Task Group to Investigate Access Issue
The Toronto ABI Network’s Systems Coordination Committee has identified an area of concern that we feel requires a targeted response.
Transitioning patients with an ABI from acute care facilities to rehab facilities has been noticeably affected by the consistent wait lists and limited bed capacity. Rather than a direct transfer to a rehab centre, patients are increasingly being repatriated to a community hospital or discharged home to wait for a rehab bed. This appears to be an issue that is unique to the ABI population, possibly due to limited capacity of inpatient rehab beds and the opportunity for ABI patients with good physical recovery to be managed at home in the meantime.
Once patients are at home, our data indicates that approximately 50% are declining admission to a rehab facility when a bed is offered. Families have a difficult time encouraging their loved ones to return to receive inpatient rehab and/or the patient and family do not immediately recognize the need for intensive rehab. Concurrently, rehab hospitals are reporting that patients who have been admitted from home are more likely to discharge themselves within 1-2 days. Anecdotally we are told that many of these people are recognizing a need for services after a period of time and are presenting to the CCACs, sometimes in a state of considerable distress.
A task group of providers representing the continuum across the ABI Network are meeting to identify the scope of this issue as well as to develop processes and strategies to increase the number of successful transitions from acute care to rehab care and to ensure appropriate follow-up for those individuals that do go home, or to a community hospital, to wait for inpatient ABI rehabilitation.
Rehab Definitions Initiative
The Toronto ABI Network is collaborating with the GTA Rehab Network in a major initiative to standardize the core components of publicly-funded rehabilitation across the care continuum.
The Rehab Definitions Initiative, which began last year, has strong participation from across the Toronto ABI Network membership and endorsement from the ABI Advisory Committee. The initiative was undertaken in response to consistent stakeholder feedback that the wide variety of rehabilitation programs and services across organizations is a source of confusion and frustration. The type of services, degree of specialization and frequency and duration of therapy can vary significantly from one program to another. The result is often uncertainty about where to make referrals and delays for patients. In addition, the lack of consistency makes it difficult to measure and compare patient outcomes between programs or to plan effectively across the system.
What is the initiative?
In the initial phase of the project, the GTA Rehab Network worked with its members to develop a generic framework and definitions that describe the key components of rehabilitation in each setting (e.g., services provided, differential criteria, degree of specialization, frequency, typical duration, etc.). The framework provided a starting point to standardize rehab programs and ensure consistency across organizations.
The Toronto ABI Network has worked with our member organizations to facilitate the process of adapting this generic framework for ABI/Neuro rehab populations using best-available evidence.
How will this involve your organization?
Based on the completion of the ABI/Neuro framework, a self assessment tool will be developed and can be used by organizations to evaluate their programs against the established definitions/standards. Respondents will be asked to report on whether they fully meet, partially meet, or do not meet individual definitions. Once the information is received, the Network (through the Advisory Committee) will work with our members to determine next steps and support system-level advocacy.
Why should your organization participate?
- Improved performance measurement ~ Survey results will allow your organization to determine how well you are meeting the evidence-based standards and help you identify quality improvement initiatives.
- Improved system planning ~ Survey results will provide all of us with a clearer picture of the current state of rehab across the Network’s membership and within individual LHINs.
- Enhanced advocacy ~ Survey results will allow the Network to conduct a system-wide analysis of ABI/Neuro rehab programming, rehab resources, and issues related to timely access. This information will support organizational and system-wide advocacy efforts for the necessary resources to ensure timely access and equitable standards of care. (Note: Any reporting of survey findings will be shared in aggregate form only.)
If you have any questions or comments, please feel free to contact Judy Moir at moir.judy@torontorehab.on.ca or 416-597-3057.
Update on SUBI Project
On October 30, 2007, the Toronto ABI Network hosted a workshop to present the Substance Abuse and Brain Injury (SUBI) Bridging Project. Dr. Carolyn Lemsky, Clinical Director with Community Head Injury Resource Services, provided background information on the SUBI project as well as a summary of the educational materials that were developed through the SUBI initiative.
