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Transforming Wound Care Management in Northwestern Ontario: A Centralised Waiting List Management Success Story Enabled by Novari Technology

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Executive Summary:
Providing wound care services in Northwestern Ontario is both complex and challenging. These challenges include a higher rate of lower-limb amputations, a geographically dispersed population, and limited access to specialised care. The Regional Wound Care Program led by St. Joseph’s Care Group in Thunder Bay, Ontario has made significant improvements in the delivery of wound care services through the implementation of a single-entry model enabled by Novari Health central intake and referral management technology. In partnership with Novari Health, the Northwest has been leading the province in centralised wait list management. This white paper provides an overview of the original state of wound care management in the region, the implementation of the centralised wait list management system, and the benefits of the Novari technology.

Introduction: Challenges to Wound Care Management in Northwestern Ontario
The Northwest is home to 256,000 people dispersed across a landmass comparable to France, with a diverse population that includes both urban, rural and remote communities. This unique landscape presents substantial hurdles in providing accessible and equitable wound care services for all residents.

Lack of Specialised Services:
One of the primary challenges in Northwestern Ontario is the limited availability of advanced practice clinicians in wound care. Many communities lack wound care specialists, such as nurses, physicians, and other healthcare professionals. This shortage results in travel burdens and delays for specialised care and, consequently, suboptimal outcomes for clients suffering from complex and chronic wounds.

Vast Geographic Spread:
The vast geographic spread of Northwestern Ontario complicates wound care management by creating logistical challenges in providing timely and efficient care. Clients living in remote communities are required to travel long distances to receive specialised wound care services. In some cases, harsh weather conditions, reliance on ice roads and flights, and lack of transportation options exacerbate these difficulties, further delaying treatment and increasing the risk of complications.

High Rates of Amputations:
Northwestern Ontario experiences higher-than-average rates of lower-limb amputations, often as a result of complications arising from diabetes and other chronic health conditions. Every 4 hours in Ontario, someone loses a lower limb due to a diabetic foot ulcer that did not heal properly[1]. This alarming statistic highlights the urgent need for improved access to best practice wound care management and the importance of addressing underlying health disparities within the region.

Financial and Emotional Burdens on Patients:
The aforementioned challenges contribute to significant financial and emotional burdens on patients in Northwestern Ontario. The cost of transportation, accommodations, and time away from work for those seeking specialised wound care can quickly become prohibitive. Furthermore, the emotional toll of managing a chronic wound and the stress associated with navigating a complex healthcare system should not be underestimated.

Overburdened Healthcare System:
These challenges not only affect clients but also place a strain on the healthcare system in Northwestern Ontario. The limited availability of specialised services and the logistical difficulties associated with the region’s vast geography result in longer wait times, disjointed care, and increased healthcare costs. This overburdened system demands innovative solutions to improve wound care management and ultimately enhance client outcomes.

Implementation of a Single-Entry Model: Northwest Wound Care Central Intake Program
In response to the wound care management challenges in Northwestern Ontario, the Regional Referral System and Regional Wound Care Program led by St. Joseph’s Care Group has adopted a single-entry model (central intake) using Novari referral management software and the Design Thinking approach. This innovative strategy intended to streamline the referral process, enhance access to specialised care, and ultimately improve client outcomes.

Design Thinking Approach:
The Design Thinking approach is a human-centered, iterative problem-solving process that prioritises empathy, experimentation, and collaboration. By employing this methodology, the Regional Referral System team was able to identify the core challenges faced by clients, healthcare providers, and the healthcare system as a whole. This understanding informed the development and implementation of a tailored single-entry model that addresses the specific needs of the region. Each client receives a unique care plan and selection of services based on their initial assessment, which is tailored to their needs and developed in partnership with services already in place. The original referral is used to create a group of subordinate or child referrals all deployed through Novari eRequest. This kind of single entry, multichannel, multiphase central intake model is only possible through innovative technology.

Novari eRequest®: The Enabling Technology for Centralised Wait List Management
The Novari eRequest® referral management and central intake software technology is playing a crucial role in the success of the program, transforming the management of referrals and enhancing communication between care providers. This powerful tool has facilitated the efficient handling of wound care referrals, contributing to improved client care and more streamlined workflows.

Axing the Fax:
Traditional fax machines have long been a source of frustration and inefficiency in healthcare communication. They are prone to errors, lost documents, and miscommunication. By replacing these outdated machines with Novari eRequest®, the Regional Wound Care Program has introduced a modern, digital solution for tracking and managing referrals. This upgrade has significantly improved the speed, accuracy, and reliability of the referral process.

