The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few ...quantitative data support its rapid implementation and positive associations with service capacity and quality.
To examine the outcomes of a cancer center-wide virtual care program in response to the COVID-19 pandemic.
This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020.
Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients.
The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946.
These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.
Resilience is defined as the capacity to bounce back and respond to pressure, unpredictability, or adversity in an adaptive and effective manner that leads to learning and positive outcomes. BRITE, ...Building Resilience within Institutions Together with Employees, the focus of this article, is a program designed to equip healthcare workers with skills to foster their resilience as they work; herein, we describe the context, development, and preliminary implementation results.
Medical advancements have now made it possible to provide allogeneic stem cell transplantation (allo-SCTs) to older patients and use stem cells from less well-matched donors. This has resulted in ...access to a life-saving modality for a greater number of patients with imminent life-threatening illnesses. However, resources have not always kept pace with innovation and expanded volumes. During the summer of 2015 in the province of Ontario, Canada, inadequate resources contributed to a capacity crisis, resulting in extended wait-lists for allo-SCT across the province. This situation presented unique ethical challenges, including the need for ongoing negotiations with health system partners and nimble process management to ensure timely delivery of care. This article reports on the process one organization used to determine how to equitably allocate scarce allo-SCT resources. With the ever-expanding landscape of new and emerging medical technologies, our experience has implications for the ethics of translating other increasingly expensive health technologies to clinical care.
Managing multiple priorities and achieving sustainable outcomes is a challenge for leaders across health care organizations. One academic health science centre set about to address this challenge ...through the development of an innovative annual goal and objectives process that aligned every unit/department around organizational priorities. The results have enabled exceptional outcomes for individuals, teams, patients/families and the organization as a whole.
La gestion de priorités multiples et l'obtention de résultats durables constituent un défi pour les leaders des organisations de la santé. Un centre hospitalier universitaire a entrepris d'affronter ce défi par la mise au point d'un processus annuel novateur de fixation de buts et d'objectifs qui unissait chaque unité et département autour de priorités organisationnelles. Ce processus a donné des résultats exceptionnels pour les individus, les équipes, les patients et leur famille ainsi que pour l'ensemble de l'organisation.
This article provides a description of the administrative model that enabled a city-wide integration effort between Greater Toronto Area hospitals and Toronto Emergency Medical Services in the care ...of patients within the city of Toronto with ST elevation myocardial infarction (STEMI). This administrative structure, known as the Toronto Heart Attack Collaborative (THAC), enabled universal 24/7 access to primary percutaneous coronary intervention within Toronto, improving patient efficacy and outcomes. The lessons and administrative enablers from this experience may be useful for regions that are embarking on multi-centre integration efforts. This article presents a five-year perspective on the THAC integration effort.
At the Wellesley Hospital in Toronto, a unit designed to house patients awaiting placement developed a communication system to facilitate integrated patient-centred care. The system included a ...patient and family orientation brochure, an interdisciplinary kardex and an interdisciplinary patient goal sheet. Patient care improved under the new system, as staff was easily able to access current assessment data and establish and document integrated patient goals. Other outcomes included improved communication among team members, enhanced team member accountability, cohesiveness and satisfaction, and increased patient and family satisfaction.
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