ElectronicHealthcare 8(3) March 2010 : e9-e16
Case Study

Innovation in ALC – Evaluation and Lessons Learned from a Pilot of Electronic Resource Matching and Referral to In-patient Rehab/CCC in an Acute Care Organization

Negin Mastouri, Hershl Berman, Hsin-Yi Yang, Mark Casselman and Dante J. Morra


Introduction: One of the root causes for Emergency Department (ED) overcrowding stems from challenges with patient flow from acute to post-acute care institutions. Significant improvements to the referral process can be made by moving to an electronic Resource Matching and Referral (RM&R) system, which could be used to facilitate accessing accurate and consistent data relating to referral patterns, waitlists, response times, referral efficiencies, and gaps in programs/services.

Objectives: To elicit user views, identify challenges, and measure acute care providers' performance and satisfaction of the RM&R system for Rehabilitation and Complex Continuing Care.

Setting: The General Internal Medicine ward at the Toronto General Hospital (TGH), part of the University Health Network (UHN), affiliated with the University of Toronto, Toronto, Canada.

Method: This study included both quantitative and qualitative assessments of the electronic RM&R process. A random effects model was used to compare the mean time taken to complete the paper and electronic forms. In total, we performed 18 paper and 21 electronic RM&R trials. An exit survey allowed participants to subjectively evaluate the two processes.

In response to some of our findings on the exit survey, we also completed seven interviews with other acute care providers.

Results: Our study showed that electronic RM&R forms required slightly less completion time than paper referrals. However, there was no significant difference in the time it took to fill out the forms (paper vs. electronic). In the random effects model, subjects took on average 22 seconds longer to complete the paper form than the electronic form (95% CI: −26s to 70s; p=0.35). For paper forms, the average satisfaction score for the six raters was 2.6, and for electronic forms it was 4.5 (p=0.035 by signed rank test). Our surveys and interviews, indicated clinicians' satisfaction of RM&R system in terms of time efficiency of task accomplishment, time to decision-making, and confidence in decision-making. The RM&R system was easy to use and required minimal training.

Conclusions: The adoption of the RM&R system to Rehab/CCC on GIM at the UHN was characterized by high satisfaction, perceived positive benefits to patient care, and minimal technical challenges.



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