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Hip Fracture - Early Referral Process

The GTA Rehab Network is working with acute care and rehab programs to roll out a new early referral process for hip fracture patients. 

The aim of the initiative is to standardize and enhance access to rehabilitation post-surgery for patients post-hip fracture to facilitate their recovery. It will also help hospitals to align with the Quality-Based Procedures Clinical Handbook for Hip Fracture.

The New Referral Process Hip Fracture Model and supporting tools were developed in 2014/15 by the GTA Rehab Network and a task group of its members. The model builds on and spreads two organizational initiatives successfully implemented by:

  • Michael Garron Hospital (formerly Toronto East General Hospital), Bridgepoint Active Healthcare - Sinai Health System, Providence Healthcare and the GTA Rehab Network (Improving and Driving Excellence Across Sectors (IDEAS) project team), and
  • University Health Network - Toronto Western Hospital - Toronto Rehab LEAN Initiative. 

Ten acute care and ten rehab hospital sites across five LHINs are currently participating in rolling out the new model. Participating hospitals have a goal of reducing the acute care length of stay from surgery to discharge (to inpatient rehab programs) to an average of six (6) days.

A case study describing the initiative, preliminary results and lessons learned was published in Healthcare Quarterly in April 2017.

Tools and Resources
Improving transitions from acute care to rehab: Spreading change across GTA hospital sites A presentation for the Quality Improvement and Patient Safety Forum 2016. The presentation provides a high-level description of the Early Referral Process Initiative for Hip Fracture, progress-to-date and lessons learned by project teams. 
Change Package Overview
(includes all the appendices)
This document, developed to facilitate adoption of the early patient referral quality improvement initiative, describes the change ideas and the model, its origins, the roles and responsibilities of project leads and the GTA Rehab Network, key milestones and implementation steps.  
Key Leads of the New Referral Process Hip Fracture Initiative (Appendix A) List of project leads of each participating hospital site. 
New Referral Process Hip Fracture Initiative Model (Appendix B) This diagram outlines the step-by-step processes and suggested timelines for the two pathways. 
Rehab/LTLD Rehab Admission Criteria Guidelines for Hip Fracture (Appendix C) This document provides a guideline of patient needs that are medically manageable in rehab/LTLD rehab programs and recommended information to include in rehab applications.  
Information Recommended When Completing Rehab (RM&R) Application for Hip Fracture (Appendix D) This tool provides acute care clinicians with a guide on what to include in rehab applications to prevent delays due to requests for information. 
Hip Fracture Rehab Referral Considerations & Referral Decision Tree (Appendix E) This document outlines criteria and/or conditions that may require more consideration during the rehab application process. 
Planning for Your Inpatient Stay in Rehab Following a Hip Fracture (Appendix F) This brochure communicates to patients and their caregivers what to expect across all rehab programs. 
Sustainability and Spread A presentation for IDEAS Alumni by the GTA Rehab Network and Health Quality Ontario quality improvement advisors. The presentation covers lessons learned in rolling out the new early referral process for hip fracture patients and tips on how to support sustainability and spread when introducing QI initiatives.