If the past year has taught us anything, it's the importance of finding unique and effective solutions to support our communities in their health care needs. Across the province, hospitals have implemented new measures to help support their fellow healthcare practitioners, their patients and their families during a global pandemic.
A program that encompasses the key principles of connectivity and support is SCOPE. SCOPE, Seamless Care Optimizing the Patient Experience, enhances primary care practitioners' (PCPs) ability to connect to a team of providers through a single point of access. The program allows for community physicians to quickly and easily connect with hospital staff to get rapid insights, including opinions, referrals and advice as well as with community services.
Starting with a soft-launch in January 2020, SCOPE Scarborough is a joint collaboration between Scarborough Health Network (SHN) and Scarborough Centre for Healthy Communities (SCHC). Together, the two partners have come together to support their community primary care physicians.
When the pandemic hit in March 2020, SHN and SCHC began to look at how to best to grow the program to support their community partners. Thus, in October 2020, the program was relaunched to broaden the number of primary care physicians that were able to access the services. Since the relaunch in October, over 80 physicians have joined the program.
"With SCOPE, there is an 'it takes a village to provide whole patient care' approach which provides a more seamless patient experience," notes Nancy Veloso, Director, Medicine, Transitional Care and Senior's Health, Scarborough Health Network.
Through the use of a direct phone line, PCPs have access to phone consultations with an Internal Medicine physician at SHN for advice or to refer a patient for urgent work-up and assessment. In addition to this, they also have access to a nurse navigator, which supports their access to over 40 community resources and programs such as mental health, palliative care, adult-day, youth programs and more. The full list of programs can be found on the SCHC time. The Nurse Navigator helps PCPs find the most appropriate community programs to meet their patient's needs.
The program has proven to be extremely beneficial during the COVID-19 pandemic, allowing for hospital care at a distance, which has resulted in reduced emergency visits and transfers.
"If primary care physicians require clarification about presenting symptoms or interventions, they have an internist they can easily access via the SCOPE telephone line," highlights Nash Hassan, Vice President, Community Health & Chief of Professional Practice, Scarborough Centre for Healthy Communities. "SCOPE has allowed us to connect with patients in long-term care, with their care team and family to review care plans, and provide up-to-date evidence around expected course of treatment and current best practices without requiring transfer to emergency."
SCOPE was originally developed as a quality improvement collaborative by Women's College Hospital, University Health Network, the TC LHIN Home & Community Care and primary care physicians. The program has now expanded across Toronto and is affiliated with 8 hospital and health care partners in the GTA and has registered over 800 PCPs. SCOPE aims to improve care for complex patients with multiple chronic conditions - conditions that previously relied on the emergency department for care. One phone call provides a streamlined connection and promotes a stronger connection between community primary care and hospital services.