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Putting vulnerable patients first: Community providers partner together to provide high-quality care to patients at end of life in East Toronto

COVID-19 has impacted healthcare services across the world, changing the way care is given and received.  However, a group of healthcare providers across East Toronto, including clinicians and physicians from Michael Garron Hospital (MGH), are working together to ensure that these changes have minimal impacts on vulnerable palliative patients, through new partnerships, increased access to care and shared resources.

“COVID-19 has forced us to change and adapt our day-to-day work but we refuse to let it affect the quality of care that our patients receive,” says Karina Wulf, palliative care specialist at MGH. “I think the primary goal for all palliative care providers, whether in hospital or in the community, is to continue to provide high-quality care and, when inevitable, allow for a dignified death.”

Increasing access to care providers in the community

One of the many ways that community care providers are ensuring that patients receive quality care and attention has been by increasing access to specialized physicians and clinicians who understand the particular needs of patients at end-of-life.

To do this, MGH has partnered with SCOPE (Seamless Care Optimizing the Patient Experience), a virtual health team that connects primary care physicians with specialty and community health services for their patients using a single access point. Through this access point, primary care providers in the community have 24/7 direct access to specially trained palliative providers from MGH and from the East Toronto Family Practice Network (EasT-FPN) over the phone and can arrange for patients to be seen by a palliative care physician in person, if needed. The direct connection eliminates barriers that physicians may normally face when searching for specialty care in such an urgent time.

“Palliative care was an area that we wanted to build out within SCOPE over the next year, but with COVID-19, that need for partnership became much more urgent,” says Dr. Ruth Hussman, family physician and physician lead for SCOPE in East Toronto. “Both MGH and EasT-FPN have been incredible in stepping up and rapidly forming these connections so we can all help our community.”

Palliative care partnerships have also expanded outside of SCOPE. MGH and EasT-FPN providers are currently working with 10 long-term care homes and eight retirement homes in East Toronto to provide on-site care, share resources such as personal protective equipment (PPE), offer rapid COVID-19 testing and at times, provide access to the hospital’s environmental services staff.

Providers are also working with the Temmy Latner Centre for Palliative Care, increasing physician-to-physician contact for smooth discharges home and allowing for home care visits. Visits are also being done by members of the South East Toronto Family Health team for elderly patients who are frail and cannot get around.

“As providers, we understand the concern that families have about whether their loved ones are still able to receive the same attention and care during this pandemic,” says Dr. Ramona Joshi, head of palliative care at MGH. “We hope these partnerships and extended networks help to reassure them and let them know that we will do whatever is required to ensure all patients have timely access to the care they need.”

Working with peer organizations to put patients first

With the quick and expansive spread of COVID-19, hospitals throughout the city recognized a need for additional beds to make space for incoming patients. This is where Emily’s House, a children’s hospice in Toronto’s east end, came in.

With parents choosing to keep their children at home during the pandemic, the hospice found itself with several open beds that could potentially be used for other patients, regardless of their age. Thus, Emily’s House offered its spare beds to MGH, allowing the hospital to transfer stable adult patients to the hospice and subsequently increase its number of available acute palliative unit beds on-site. Transferred patients receive care both from Emily’s House staff and dedicated MGH physicians who also support staff if needed in adult palliative care.

“The project really demonstrates how beneficial hospital partnerships can be and how community providers are being nimble and responsive during the pandemic” says Karina. “It’s been so nice to see everyone come together – from the patients and families we’ve worked with to the staff making it happen. This is what cooperation and thinking outside of the box is.”

The benefits of this partnership have also been recognized by Emily’s House’s CEO and founder, Rauni Salminen.

“My entire team feels this opportunity to work with MGH is a productive and meaningful way to do something tangible amidst this crisis,” says Rauni. “It’s a way of standing with all the front line workers who are so diligently and compassionately caring for the sick.  We are standing together with you all to see this through.”

As the COVID-19 situation continues to evolve, MGH’s palliative care team hopes that these partnerships and initiatives serve as a reminder about what is possible when people work together.

“The work that has been done throughout our community during COVID-19 has been incredible and a real reminder that at the end of the day, we all, as providers, will do whatever it takes to keep our patients safe and comfortable,” says Dr. Joshi. “That is our goal at all times, after all.”

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