Complex Issues. System-wide Solutions.

Complex Issues. System-wide Solutions.

Improving patient flow. Reducing stays in alternate level of care. Responding to increased medical complexity. The issues facing the health care system today are complex and challenging. But the GTA Rehab Network is bringing together providers from across the acute, rehabilitation and community sectors to find solutions. Our member organizations have much to offer, including extensive clinical, planning and management expertise. They also share a strong commitment to working collaboratively. The result is system-wide solutions that work for patients, health care providers and the health care system as a whole. Our initiatives are improving rehabilitation services across the Greater Toronto Area. We re streamlining the delivery of care to improve access. We re aiding system-wide planning to ensure better use of limited rehabilitation resources. And we re helping our members implement best practices so that patients receive consistent, high quality rehabilitation services across the entire continuum of care. At the same time, the GTA Rehab Network continues to raise the profile of rehabilitation within our ever-changing health care environment. We are a strong voice for rehabilitation among our partners, the Local Health Integration Networks (LHINs) and the Ministry of Health and Long-Term Care. Innovative strategies for complex issues. The GTA Rehab Network is finding solutions. Streamlining referrals with common forms and guidelines The smooth and efficient transfer of patients is critical to ensuring individuals have access to appropriate rehabilitation care when they need it. But data gathered by the GTA Rehab Network found that inefficient referral processes were causing problems. Every hospital used a different rehabilitation referral form, and rehab hospitals often received inadequate patient information. Furthermore, delays in making and responding to referrals were resulting in lengthy patient stays in alternate level of care (ALC) beds as patients in acute care hospitals waited for transfer to a rehabilitation facility. Similarly, patients who completed rehabilitation faced delays as they waited for alternate level of care arrangements in the community. To help address the problem, the Network established standardized criteria and benchmarks for ALC designation and the timing of, and response to, rehab referrals. The Network also created a common, easy-touse referral form for rehab and complex continuing care for use by all organizations. The result is a streamlined referral process that is both efficient and transparent. The common referral form is also supporting another innovation to further streamline the referral process. It provides the foundation for a new electronic referral system, recently launched by the Toronto Central LHIN. Improving quality through standardizing rehab services For health professionals making a rehabilitation referral, the wide variety of programs and services across organizations is frequently a source of confusion and frustration. The type of rehabilitation services and degree of specialization can vary significantly from one program to another. The result is often inappropriate referrals and subsequent delays for patients. To address the issue, the GTA Rehab Network launched an initiative to standardize services across the continuum. Using evidence-based best practices, the Network is defining core components and standards of practice for 12 different rehab population groups, such as stroke and geriatric/ medically complex. The comprehensive frameworks cover all rehab settings acute care, inpatient rehab, outpatient/ambulatory and community and will promote consistency across organizations. The Network has also developed self-assessment tools to allow organizations to evaluate how well their rehab programs are meeting the standards. The tools allow organizations to compare their services and outcomes with other similar programs and identify any necessary quality improvement initiatives.

