Vancouver General Hospital, Mount Saint Joseph Hospital, St. Paul’s Hospital (Vancouver)

As part of a comprehensive strategic plan to address the complex care needs of our senior population, Vancouver Coastal Health (VCH) and Providence Health Care (PHC) have implemented the Emergency Department (ED) iCARE model at Vancouver General Hospital, Mount Saint Joseph Hospital, and St. Paul’s Hospital (launching January 30, 2017).

Focusing on frail seniors who don’t require an acute inpatient admission, the ED iCARE model embeds a multi-disciplinary team into the ED to provide intensive interventions that promote self-management and maintain patients’ safety and well-being at home. Team members and ED staff work together to eliminate barriers to discharge and ensure a safe transition back into the community, while improving health outcomes for patients in the process.

The ED iCARE team is a multi-disciplinary approach, with the clinicians working together to develop an appropriate plan for each patient:

• Transition Services Coordinator (RN): plans and coordinates community services required to support the patient at home
• Care Management Leader (RN) or Geriatric specialist (RN): assesses current/acute needs and how this will relate to the care plan at home
• Physician (Family Practice/GP): Assesses and reviews medical needs, and provides physician to physician communication within acute and to primary care. Is able to become MRP for patients in the ED when appropriate, for discharge orders and referrals
• Quick Response Team – RN: provides same day or next day community RN care
• Quick Response Team – OT: provides same day or next day OT assessment and care
• Quick Response Team – NP: provides short term primary care support for clients in the home
• ED staff as needed (SW, PT): As needed, the ED team participates, including SW for complex social and housing issues, and PT for mobility and function

ED iCARE continues to build on demonstrated successes – that of freeing beds up for patients in need of in-hospital care, easing some ED congestion, and enhancing both the quality of and access to care for Vancouver’s frail seniors.

Early results from the launch at Mount Saint Joseph are significant: They have experienced a decrease in the number of ED patients admitted, resulting in an impact on the in-patient units (occupancy rate is down to 89%). This has created opportunity for St. Paul’s Hospital to transfer patients into these freed-up beds.