Grant: Project Grant

With the aging of the population the number of people living with chronic diseases is going to go up dramatically. When these patients have flares of their disease, they go to the ER. After treatment in the ER, many of these patients could go home to their own beds (instead of being admitted to hospital), IF reliable, timely outpatient followup care was available. Unfortunately, there is no real 'system' of care between ERs and family doctor (FD) offices; in fact, patients themselves constitute the current system, arranging their own followup care. For older patients in particular, this can be challenging, and they are the people at the greatest risk of poor outcomes. To solve this dilemma the PI conducted a CIHR-funded meeting of leaders from the government, hospitals, and FD offices. They chose an online FD appointment system as the best solution to this problem. ERs can login and give patients being discharged from the ER an appointment at their FD's office in real-time, before they leave the ER (24h/day). Because the emergency doctor knows when the patient is going to be seen next, he or she feels safe discharging the patient (rather than admitting them to hospital), and the patient doesn't have to call the FD office, nor try to explain the diagnosis and importance of follow-up care to the office receptionist. We have 3 ER test sites, and we will engage FD offices in the surrounding areas to upload several open appointments per week to the online system. We have created a similar scheduling system at our hospital using hospital clinics. If early followup is improved for patients at these ERs, we can use the techniques learned in this project to efficiently roll-out to all of Ontario's EDs and FD offices, and eventually to all of Canada. Our partners at eHealth and Ontario government will help us do this. We believe that we can dramatically improve continuity of care for ER patients, resulting in less deaths, hospitalizations, and return ER visits for them.