Network initiatives System-wide solutions A trusted source for rehabilitation data and analysis The GTA Rehab Network is an important and trusted resource for detailed data collection and analysis. The Network regularly gathers and analyzes data from members and other data sources to create detailed pictures of patient populations, their specific rehabilitation needs, resource use, length of stays, access to service and outcomes. The Network s leadership in identifying issues and developing comprehensive action plans has resulted in a variety of initiatives led by the Network, providers, LHINs and others. In addition, the Network s inventories and needs assessments provide an important baseline for measuring progress in addressing issues across the system. Searchable database facilitates referrals Access to information is the first step to ensuring access to services. Rehab Finder is a web-based searchable database that provides access to comprehensive information on rehab programs in the GTA. Created by the GTA Rehab Network, Rehab Finder provides a convenient single source of information for professionals searching for rehab programs for their patients. The database also improves transparency and accountability by providing clear information about service components and admission criteria for each program. Since its launch in 2004, the site has become a trusted source of information for rehabilitation professionals. Patient education website supports new model of care Patient education was identified as a critical component when a new model of care for total joint replacement surgery was implemented across the GTA a few years ago. To address the need, the GTA Rehab Network partnered with orthopedic researchers and the Total Joint Network to create myjointreplacement.ca, a popular, award-winning website for patients undergoing hip and knee replacement surgery. The site reflects best practices and the input of patients, surgeons, physiatrists and allied health professionals. The site is now owned and operated by The Arthritis Society. Building a best practices community The Network s annual one-day Best Practices event has grown to become the only province-wide conference focused on rehabilitation. This collaborative showcase of research, best practices and innovation in rehabilitation facilitates the dissemination of best practices and increases knowledge transfer between researchers, clinicians and policy/management professionals. Supporting system planning A new collaboration with the Toronto Central LHIN reflects the GTA Rehab Network s reputation for effective stakeholder engagement and actionable solutions. The Network will lead a variety of LHIN initiatives to enhance patient flow for rehab and complex continuing care, building on work currently underway by both the Network and the LHIN. The work draws on the Network s expertise in rehabilitation planning, best practices and patient transitions. Specific responsibilities include: Identifying and developing policies and practices to enhance patient flow Analyzing data from the LHIN s e-referral system to monitor organizational and system-wide performance and capacity, and Engaging stakeholders to inform system-wide planning. Innovative strategies for complex issues. The GTA Rehab Network is finding solutions.

GTA Rehab Network Member Organizations Rehab Centres Bloorview Kids Rehab Bridgepoint Health Providence Healthcare St. John s Rehab Hospital Toronto Rehab West Park Healthcare Centre Toronto Acute Teaching Hospitals Mt. Sinai Hospital St. Michael s Hospital Sunnybrook Health Sciences Centre University Health Network Toronto Community Hospitals Baycrest Humber River Regional Hospital Rouge Valley Health System (Centenary site) St. Joseph s Health Centre The Scarborough Hospital Toronto East General Hospital Toronto Grace Health Centre Halton-Peel Community Hospitals Credit Valley Hospital Halton Healthcare Services Trillium Health Centre William Osler Health Centre York Community Hospitals Markham Stouffville Hospital Southlake Regional Health Centre York Central Hospital Durham Community Hospitals Lakeridge Health Rouge Valley Health System (Ajax-Pickering site) CCACs Central CCAC Central West CCAC Toronto Central CCAC Ex Officio Members Regional Geriatric Program of Toronto Toronto Acquired Brain Injury Network University of Toronto 520 Sutherland Drive Toronto, Ontario M4G 3V9 Telephone: 416.597.3057 Fax: 416.597.7021 Email: info@gtarehabnetwork.ca www.gtarehabnetwork.ca May 2009

