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Common Referal Form to be Launched
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The Toronto ABI Network has been working with the GTA Rehab Network to develop a standardized inpatient referral form that can be used for referrals to inpatient rehabilitation 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).
This initiative is part of a continued focus by the GTA Rehab Network on reducing Alternate Level of Care (ALC) days and improving patient flow from acute care to post-acute care. The form reflects an agreement between member organizations of the networks on information required for referrals from acute care to post-acute destinations.
Draft versions of the form were reviewed by the ABI Network's Systems Coordination Committee and the GTA Rehab Network’s Patient Access and Flow Committee, representing acute care and rehab hospitals. Broader stakeholder feedback was sought from all rehab population groups and representatives from CCC. The feedback was used to refine and shorten the form and maximize work flow processes.
Why a common referral form for inpatient rehab and complex continuing care?
Feedback from the GTA Rehab Network’s ALC surveys has indicated that referral inefficiencies (e.g. timing of referrals, number of referrals submitted, response to referrals, and communication around special needs) contribute to delays in the transfer of patients from rehab to a post-acute care setting. Rehab providers reported that the amount and relevance of information currently provided with inpatient rehab referrals and on patient transfer also contributes to delays.
The new standardized referral form supports improved coordination and efficiency in the referral process by:
- Providing the right referral information from acute care to streamline the process of review for rehab providers; and
- Reducing workload for referrers who are referring to multiple programs at different organizations (e.g. stroke/neuro/geriatric).
The new Inpatient Rehab/CCC Referral Form also lays the groundwork for use in developing an electronic referral system in the future and increases the capability to monitor system access indicators consistently across programs via e-referral.
What will the form be like and for whom will it be used?
Finding a balance between the competing demands for a form that captures relevant and individualized patient information with a form that is succinct and easily completed was a challenge.
The new form, which includes population-specific sections, was first drafted by:
- Building on existing population-specific forms to standardize sections for use across all rehab populations (e.g. demographic, referral, medical, care needs and social sections);
- Maintaining referral information required for specific populations; and
- Standardizing information required by rehab/CCC for patients with wound care needs.
Wherever possible, the form makes use of tick boxes to maximize ease of completion for referrers and optimize review of referrals by service/admission coordinators in rehab hospitals. However, there is an opportunity for referrers to provide some individualized information to describe the patient’s care needs, medical/functional status and rehab goals.
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. Referrals for stroke rehab will continue to be made through the E-Stroke Rehab Referral System although the form has been reviewed by the E-Stroke Rehab Referral Coordinator to ensure that it can be adapted later for use in an electronic format for inpatient stroke rehab referrals. Discussions are underway with the Toronto Palliative Care Network regarding the use of the common form for palliative care referrals in the future.
What are the implications for ABI rehab?
The Toronto ABI Network’s Inpatient ABI Client Profile was a significant resource in the development of this common post-acute care referral form. While there will be changes to the look and the format of the referral form from what we are accustomed, we are confident that the content of the existing ABI form has not been compromised.
Given the overlap between ABI, stroke and neuro programs (and even with spinal cord and MSK rehab programs), those making referrals through the Toronto ABI Network have much to gain by the introduction of a common form. This should significantly reduce the duplication of work that results when referrers are not certain which rehab program is the most appropriate for their patient.
The GTA Rehab Network has established an implementation plan and is anticipating a launch of the common form sometime in November. Education sessions to introduce the new form will be conducted in late October with referrers from acute care and service/admission coordinators from rehab hospitals.
The Toronto ABI Network will enusre that the implementation plan continues to reach our stakeholder group in a direct and deliberate manner.
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