Representatives from the Centre for Addictions and Mental Health also attended this workshop and were able to address the importance of collaborating and building successful partnerships to better meet the needs of clients with issues related to substance use and acquired brain injury.
The SUBI project developed and provided educational materials that community providers can use to assist their clients. Materials include:
- Manual for brain injury providers and substance use providers
- Client workbook
- Pamphlet for clients entering the system with brain injuries in acute care settings
- Recommendations for screening, prevention and education for use in acute rehabilitation settings.
The Toronto ABI Network will continue to provide opportunities to support ongoing dissemination for SUBI.
For further information on the SUBI project, please visit the SUBI website.
Forum on Restraint Use
In May 2006, a group of clinical providers attended a workshop addressing the use of restraints within hospital settings. The workshop, entitled “The Restraints Dilemma”, highlighted current practices within various healthcare organizations and also addressed possible solutions or directions to reduce the use of restraints to help prepare patients for rehab.
As a follow-up to this initial workshop, clinical providers will once again be invited to attend a morning session to address changes that have occurred in hospital practice within the last 18 months. This session, which has been scheduled for January 17, 2008, will provide an update and summary of the efforts made by various hospital organizations.
The following topics will be highlighted during the January forum entitled “Transforming Practice: The Restraint Dilemma”:
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“Seek First to Understand: Creating a Cultural Transformation to Support a Least Restraint Environment”
Presenter: Tiziana Rivera ~ Health System Manager, Seniors' Health Program & Geriatric Mental Health Ambulatory Program, Trillium Health Centre - “Sustaining a Least Restraint Environment: Findings from RNAO Advanced Clinical Practice”
Presenter: Farah Choudhry ~ Sunnybrook Health Sciences Centre and Catherine Morash, Advanced Practice Nurse, Trauma and Critical Care Program, Sunnybrook Health Sciences Centre - “Best Practice in the Management of Complex Behaviours in Patients with Acquired Brain Injury”
Presenter: Nancy Boaro ~ Advanced Practice Leader, Neuro Rehab Program, Toronto Rehabilitation Institute - “Restraint Resource Guide”
Presenter: Judy Moir ~ Executive Director (Acting), Toronto Acquired Brain Injury Network
For more information about the forum on January 17th and for details on how to register, please see the event flyer.
Data on Referrals Received
The Toronto ABI Network manages referrals for acquired brain injury services in the Greater Toronto Area. Referrals for inpatient service are triaged through the Network office to the first available bed that is appropriate to the individual's needs. The Network also facilitates the process of referring to community-based ABI providers.
The following information reports only on patients/clients referred through the Network office and is not intended to reflect incidence data.
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Events Listing
The events listed here are provided for your information and are not necessarily being organized by the Toronto ABI Network. If you are interested in further details about any of the events below, please contact the appropriate individual identified in the event listing.
January 17, 2008
Toronto ABI Network presents:
Transforming Practice: The Restraint Dilemma
Location: Sunnybrook Health Sciences Centre, Toronto, Ontario
FOR FURTHER INFORMATION:
See flyer for more information about the agenda and information on how to register
February 19-22, 2008
Ontario Brain Injury Association in conjunction with Brock University presents:
Certificate Training Program ~ Neurorehabilitation: Assisting Recovery and Function in Everyday Life Following Brain Injury
Facilitators: Dr. Sherrie Bieman-Copland and Dr. Dawn Good
Location: Brock University, St. Catharines, Ontario
FOR FURTHER INFORMATION:
Contact: Debbie Spaulding or Ruth Wilcock
Phone: 1-800-263-5404
Web: www.obia.on.ca
March 25-26, 2008
Baycrest presents the 18th annual Rotman Research Institute conference:
Neuroimaging in Dementia
Location: The Four Seasons Hotel, 21 Avenue Road, Toronto, Ontario
FOR FURTHER INFORMATION:
Contact: Paula Ferreira, Conference Coordinator
Phone: 416-785-2500 ext. 2363
Email: pferreira@baycrest.org
Web: www.rotman-baycrest.on.ca
April 9-12, 2008
Seventh World Congress on Brain Injury
Location: Pestana Palace Hotel, Lisbon, Ontario
FOR FURTHER INFORMATION:
Web: www.internationalbrain.org
May 7-9, 2008
Ontario Brain Injury Association in conjunction with Brock University presents:
Certificate Training Program ~ Neuropsychological Assessments: Beyond Testing
Facilitators: Dr. Sherrie Bieman-Copland and Dr. Dawn Good
Location: Brock University, St. Catharines, Ontario
FOR FURTHER INFORMATION:
Contact: Debbie Spaulding or Ruth Wilcock
Phone: 1-800-263-5404
Web: www.obia.on.ca
This listing provides details of events taking place within approximately three months of the newsletter’s release date. For a more comprehensive list of events of interest to the ABI community, please see the conference listing on our website.