Efficient Management of Referrals:
Novari eRequest® enables the efficient management of referrals by providing a centralised platform for tracking, updating, and communicating client care information. This system ensures that all relevant parties have access to the most current information, reducing the risk of errors and delays. The platform’s intuitive design makes it easy for healthcare providers to navigate, further improving the efficiency of the referral process.

Improved Communication Between Care Providers:
One of the key benefits of Novari technology is the enhanced communication between care providers. The platform facilitates real-time collaboration and information sharing, ensuring that healthcare providers are on the same page regarding client care. This level of communication is vital for coordinated care, as it allows healthcare providers to work together to develop comprehensive treatment plans that address the unique needs of each client, especially in therapeutic areas like wound care when health status can change quickly.

Highly Configurable Software:
The Novari software is highly configurable, allowing it to be tailored to the specific needs of the Regional Wound Care Program. This adaptability enables the platform to accommodate the unique requirements of the region, such as specific clinical and administrative workflows, data formats, and communication protocols. As a result, the software has been fine-tuned to optimally support the centralised waitlist management model and drive continued success in wound care management across Northwestern Ontario.

eReferral Integration
Integration with OceanMD, Ontario’s eReferral solution, has further streamlined the referral process by automating data transfers, reducing manual entry, and enhancing communication between care providers. Incoming referrals aggregate in the Novari inbox, ensuring a consolidated list of clients for efficient referral and wait list management. The system provides real-time data on referral volumes and status, enabling better management of wait times and a more efficient workflow.

Benefits for Staff and Clients: A Success Story in Centralised Waitlist Management
The region’s central intake model enabled by Novari technology has provided numerous benefits to staff and clients in Northwestern Ontario, including:

  • Equitable access to specialised care
  • Reduced wait times
  • Consolidated waitlists
  • Improved communication between care providers
  • Enhanced overall client care
  • Reduced duplication of referrals for the same issue

Centralised Intake System:
The centralised intake system serves as a hub for managing all wound care referrals within Northwestern Ontario. By consolidating referrals in a single location, the system can more effectively coordinate care and reduce fragmentation. This approach ensures that all clients, regardless of their location, have equitable access to advanced practice assessments and care plans tailored to their specific needs. This helps to backfill tightly constraint health human resources by working as one distributed regional team.

Designating Wound Care Services:
The single-entry model designates wound care into over 20 distinct services (e.g., dressing changes, vascular consult, etc.) creating a comprehensive directory of wound care services across Northwestern Ontario in the Novari system. This directory enables healthcare providers to quickly identify and access the appropriate resources for their clients, streamlining the referral process.

Improved Wait Times and Consolidated Wait List:
The single-entry model has led to notable improvements in wait times for wound care services. By streamlining the referral process and optimising resource allocation, clients can receive timely care and avoid prolonged waiting periods. Additionally, the centralised intake system has consolidated wait lists, allowing healthcare providers to manage client flow more effectively and address any bottlenecks that may arise. With the help of enhanced regional data, the Regional Wound Care Program can effectively convey the wound care requirements in Northwestern Ontario, which is crucial for strategic planning and ensuring the system’s future resilience.

Better Overall Patient Care:
The implementation of the single-entry model has ultimately resulted in better overall client care in Northwestern Ontario. Clients now have improved access to specialised wound care services, regardless of where they reside. The streamlined process and enhanced communication between healthcare providers have contributed to more coordinated care, leading to better treatment outcomes and an improved quality of life for clients.

Conclusion
The Regional Wound Care Program and Regional Referral System has successfully addressed the challenges of wound care management in Northwestern Ontario by implementing a single-entry model supported by Novari eRequest® technology. This success story serves as a testament to the power of centralised wait list management and the enabling technology that supports it. By embracing innovation and utilising the highly configurable Novari eRequest® system, the Northwest has become a leader in the province, showcasing the potential for improved client care, streamlined workflows, and increased efficiency in the healthcare sector.

As healthcare organisations throughout the province and beyond grapple with similar challenges, the Northwest Wound Care central intake model offers a valuable blueprint for success. By adopting centralised wait list management systems and leveraging the power of Novari, other regions can similarly transform many different clinical services (e.g., mental health & addictions, diabetes, medical imaging, orthopedics, etc.) benefiting both clients and care providers.

[1] Thambirajah, A. (2020). Advocating for Wound Patients in Ontario. Wound Care Canada, 18(1), 36-39.
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