LTCH Community of Practice April 12, 2013

1. LTCH Community of Practice April 12, 2013 “OTN Intentional Connections: Building a Collaborative Model of Care Between LTC and Hospital” Southlake Regional Health Centre (SRHC)Sandra Mierdel, Manager of Chronic Disease ProgramsSandra Cousins & Anna Thomas, Telemedicine Resource

2. How Did Chronic Disease Program Get Hooked on OTN?

3. Our Vision: Increase Clinical OTN Use

4. Our OTN Journey……… • First exposure to OTN via Nurse Led Outreach Team (NLOT) start up • Outreach Nurses focused on partnering with long term care homes (LTCH) to reduce avoidable emergency room visits • Southlake team proposal had an OTN component (2 LTCHs & SRHC funded by OTN to receive telemedicine units) • NLOT model involved regular OTN rounding & capacity building sessions with LTCH partners

5. Building New Connections • Success with our 2 LTCHs with OTN units – began a conversation with our other LTCHs to gage interest • Expanded OTN network to include 6 more LTCHs – expansion supported via CLHIN reallocation funding • Added new connections within SRHC to support LTCH resident medical needs • Medicine Clinic (internal medicine consults, GI consults, Geriatrics) • Mental Health • SRHC Tannery Outpatient Clinics (The Arthritis Program, Stroke Prevention, Cardiac Rehab, Respiratory Rehab, Diabetes Education Centre)

6. “Intentional LTCH Connections” • Bimonthly rounding with 7 LTCH & NLOT teams • Clinical consults for LTCH residents: • Ontario Shores • Mental Health Clinical Nurse Specialist • Urgent Medicine Clinic • Diabetes team • Stroke Prevention Clinic • Launched Telederm program • Clinical education and capacity building for LTCH staff

7. Supporting our LTCH Partners • Championed for OTN equipment with CLHIN • Funding proposals submitted by SRHC on behalf of our LTCH partners • Purchase and set up organized by SRHC in partnership with OTN Regional Manager • In-service education to LTCH leadership and teams • Practice sessions with the equipment • OTN resource support to assist in use of camera for OTN consults, assistance with scheduling, accessible contact for OTN related questions/concerns

8. Long Term Care Home OTN Activity

9. NLOT Team - OTN Embedded in Care Model

10. New Directions……New Opportunities • Expand community access for distant medical consults (Currently averaging 8/month) • Offering Hematology, Internal Medicine, Endocrinology specialist consults • Launched Telederm Program • Diabetes education and management training to LTCH teams and consults for residents by Certified Diabetes Educator • Expanded OTN service to other hospital programs (Cardiac, Mental Health) • Launched train the trainer program for primary care providers for patient methotrexate self-injection • Inclusion of OTN Rheumatology patients in research study based at Southlake

11. “Intentional Chronic Disease Program Connections” • The Arthritis Program (TAP) • Rheumatology Clinics for Kenora, Sudbury, Alliston, Espanola • Osteoporosis Patient Education Program for Fenelon Falls, Alliston, Orangeville, Shelburne, Markham • Fibromyalgia Patient Education Program for Orangeville, Shelburne,Longlac,Mount Forest, Ignace, Cambridge and Haliburton. • Osteoarthritis Education Program to Launch in April.

12. Patients Accessing OTN has increased dramatically in Jan 2012 due to the introduction of OTN Clinical Education Events where we have been able to work with approximately 30 patients per event. Data Source: Lisa Smith, Sandra Cousins, Sandra Mierdel

13. Life is Not Without Challenges…. • “Selling the service” • Shift in thinking from face to face to technology • New thinking on not transferring residents to hospital for care • Overcoming fear and anxiety of staff, physicians and patients using the system • Recruitment of Physicians and teams • Go with the energy and look for champions! • We are constantly reaching out and connecting with others

14. The Stories of Success……. A elderly gentleman, a new resident to LTCH was showing signs of aggression and outburst to family and staff. A urgent OTN was booked the next day with the Director of Care of the LTCH , our Psychiatric Consultation Liaison Nurse and one of our nurses from ( NLOT) Nurse Led Outreach Team. A clinical consult was completed and recommendations made regarding this gentleman’s behavior and medications. A referral was sent to Ontario Shores that day. This man was seen by Ontario Shores via OTN the next week and a bed was offered less then 2 weeks from referral.

15. The Stories of Success……. • Female resident of LTCH with Advanced Alzheimer’s was to be seen at Southlake Regional Health Centre for a follow up appointment in the Fracture Clinic by an Orthopedic Surgeon. • A letter was sent by the Telemedicine Resource staff to the Orthopedic Surgeon to see if he was willing to see this resident over OTN. • With the help of the Nurse Practitioner and a Physiotherapist from the LTCH, this resident was seen over OTN without having to leave her home. • An  x-ray on a CD was ordered for the clinic as per surgeon, MARS and a history was provided for the clinic. • First OTN experience for this Orthopedic Surgeon, he was impressed that a hand held camera was used so that he could view her healing incision.

16. The Stories of Success…….. Male patient at Southlake in early 60’s had been in hospital for 100+ days on Rehab unit Request made for patient to be admitted to rehab facility for further rehabilitation – patient +++ motivated to go Admission request held due to small open area (rehab facility did not take admissions for patients with any type of ulcer) OTN Resource team and Patient Flow Navigator worked together to arrange an OTN consult for patient with rehab facility team and physician for assessment of open area (arranged within 24 hours of the request) Patient was accepted for transfer to rehab facility and discharged within a week