Abstract
The Enhanced Community Care (ECC) programme of reform in Ireland represents a population-based approach to the expansion of primary and community care and, importantly, its integration with the acute hospital sector, providing health services closer to people’s homes and reducing pressure on acute hospitals.
The community dietetic service in Cork Kerry Community Healthcare always had established pathways for referrals from dietetic colleagues in Cork University Hospital, (CUH). However, the original transfer system e.g. paper transfers, via post or email, was not efficient or user-friendly and could result in a lack of information at times.
The Covid-19 pandemic created an urgency in terms of providing services in the community. During the pandemic, the dietitian teams in Cork Kerry Community Healthcare and CUH worked together with colleagues in IT on an initiative to create a dietetic discharge process via the iCM portal (an existing IT system used by both acute and community services.)
Objectives of the initiative:
- Improve the quality of referrals by ensuring all relevant information included.
- Reduce duplication of information by having the document on a system available to both acute and community dietetic services.
- Improve hospital transfer rates out to community dietetics.
- See patients in a more timely fashion in community.
Measurable outcomes:
- There was a 50% reduction in the time taken by acute dietitians to complete the transfer form as the new system eliminated transcribing of details such as patient name, address, GP, next of kin and medical record number as the iCM system extracts this information.
- A higher level of relevant clinical information (e.g. from doctors, SLTs) is now shared with community dietitians as iCM extracts this information.
- In 2020, 37 transfers per month were processed. This went up to 98 transfers per month in 2021 and increased again in 2022 to 115 transfers per month. Projections suggest transfers will be in excess of 125 per month in 2023.
- The increased transfer rate out to community reduced the need for some acute outpatient clinics and supports the overall aim of Slaintecare by providing health services closer to people’s homes.
Next steps:
The move to use of the iCM system has been hugely successful in terms of increasing the efficiency of the dietetic transfer process. This has resulted in significant increases in referrals to community dietitians. It takes a significant amount of community dietetic time to process referrals (approximately five minutes per referral) so the next step is to consider automating the process. The Community Nutrition and Dietetic Service submitted a proposal to participate in ‘Chat23’ and were successful in securing a place. Only six out of >70submissions were accepted. Chat23 was a 1-day hackathon that brought together HSE frontline staff and their eHealth colleagues to focus on ways to improve workflows and resolve specific task-related pressure points or bottlenecks across the health service, through the innovative deployment of intelligent workflow automation and AI technologies. We are currently awaiting further feedback on the viability of automating the process (from eHealth).