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Call me maybe? One step closer to home

Toronto, February 27, 2015

By Emily Holton

Tony practises using the call bell with Sarah Wallace
Tony, a patient in Trauma/Neurosurgery practises using the call bell with Sarah Wallace, a recreation therapist. Tony underwent the training while recovering from two back-to-back brain surgeries. After the training, he graduated to a rehab facility within days. (Photo by Katie Cooper)

“If you need help, push this button.” For some patients with traumatic or acquired brain injury, learning to follow these simple instructions can mean the difference between weeks of hospitalization and moving on to the next stage of their recovery.

In the Trauma/Neurosurgery Unit, patients who are at high risk of falling or wandering away from their beds stay in “high observation” rooms. For their own safety, these patients are watched by clinical assistants 24 hours a day, seven days a week.

Until recently, once a patient was under high observation, there were no standard criteria to help the interprofessional team decide when he or she was safe to transfer out. Without clear guidelines, patients’ transitions to rehab or long-term care were often delayed; rehab and long-term care facilities won’t accept patients straight out of constant care.

The team got together to develop its own criteria and came up with a simple solution. If a patient under high observation could demonstrate that he or she consistently used the call bell to ask for help, the team could feel confident that patient wouldn’t try to get up alone and risk a fall.

To begin, occupational therapist Shari Vanderhoek developed a set of repetitive questions for patients, guided by OT principals of cognitive retraining, to reinforce the use of the call bell. Additional members of the Trauma/Neurosurgery team including a case manager, physiotherapist, recreation therapist and nurses worked together to create guidelines to help identify patients who were good candidates for the training. Once eligible patients demonstrate that they can use the call bell consistently and effectively for 24-72 hours, they are deemed ready to move out of constant care.

Not every traumatic brain injury patient is a candidate, but the ones that are eligible have done extremely well.


If a patient under high observation could demonstrate that they consistently use the call bell to ask for help, then the team could feel confident that patient won’t try to get up alone and risk a fall.

“We were pleased to find out that on occasion, the successful participation in our call bell training was all rehab required to accept the patient,” said Sarah Wallace, a recreation therapist on 9CC. “For the first time, we’re transitioning patients straight from constant care to rehab.”

Speeding up these transitions can make a big difference to a patient. Semi-private rooms are quieter and more comfortable, and moving to rehab means a patient is one step closer to home. The next patient on the ward benefits as well; in a program that operates at 94 per cent capacity, the sooner one patient transitions home or to another facility, the sooner the hospital can move the next trauma or neurosurgery patient out of the Emergency Department and into the ward.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.