Project Details
About the Project
The High Complexity Care Team (HCCT) is a multidisciplinary primary care team dedicated to serving the most medically and socially complex individuals in the Western Communities. There have been increasing requests for the HCCT to assist inpatient services with management of individuals with complex care needs. Dr. Spencer Cleave sought SIFEI funding to clarify which services would be best served by the HCCT and put forward some possible processes to improve acute care practices for complex patients.
Key data trends were observed in both Gastroenterology and Neurology. For patients with functional neurological disorder or functional GI disorder, the lack of standardized processes could mean that treatment options were explored and then reinvented for each case. To create more efficiency, the original proposal involved forming a single committee to explore trends and propose solutions in these areas. In light of the high rate of turnover within the health authority, it became clear that separate committees were needed to manage the complexities associated with each of these presentations.
For the patients with functional GI disorder, conversations with hospitalists and GI physicians identified a lack of coordination in their care, without any agreed-upon ‘off ramps’ to de-escalate the patients’ institutionalization. To address this, a standardized process was developed: two gastroenterologists will assess the patient, psychiatrist will screen for comorbid psychiatric disorders, and the HCCT team agreed to consult.
For the functional neurological disorder patients, the team explored the resources necessary to manage these patients, as well as the numbers of cases per year that would require this new process. Examining the data revealed that the closure of the previous outpatient functional neurological disorder program correlated almost to the month with a significant uptick in functional neurological disorder-related acute care use. Based on this data, the group then approached the leadership of Victoria General Hospital to seek approval and support to launch a pilot. As a result, the Greater Victoria area has a pilot functional neurological disorder program, involving a consulting neuropsychiatrist, and some dedicated time from both a physical therapist and an occupational therapist, with a commitment to review and expand service based on the data when the pilot is complete.
The outcome of this project was not only improving care for the specific patients experiencing functional neurological and functional GI disorder. In the words of Dr. Cleave, it “reduced the sense of aimlessness among clinicians – everyone wanting to help but not knowing where to take things. Now we have a process that everyone is enthusiastic about, and no one has to feel like they are shouldering the burden alone.”
When asked about any advice he would provide to other physicians looking to initiate change, Dr. Cleave responded that when meeting with Island Health administrators, he always make an effort to learn “who is in charge of what.” He observed, “Often when physicians run into problems, they are asking someone for something they can’t really give.” He also encouraged physicians to regard their role – outside of the chain of command of the health authority – as a special advantage, meaning that they can connect with different layers of leadership as needed to advance their objectives.