Common Referral Form to be Launched
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 GTA Rehab Network 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).
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.
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.
Substance Use and Brain Injury Project
Representatives from the Toronto ABI Network collaborated earlier this year on the Substance Use and Brain Injury (SUBI) project, an initiative led by Community Head Injury Resource Services (CHIRS) and the Centre for Addiction and Mental Health (CAMH) to facilitate ongoing interdisciplinary management of clients living with both an acquired brain injury and problematic substance use.
The objectives of the SUBI project were to:
- Develop initial treatment alternatives for ABI clients whose cognitive impairments precluded their treatment in mainstream substance use programs;
- Provide support to CAMH in managing cognitive impairments presented by clients with brain injury;
- Facilitate training between CHIRS and CAMH; and
- Provide prevention and secondary prevention materials to clients with ABI.
These materials included:
- a manual for brain injury providers and substance use providers;
- a workbook for clients (to be used by clients and their providers);
- a pamphlet for clients entering the system with brain injury in acute care settings; and
- recommendations for screening, prevention and education for use in acute care and/or rehabilitation settings.
Efforts are now underway to support the dissemination of the findings of this initiative. As a first step, the Network’s Best Practice Committee will be hosting a stakeholder education session to provide an overview of SUBI and to facilitate a discussion about implementation within organizations.
This session has been scheduled for October 30, 2007 from 9:00 am - 11:00 a.m. at Bloorview Kids Rehab. Invitations for this session will be sent out by email.
Community Services Project Initiated
Building on our work to develop a planning framework for ABI services, the Toronto ABI Network is undertaking a community project that will assist in further defining the scope of services in the community for individuals with an acquired brain injury and allow us to look at alternative models of service delivery.
The work of this committee is still in a developmental stage but it is anticipated that its activity will revolve around the following:
- Map the current state of community services
- Define/clarify the geographic scope of services to be considered
- Describe current basket of services, considering issues related to capacity and access, public and private funding, and transition points.
- Better define the profile of individuals waiting
- Will require access to wait lists and the ability to survey those waiting. Include current clients waiting for different level of services (may be able to use modified MPAI-4 to better express resource requirements).
- Identify gaps in existing community services that present barriers to adequately responding to the needs of those waiting for service.
- Identify system model features, structures, tools, processes and service modifications needed to enhance access to community services. For example:
- Alternative models for service delivery;
- Identify opportunities for collaboration across sectors and establish partnerships for sharing resources/coordinating advocacy efforts;
- Mechanism for communicating ongoing and emergent needs (e.g. central wait lists);
- Mechanism for identifying individuals in urgent need; and
- Develop protocol for prioritizing individuals in need of urgent support.
Recent Advocacy Activities
The Toronto ABI Network had some very exciting opportunities this summer to further advocacy efforts for the needs of individuals with an acquired brain injury.
Meeting with the Minister of Children and Youth Services
At the end of August, Network chair Malcolm Moffat and Acting Executive Director Judy Moir met with the Minister of Children and Youth Services, Mary Anne Chambers, and senior members of her staff.
The Network requested this meeting to draw the Minister’s attention to the complex needs of children and youth with an acquired brain injury and ask for her assistance in providing leadership and policy direction in the implementation of a coordinated, cross-ministerial approach to supporting these children and their families.
Also attending the meeting were staff from Bloorview Kids Rehab: Sandi Cox, Chief Nursing Executive and Senior Director of Rehabilitation & Complex Continuing Care and Iris Hogan, Manager for Inpatient Rehabilitation & Complex Continuing Care.
We were very encouraged by the obvious interest in and appreciation of the needs of this complex population demonstrated by the Minister and her staff. They advised that they are in the process of developing a framework for the delivery of services to all children and will invite our feedback on the applicability of this framework to children and youth with acquired brain injury.
Meeting with Director of LHIN Liaison Branch
Malcolm Moffat and Judy Moir also met with the Director of the LHIN Liaison Branch, Carrie Hayward, and her staff.
The purpose of the meeting was to highlight the needs of individuals with ABI and the need for cross-LHIN planning and coordination of services for the ABI population. This meeting also provided an opportunity to highlight the role the Toronto ABI Network can play, through its membership, in supporting the planning and decision-making of the Ministry and the LHINs as we move forward.
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.
