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Having a rapid impact on patients

Toronto, October 6, 2016

By Leslie Shepherd

Dr. Robert Sargeant (left) discusses the new Rapid Referral Clinic with Dr. David McKinnon
Dr. Robert Sargeant (left), head of the Division of General Internal Medicine, discusses the new Rapid Referral Clinic with Dr. David McKinnon, deputy chief of the ED, who calls the new clinic “a great resource.” (Photo by Yuri Markarov)

A man arrived in the Emergency Department one Friday this summer complaining of shortness of breath and swollen ankles. He had no previous medical history and was a heavy smoker, so staff thought he might have emphysema and prescribed him an inhaler.

When that didn’t work, ED staff had two options: refer the patient to General Internal Medicine for consideration of admission to hospital or refer him to the hospital’s new Rapid Referral Clinic. The choice was obvious.

The man was seen in the clinic the following Monday and was also able to snag an open slot in the Echocardiogram Lab, allowing doctors to confirm a diagnosis of congestive heart failure and start him on diuretics.

The Rapid Referral Clinic opened in May as a six-month pilot project to provide expedited care within 48 to 72 hours to patients who present in the ED with acute medical problems but who can be managed safely as outpatients, thus avoiding hospital admissions and readmissions.

The results so far have exceeded expectations, said Dr. Robert Sargeant, head of the Division of General Internal Medicine, which runs the three-mornings-a-week clinic.

By early August the clinic had seen 142 different patients over 171 appointments. The average time from ED referral to clinic appointment was 65 hours (2.7 days). Sixty-seven hospital admissions were averted. Followup plans were created for all 142 patients and 47 people were referred to subspecialists.

The clinic saw the congestive heart failure patient every two days until his symptoms were under control, got him into the hospital’s congestive heart failure clinic, and found him a family doctor in the Family Health Team. Without the Rapid Referral Clinic, Dr. Sargeant estimated the man would have been admitted to the hospital for four or five days.

   
Comments from patient feedback forms:
  • 95 per cent felt they wouldn’t necessarily have been served better by a hospital admission
  • 80 per cent rated the wait time between ED referral and clinic visit as excellent or very good
  • 100 per cent of patients said the clinic answered their concerns and questions in a way that was helpful and easy to understand
  • Average clinic rating on a scale of 1-10: 9

“Instead, we treated him as an outpatient and he was delighted,” Dr. Sargeant said.

Dr. David McKinnon, deputy chief of the ED, called the new clinic “a great resource.”

“Most patients prefer to go home and this allows a subset of them to do so safely when they would have been admitted to hospital otherwise,” he said. “In this way, the Rapid Referral Clinic is beneficial for both the patient and the system."

Dr. Sargeant said the Rapid Clinic was needed not just to co-ordinate care of complex patients as outpatients, but also because of changes to the University of Toronto curriculum for residents. As of July 1, residents are required to have more learning opportunities in ambulatory clinics, and the Rapid Referral Clinic provides a teaching venue for senior residents. The clinic is staffed by one physician, one resident and one nurse.

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.