In Brief
CHIRS wins business excellence award
Community Head Injury Resource Services of Toronto (CHIRS) has won the 2007 Business Excellence Award for "Business of the Year - Innovation and Leadership" from the Toronto Board of Trade and North York Chamber of Commerce.
This award recognizes CHIRS as providing extraordinary service and leadership, innovation and overall excellence. We are very pleased to congratulate the board and staff of CHIRS on this outstanding achievement.
To find out more about this achievement, read the story on the Central LHIN website.
Participants wanted for study on brain injury and coping
The Kunin-Lunenfeld Applied Research Unit at Baycrest is looking for people who have suffered a traumatic brain injury, and who are otherwise healthy, to participate in a study to advance the understanding of coping following brain injury. Participation involves going to Baycrest on two occasions (for the day) and completing some cognitive and real-world tests of function. Participants will also be asked to complete some questionnaires. If possible, the study coordinators would also like a family member or close friend to participate in the study.
Eligible people:
- have had a traumatic brain injury;
- have no history of serious medical problems;
- have no history of a psychiatric disorder;
- have no history of substantial substance abuse; and
- are 16 years of age or older.
If interested, please contact Katherine Krpan at katherine@psych.utoronto.ca or by calling 416-785-2500 ext. 2170.
Funding opportunity for Ph.D. and Postdoctoral fellowship awards in ABI research
The Ontario Neurotrauma Foundation has launched a funding opportunity for Ph.D. and Postdoctoral Fellowship Awards in ABI Research. The Call for Abstracts may be found on the ONF website in the funding initiative section by clicking on the December 2007 link.
The deadline for submissions is February 11, 2008.
Date and venue selected for Network's 2008 conference
The Toronto ABI Network's bi-annual conference will be held on November 27 & 28, 2008 at the Hilton Toronto in downtown Toronto.
A Call for Abstracts will be distributed widely in early 2008. Opportunities for sponsorship of this event will also be offered in January 2008. Further details will be announced in our Winter 2008 newsletter.
Reminder to use common rehab referral form
As reported in our last issue, a standardized inpatient referral form has been developed for use for referrals to inpatient rehab and Complex Continuing Care (CCC) programs. The Inpatient Rehab/CCC Referral Form includes questions common to all rehab populations and population-specific inserts for different rehab populations (ABI or MSK, for example).
The form will be used for all rehab and CCC referrals except for stroke rehab, elective arthroplasty, non-complicated elective cardiac bypass/valve surgeries and palliative care referrals.
The common rehab referral form replaces the use of the former ABI Client Inpatient Profile for referrals for inpatient ABI rehab.
Copies of the common rehab referral form with the ABI/Neuro functional supplement are available on the applications page on the ABI Network website.
For more information about this initiative, please visit the Referral Forms page on the GTA Rehab Network website.
City Mix ~ An inclusion awareness event planned for August 2008
City Mix 2008 is the first citywide celebration of its kind. This event is an extension of The Mix Community Club's monthly community inclusion concerts and social events which are co-hosted by CHIRS and Community Living Toronto.
The purpose of this event is:
- Social Empowerment ~ To celebrate all people.
- Social Awareness ~ To cultivate greater acceptance of inclusion for people with disabilities.
- Social Diversity ~ To connect different people and organizations together.
For more information, see the event website.