September 27, 2007
Community Works: Back to Basics ABI Rehabilitation in the Community
Location: Whitby Mental Health Centre, Whitby, Ontario
FOR FURTHER INFORMATION:
Contact: Head Injury Association of Durham Region
Phone: 905-723-2732
See agenda and registration form
October 19, 2007
7th Annual Kunin-Lunenfeld Applied Research Unit (KLARU) conference:
Enhancing Cognition in Older Adults: Connecting Research and Clinical Care
Location: Baycrest Campus, Toronto, Ontario
FOR FURTHER INFORMATION:
Contact: Paula Ferreira, Conference Coordinator
Phone: 416-785-2500 ext. 2363
Email: pferreira@baycrest.org
Web: www.klaru-baycrest.on.ca
See flyer and registration form
October 21-23, 2007
Partnering for Quality: Integrating the Right Services, At the Right Time, In the Right Place
Location: Waterloo Inn, Waterloo, Ontario
FOR FURTHER INFORMATION:
Contact: Linda
Phone: 905-335-7993
Email: linda@mmsonline.ca
Web: www.oacrs.com/about-conference.php
October 25-26, 2007
Provincial Acquired Brain Injury Conference (formerly known as the Inter Urban Brain Injury Conference):
Coming Together: Quilting the Pieces after Brain Injury
Location: Holiday Inn, Kitchener, Ontario
FOR FURTHER INFORMATION:
Contact: Terry Wilcox, Ontario Brain Injury Association
Phone: 1-800-236-5404 ext. 234
Email: obia@obia.on.ca
Web: www.obia.on.ca/2007conference/index.html
November 7, 2007
Brain Injury Services of Hamilton, Haldimand-Norfolk, Niagara's 3rd Annual Conference:
The Balancing Act in ABI Rehabilitation; Empowerment vs. Control
FOR FURTHER INFORMATION:
Contact: Brain Injury Services of Hamilton, Haldimand-Norfolk, Niagara
Web: www.braininjuryservices.com
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
Cora Moncada named Acting Assistant Executive Director
The Toronto ABI Network is pleased to welcome Cora Moncada to the Network as Assistant Executive Director (Acting). This is a full-time contract position shared with the GTA Rehab Network, for whom Cora will work as Project Coordinator/Planner (Acting).
Cora is an occupational therapist who has many years of experience working in both the private and the public sectors. She was the Conference Coordinator for the Toronto ABI Network's conferences in 2004 and 2006 and was instrumental in ensuring the success of both events through her strong leadership and project management.
She is on the Board of Directors of the Brain Injury Society of Toronto and brings extensive knowledge about rehabilitation from clinical and client perspectives to her role.
Cora can be reached by telephone at (416) 597-3422, ext. 3688 and by email at moncada.cora@torontorehab.on.ca. Please join us in welcoming Cora to the Networks.
Network office moved
On September 13th, the office of the Toronto ABI Network moved from University Avenue to Toronto Rehab's Lyndhurst Centre at 520 Sutherland Drive. This move affects our mailing address only. All telephone extensions and email addresses remain unchanged.
Until now, the Network offices have been located at the University Centre site of Toronto Rehab. This site is undergoing a long-term construction project which includes the demolition of the south wing of the building. As part of the construction strategy, some offices at the University Centre (including those of the Network) were required to move to accommodate the relocation of clinical services and staff from the south wing to other parts of the building.
Our new mailing address is:
Toronto ABI Network
520 Sutherland Drive, Room B59
Toronto, Ontario, M4G 3V9
Network workshop wins award
In March, a workshop was held for local psychiatrists to enhance their knowledge of the assessment and management of patients with acquired brain injury. Twenty-five community psychiatrists attended the workshop and the feedback received was overwhelmingly positive. We are very pleased to announce that this workshop was awarded the Ivan Silver Award for best CME program in Psychiatry at the University of Toronto.
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.
Participants wanted for study on brain injury and 'getting in shape'
People with brain injury are required to participate in a project promoting physical activity. Participation involves doing a physical activity that you choose three times a week with a fitness partner. It also involves completing some brief questionnaires and psychology-type tests at the beginning of the project and again at 3 to 6 months after you start the physical activity. Testing will be done at Baycrest. Your physical activity will be done in your own community.
Eligible people:
- have had a traumatic brain injury;
- are not currently involved in a regular physical activity program;
- are 18 years of age or older; and
- have an email address that is checked regularly.
If interested, please contact Michelle Ryan at mryan@klaru-baycrest.on.ca or by calling 416-785-2500 ext. 3014.
Having trouble getting or keeping your life in order?
If so, you may be eligible to participate in a new, real-world rehab project. You will work with an experienced occupational therapist and get help developing strategies to accomplish those things in your life you are currently having trouble doing. Participation involves completing some cognitive and real-world tests of function both before and after strategy training. The training will be provided twice each week for ten weeks (about an hour each time) and will take place at Baycrest or in your own community and home.
Eligible people:
- have had a traumatic brain injury;
- are able to identify 3 things that they want/need to do in daily life but are having trouble with; and
- are 18 years of age or older.
If interested, please contact Michelle Ryan at mryan@klaru-baycrest.on.ca or by calling 416-785-2500 ext. 3014.