Introduction & Background
In response to the COVID-19 pandemic, new bedded capacity was urgently required in Sudbury in order to free-up acute care space in anticipation of an impending surge of admissions. Numerous local healthcare organizations came together to rapidly transform the Clarion hotel into an alternate health facility. As an interim setting to provide care to patients designated Alternate Level of Care (ALC), North East Specialized Geriatric Centre (NESGC) resources were directly involved in planning, developing, and implementing an evidence-informed model of transitional care.
Purpose & Methodology
The purpose of this evaluation is to assess the initial results of adding bedded capacity to the healthcare system in Sudbury (Phase I - April 6th to June 19th 2020). The specific contribution of specialized geriatric service (SGS) resources was explored to understand the value and impact with respect to patient, provider, and system outcomes.
A mixed-methods approach was used in this evaluation to gain a broader understanding of the model and recommendations for next steps.
Key Findings and Conclusions
A number of important findings emerged from this evaluation:
- Characteristics of the patient population cared for at the Clarion are consistent with existing literature. Patients designated ALC are predominantly older, have functional and cognitive impairments, and multiple co-morbidities, and present with diagnoses including dementia, falls, and general medical conditions.
- Patients designated ALC spend an extended length of time in acute care, placing them at increased risk for adverse events (e.g. functional decline, delirium, etc.)
- ALC designation alone did not correspond to the most appropriate next level of care. An understanding of individual care needs and the identification of restorative potential is essential to determining the ‘right’ type of post-acute care once the issue that precipitated the hospital stay has been resolved
- Two care streams were offered at the Clarion: Rehab and Long Term Care (LTC). The largest cohort of patients were admitted to the LTC stream.
- The model of care was based on provincial best practices for the care of older adults with frailty. Comprehensive Geriatric Assessment (CGA), the gold standard for care of this population, was delivered in the transitional care environment.
- Care was delivered by an inter-professional team with limited experience or expertise working in SGS. Dedicated clinical leadership roles (e.g. Senior Friendly Care Lead) provided on-the-ground knowledge translation to build capacity in the team’s awareness and understanding of a geriatric approach to care.
- An increased understanding of CGA, geriatric syndromes, and patient-centered goals was demonstrated by staff. Perceived team cohesiveness also improved.
- A third of patients transitioned to the Clarion during this 11 week evaluation period were discharged; discharge destinations included home with service, retirement home, HSN, SJCCC, and LTC.
Since Phase I of Clarion implementation, the occupancy rate and ALC numbers at Health Sciences North (HSN) have continued to climb, now exceeding pre-pandemic levels. The added capacity afforded by the Clarion met the goal of freeing up space in acute care however, on its own, was not sufficient to maintain reduced occupancy and enable patient flow across the local healthcare system. Planning, developing, and implementing a model of transitional care that is based on the known characteristics and specialized care needs of the patient population designated ALC is imperative. Recognizing that the largest cohort of patients waiting in hospital for the next best level of care are older adults with cognitive and functional impairments, direct access and support from SGS resources is essential to addressing the prevalent needs.