1. Patient Access & Flow “One Number” June 27, 2014

2. History of the “One Number”  The One Number process was initiated in May 2010 and was a joint project within the SWLHIN. We currently receive approximately 250- 300 calls/month/site  The “One Number “ at LHSC is supported 24/7 with nursing( After Hours Coordinator/Charge Nurse) and clerical support. They will guide you through the call with presenting the patient to be discussed, where the call is from and reason for the call.  Exclusions for One Number Process: Mental Health, OB, Paediatrics, SJHC Hand and Upper limb, UCC, PCI, Stroke bypass

3. History of the “One Number” (con’t)  It is designed to:  Facilitate the access/movement of patients to and from LHSC in a coordinated and timely manner  Facilitate unplanned admissions or potential admissions/assessments  Assist physicians in the triage of referrals from the region to include consults or redirect to clinic  Meet the needs of emergent and urgent patients who need a tertiary level of care within the agreed upon time right away <4h within 24 hours within 48 hours  and in support of our “life and Limb” policy, to ensure Critically Ill patients are accepted for care if deemed necessary by the physician regardless of bed availability

4. Why the Changes ?  Patients who needed tertiary care at LHSC often could not access our resources  Patients would arrive in an “unplanned” manner to the Emergency Department which could overwhelm the system adversely affecting the care of patients  On occasion, critically ill patients from the region were being referred to distant centres for care, often to the US  There was no system to inform on-call physicians of the resources available or to assist in the triage of these patients  There was not a consistent approach with the repatriation of patients to their home hospital when tertiary care was no longer needed, often causing delays.

5. The “One Number” Process  The LHSC “One Number” is extension 33367 or (519) 663-3367  The One Number” line is to be used for all admission requests from outside LHSC  The “One Number” clerk will page the Consultant or the Senior Resident depending on service (each service has determine 1 st call, please check with your Consultant)  The “One Number” clerk will ask the referring Physician:  If the call is life or limb  If they are wanting to transfer their patient or if the call is for a consult only and will direct the call accordingly  When you receive a page, you will see the call back number, followed by a 4 digit ID code. When you call into the number, you will be prompted to enter the 4 digit code.  If the ID code is followed by 999: This indicates a “life or limb” referral through Criticall.

6. “One Number” Process  When you answer the page, you will dial into a conference line from the pager number you received, please wait while others are connected  The LHSC Access Coordinator, the Referring Physician (and CritiCall if appropriate) will be on the call. The ICU Extramural Physician will also be on the call if ICU is required.  The Access Coordinator will facilitate adding other physicians or services online if requested.  If the patient requires immediate transfer, the Access Coordinator will facilitate the transfer to include notifying the ED if necessary, otherwise the patient will be placed on the request list related urgency ( i.e. 24-48h)  Please redirect any direct calls from physicians regarding critically ill patients to:  CritiCall at 1-800-668-4357(HELP)

7. What we need from you?  To be familiar with the process and respond to your page in a timely fashion  Your role is to determine the appropriate patient outcome and urgency (i.e. admission, consult or redirect to other recourses)  If you receive a call directly from the region to redirect the referring Physician to the “One Number”, or Criticall when appropriate (this is still new to some regional Physicians)  To ensure that you use Patient Access to facilitate the repatriation of patients.

8. Predictive Discharges  Red: not ready for discharge  Yellow: expected to be discharged b/w 24 and 48 hours  Green: expected to be discharged in the next 24 hours

9. What we need from you as Residents (con’t) Repatriations  Patients can be flagged at least 24-48 hours in advance of being ready to transfer.  Please complete the repatriation form (can be completed by a designated – NP, RN, Coordinator, Discharge Planning)  The floor will send the completed form to the Patient Access/Admitting department.  The “One Number” contact will find the bed and the accepting physician.  You are to be available for a physician to physician call if requested by the accepting physician

10. Bed Capacity Issues at LHSC  LHSC can be found to run at greater than 100% occupancy, therefore please use discretion when determining urgency  Alerts are sent out to all the hospitals in our LHIN when LHSC is having bed capacity issues and is restricted to the region (this restriction does not apply to “Life or Limb” or critically ill patients)  Regional hospitals are asked at this time to assist LHSC by prioritizing repatriations, etc.  Through the Access Coordinator, patients can be placed on our Regional list to be brought in to LHSC when a bed comes available in the time frame specified by the accepting team (i.e. Urgently 24-48hrs or When bed available)

11. Comments, Questions