Risk Profile: Care – Access

Risk Profile: Care – Access (PDF version)

Access to care issues include but are not limited to: access to health providers, care across the health continuum, access to supplies or diagnostic equipment, and demand greater than capacity. Access to care challenges may result in wait times (assessment, treatment, discharge), waitlists and can lead to patient safety issues and dissatisfaction by patients and staff.  Not having the right care at the right time can also impact the need for reassessment and system issues for health partners in the patients care continuum. This document contains information entered by your peers in the Risk Register application to help you manage this risk.

Ranking/ratings[1]

  • Likelihood – average score 3.50
  • Impact – average score 3.46

The Risk Register allows for risks to be assessed on a five-point likelihood and impact scale, with five being the highest.

Key controls/mitigation strategies

  • Patient/family-centred care
    • Patient and family advisory council to bring patient/family perspective to planning
    • Staff education on family meetings and  engagement
    • Develop a common language for supported discharge process
    • Post discharge telephone follow up to avoid hospital re-admission
  • System partnerships
    • Preplanned discharge process with care team involvement for transitions
    • Identifying barriers to discharge and fostering system strategies  
    • Maintain strong collaborative relationships with programs and services
    • Partner meetings with Long Term Care Homes to improve transfers and communication and avoid hospital admissions
  • Mental health
    • Crisis intervention team operates from Emergency Department
    • Mental Health short stay unit within Emergency Department
    • Outpatient group appointments as a choice for patients referred
    • Maximize appointments and improve office flow. Booking practices to decrease no-shows through reminder calls, and filling of cancellations
    • Intake processes to improve efficiencies and actively triage for acuity
    • Rounds to discuss complex patients with long lengths of stay
    • Staff education on non-violent crisis training
    • Supports by crisis team to nurses and mental health patients not on a specialized unit
    • Escalation policy for psychiatry consultation
    • Ongoing strategies to meet patient needs in different ways, e.g.  group sessions, exploration of rapid assessment and treatment clinic
  • Acute
    • Overflow beds
    • Surge plan  protocols and notifications
    • Readiness for discharge tools utilized at bullet rounds
    • Daily bed review (admissions, discharges, resources needed)
    • Daily multidisciplinary patient assessment rounds in ED to prevent admissions
    • Daily safety huddle
    • On call access on weekends for various health professional groups
    • Bed turnaround time efficiencies
    • Access to physical environment in inclement weather, and increase facility inspections
  • Diagnostic Imaging
    • Dashboards and reports for MRI and CT scan. Adjustments to booking schedules based on need 
    • Downtime prevention strategies
    • Downtime business continuity plan
  • Community Care
    • Strategies to meet needs in different ways, i.e. group sessions
    • Contingency plan development and resource recommendations for individuals on a waitlist
    • Navigation to programs or community agencies that may assist to meet patient needs
    • Communication with primary care physicians
    • Case review and/or assessment for care planning of changing needs
    • To the extent possible, resources are shifted through workforce planning to meet the areas of higher demand
    • Continue implementation of evidence based care paths
    • Community Health Links for patients with complex needs

Monitoring/indicators

  • Patient/family feedback and/or complaints related to access
  • Incident reports related to access and flow
  • Feedback from system partners if a service is declined
  • ED patient flow and wait time indicators
  • Audits of documentation of estimated date of discharge documented on admission
  • Average length of stay and readmission rates
  • Quality review for wait time to assessment and to service initiation
  • Diagnostic imaging indicators monitoring adherence to scheduling within priority targets    
  • Process measures monitoring (e.g. appointment no show rate and referral rate)
  • Daily Access Reporting Tool (DART)
  • Support services on call utilization tracking 
  • Reviews related to in-patients who may have benefited from a consultation service during a weekend
  • Staff culture survey’s monitoring morale
  • Workload data and staff overtime review
  • Quality reviews related to access
  • Quality improvement plan metrics

[1] As of January 1, 2017

Note: information presented in this document has been taken from the shared repository of risks captured by HIROC subscribers participating in the Integrated Risk Management program.

© 2017 HIROC. For quality assurance purposes.