75 Implementation of a family physician-staffed streamlined care team at an academic tertiary care children’s hospital

Abstract Background CHEO is an academic tertiary care children’s hospital in Ottawa, Ontario that serves a catchment of 500,000 children and youth in eastern Ontario, western Quebec and Nunavut resulting in ∼3000 annual admissions to our general paediatric inpatient units. With population growth, increasing complexity of patients and limited health care resources, there is a need to modify existing inpatient care delivery models to increase capacity, efficiency and improve patient flow. Family physician (FP) hospitalist models have been successfully employed in adult hospitals in response to a complex set of provider, system and patient factors. Objectives A streamlined care team (SCT) staffed by FPs was proposed to provide care to short-stay paediatric inpatients with simple, single-system diagnoses. This innovative patient care model allows for better alignment of patient needs to physician scope of practice, improved access to care, facilitation of community connections and enhancement of learner experience on the inpatient medicine units. Design/Methods A multidisciplinary Kaizen event was held in September 2022 and employed quality improvement methods (Define-Measure-Analyze-Design-Validate) to reimagine care delivery on the inpatient units. A SCT working group engaged stakeholders, secured funding, recruited FPs, developed orientation materials and created a system of peer support for FPs. Measures being monitored include number of patients assigned to the SCT, length of stay and the percentage of discharges before noon. Results The SCT was launched in January 2024. Four FPs rotated through the SCT in one-week intervals, Monday to Friday, daytime hours. Learners were not assigned to the SCT during the implementation period. Overnight and weekend coverage was assumed by the hospital paediatricians and learners on-call. In the first 4 months (January-April 2024), the median number of patients attended by the FP per week was 10. During this same period, 111 patients were discharged with 39% leaving the hospital by noon. The median length of stay was 3 days. There were no major patient safety incidents. Challenges included recruitment of FPs, balancing patient inclusion criteria with maximizing census, streamlining communication between team members, FP orientation and “in-time” peer support. Conclusion The implementation of a SCT staffed by FPs successfully improved access to care through timely transitions with no major patient safety concerns. A comprehensive post-launch evaluation is underway to inform future improvements as we transition to a more permanent model. Future directions include expanding the scope of patient care, advocating for 7-day FP coverage and integrating learners into the SCT. A comprehensive KT strategy will also be created to enable broad dissemination to CPS members.

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