September 2009 A message from the Chair and Executive Director The brochure in your hands highlights the GTA Rehab Network s accomplishments of the past several years a timely summary as the Network looks ahead to the implementation of a new strategic plan. This new plan reflects extensive consultations with members over the past year consultations that strongly affirmed the Network s value while challenging us to continue to demonstrate that value in very tangible ways. What did our members tell us? The Network s ability to address system-wide issues with consensusbased, workable solutions wins high praise from our members and others in the healthcare system. With its broad-based membership, the Network is able to develop and implement strategies that require consultation and coordination across multiple organizations and to do it cost-effectively. This is particularly evident in the Network s recent initiatives to reduce ALC wait times and enhance patient flow. Members also told us that they depend on the Network as an important resource: for tools that assist in referrals, patient transitions and flow; for detailed data collection and analysis to inform their planning; and as a trusted source of information for best practices and standards. Lastly, our members affirmed the Network s role as a strong voice for rehabilitation. As an advocate for rehabilitation among health care providers, LHINs and the Ministry of Health and Long-Term Care, the Network continues to raise the profile of rehabilitation within a rapidly evolving health care environment. As the Network moves forward with a new plan and a renewed sense of direction, we will build on these strengths while responding to the needs of our members, our partners and the healthcare system as a whole. The work of the Network is made possible only through the immense contribution and commitment of the members of the Network s Coordinating Council, task groups and committees, and secretariat staff. Thank you. With your support the Network will continue to advance rehabilitation and support our members in delivering the highest standard of care for patients and their families. Charissa Levy Executive Director Tina Smith Chair Financial summary 2008/2009 Year ended March 31, 2009 Operating Account Revenue Member contributions $ 446,633 Interest income 10,749 E-stroke administration fee 5,500 Total Revenue 462,882 Expenses Staffing and benefits 253,223 Project support (includes professional fees) 10,421 General operating expenses 42,188 Total Expenses 305,832 Revenue less expenses 157,050 07/08 carry forward 185,186 E-stroke administration fee 06/07, 07/08 19,638 Operating balance at March 31 $361,874 1 Project Accounts Revenue Expenses Balance E-stroke rehab referral 90,177 84,758 5,419 Patient flow TC LHIN 200,000 2 40,029 159,971 Common referral HSIP 84,225 55,011 0 3 Canadian Nurses Foundation pain grant 26,847 17,140 9,707 Best Practices Day 46,917 4 16,425 30,492 Total project funds remaining $205,589 1 Additional cash in investments of $150,000 (contingency fund) 2 Project duration January 2009 March 2010 3 Surplus of $29,214 returned to MOHLTC 4 Includes reconciliation of 08 and 09 events

GTA Rehab Network Task Groups and Committees Coordinating Council ABI Rehab Definitions Task Group ALC Advisory Committee Ambulatory Care/Outpatient Task Group Amputee Rehab Definitions Task Group Best Practices Day Task Group Burn Rehab Definitions Task Group Cardiac Rehab Definitions Task Group CNF Pain Grant Team e-stroke Rehab Referral Advisory Committee Geriatric/Medically Complex Task Group HTLD Project Team Membership and Governance Task Force MSK Rehab Definitions Task Group Oncology Rehab Definitions Task Group Pandemic Planning Task Group Patient Access and Flow Committee Pulmonary Rehab Definitions Task Group Rehab Definitions Advisory Committee Spinal Cord Rehab Definitions Task Group Stroke Rehabilitation Task Group Chair, Tina Smith, University of Toronto Vice Chair, Mark Rochon, Toronto Rehab Chair, Malcolm Moffat, St. John s Rehab Hospital Chair, Diane McLaughlin, Credit Valley Hospital Chair, Dr. Mark Devlin, West Park Healthcare Centre Chair, Dr. Gaetan Tardif, Toronto Rehab Chair, Dr. Joel Fish, Sunnybrook Health Sciences Centre/St. John s Rehab Hospital Chair, Dr. Paul Oh, Toronto Rehab Chair, Dr. Richard Crilly, University of Western Ontario Chair, Tina Smith, University of Toronto Chair, Dr. Susan Jaglal, University of Toronto Chair, Rhonda Galbraith, St. John s Rehab Hospital Chair, Dr. Gaetan Tardif, Toronto Rehab Chair, Barbara Wotton, Providence Healthcare Chair, Dr. Roger Goldstein, West Park Healthcare Centre Chair, Mary Ann Neary, University Health Network Chair, Malcolm Moffat, St. John s Rehab Hospital GTA Rehab Network Staff Charissa Levy Executive Director* Patty Aird Office Manager* Sue Balogh Project Coordinator/Planner Hannah Seo Project Coordinator/Planner Robert Jessop Communications/Data Coordinator* Linda Milan Data Entry/Office Assistant* Judy Moir Project Coordinator/Planner* * staff shared with Toronto ABI Network 520 Sutherland Drive Toronto, Ontario M4G 3V9 Telephone: 416.597.3057 Fax: 416.597.7021 Email: info@gtarehabnetwork.ca www.gtarehabnetwork.ca