a combination of skilled staff and specialized technology – that’s currently keeping tabs on the health of 16,000 clients across Ontario.
By the end of 2024, those figures are expected to reach between 25,000 and 30,000.

“The numbers are growing by 1,000 referrals each month,” said Toronto Grace’s president and CEO, Jake Tran.
“We’ve scaled up and we’re working as far north as Thunder Bay, as west as London, and as far east as Ottawa.”
Moreover, the hospital began monitoring out-of-province patients in British Columbia in June and as of September, it started providing virtual care in Prince Edward Island. It’s all a testament to the effective approach created by the hospital and Tran’s vision of what could be accomplished through virtual care.

“The goal is to eliminate the term ALC,” said Tran.

Alternate Level of Care (ALC) patients are hospital patients that are largely stable, but who require special attention in nursing homes or assisted living facilities. They’ve been unable to leave hospital because spots are unavailable in these continuing care centres.

However, with remote monitoring from Toronto Grace, they’re able to return home. That’s freeing up beds in hospitals and allowing sicker patients to get the attention they need.

Since starting their Remote Care Monitoring program, about 25,000 patients have been enabled to return home from hospital, many of whom were pre-ALC or ALC patients.

The success of the program has led Ontario Health to ask Toronto Grace to keep growing. For his part, Tran is now asking the provincial government for additional support to expand and sustain the project across Ontario.
“It makes great financial sense for the government, as well as for us,” said Tran. “A transitional bed in hospital costs $500 a day. We can do home monitoring for $10 a day.”

The patients being monitored at home are largely older adults living with frailty, and they’re at risk of falls and wandering. They’re also living with chronic diseases, such as COPD, heart failure and diabetes, and some have dementia, said Danielle Kilby-Lechman, manager of Toronto Grace’s Remote Care Monitoring program.

On the innovation front, the hospital has developed a system with its technology partner, GRTHealth, of Aurora, Ont., that has enabled a team at the hospital to continuously monitor these patients.

The home-based technology includes a pendant worn by patients that detects falls and provides voice communication. It has an SOS button, enabling the patient to obtain help, when needed.

Passive sensors in the home can tell the team if the patient isn’t moving about in a normal way and needs to be checked on.

There’s also geofencing – sensors that detect if the patient goes out the door when it’s unexpected.
And a medication dispensing machine is connected to the command centre. It lets the team know if the client isn’t taking their meds.

Finally, there’s a set of devices for measuring vital signs – weight, blood pressure, blood oxygen and temperature. The equipment connects to a tablet computer in the home, which in turn sends data to the command centre.
“It’s all automated,” said Kilby-Lechman. “The client just has to use the device.”

If there’s ever a problem, the team can quickly contact a doctor for an opinion, and visiting nurses and PSWs, paramedics or even the police can be quickly alerted if in-person help is needed.

“We have people monitoring day and night,” she said. They’re watching for alarms, and they can instantly contact the patient using the two-way calling on the pendants worn by patients. They can also escalate the calls, when additional help is needed,” said Kilby-Lechman.

The command centre is run by PSWs with training in geriatrics. Other members of the Remote Care Monitoring team include clinicians, administrators, and installers.

They’ve been successfully helping the patients return to health, or stay stable in the comfort of their homes, instead of in hospital wards.

For that reason, the two other provinces have asked Toronto Grace to monitor patients in their jurisdictions, enabling them, too, to move more patients from hospital to home and to free up beds.

Tran noted that Toronto Grace is now monitoring patients in British Columbia in a pilot project with Kin Village. It has also started providing remote monitoring for Prince Edward Island. With ultra-fast communication networks, all the monitoring can be done from Toronto.

The nurses and PSWs staffing the command centre in Toronto are set up to contact the right people in BC and PEI if needed.

In the future, Toronto Grace plans to add a rehab-at-home component to its program.

It’s also testing AI. “We’re analyzing the level of activity of clients and predicting possible declines, so we can intervene more quickly,” said Tran.

“We’re also working on the problem of social isolation,” said Tran. On this front, Toronto Grace has been developing a toy-like dog that’s capable of holding conversations with clients. “It works, but it’s a little ugly-looking right now,” said Tran. “It needs to look better before we use it.”

Another application will deploy AI to detect shortness of breath in the speech patterns of clients as a way of spotting COPD.

Technological innovations are enabling it all to happen, but in the end, it’s a safety net of people – all skilled professionals – who are monitoring the patients and caring for them. At the same time, Tran observed that’s it’s a cost-effective solution, as the Remote Care Monitoring program cares for patients at a fraction of the cost of hospitalization.