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Connecting patients’ health records in Niagara

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SCOPE Niagara celebrates one year of supporting health professionals and reducing emergency department visits for patients

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A program that connects Niagara Health physicians with community primary care providers diverted an average of 90 per cent of calls each month away from emergency departments (ED) in its first year.

Since its launch in May 2022, SCOPE Niagara – Seamless Care Optimizing the Patient Experience – has registered more than 135 family physicians and nurse practitioners.

“The program provides an easy, quick connection between community primary care providers and the hospital,” says Sarah Furnival, SCOPE Nurse Navigator and recipient of this year’s Nursing Excellence Award – Excellence in a Non-Traditional Nursing Role. “By creating pathways, we are able to help identify and improve gaps in care all while reducing unnecessary visits to the ED.”

SCOPE Niagara connects family physicians and nurse practitioners to a dedicated team of specialists from Niagara Health and from Home and Community Care. The primary care providers connect with SCOPE Niagara’s nurse navigator, who directs them to the most appropriate service, providing support for complex and urgent patients in real-time.

The program originated in 2012 to support family physicians in Toronto. The program has since grown and has been effective in streamlining care and averting both ED visits and hospitalizations.

“We are fortunate to be a part of this extension to create a local solution for seamless patient care in Niagara,” says Dr. Darija Vujosevic, Clinical Lead, Niagara Ontario Health Team – Équipe Santé Ontario Niagara and SCOPE Niagara Steering Committee Member. “As SCOPE Niagara continues to grow, it will attract more family physicians and primary care providers to the program.”

“I was very impressed with the service that SCOPE offered for my family doctor in coordinating my care with the General Internal Medicine Rapid Assessment Clinic and diagnostic imaging,” says Niagara resident Lukas Gotfryd, who is grateful for the timely care the program provided. “I was not required to have long wait times in the ED for appointments, scans and blood work. All of my appointments have scheduled times, which helps with time management, work and family.”

As of May 2023, there were nearly 500 calls to SCOPE Niagara, which varied in nature, such as requests for support with general internal medicine, diagnostic imaging and kidney care. Opportunities to expand the program are currently being explored, including orthopedic services, mental health and addictions.

“I cannot say enough about how grateful I am for this service, especially being a new doctor to this area and still finding my bearings,” says Dr. Victor Ogala from Grantham Medical Clinic in St. Catharines. “SCOPE Niagara has given me confidence with my work, knowing I have somewhere and someone to turn to when help is needed to navigate the system and get the best care for my patients.”

SCOPE Niagara is a partnership between Niagara Health, Niagara Practitioners’ Healthcare Alliance and Home and Community Care as part of the Niagara Ontario Health Team – Équipe Santé Ontario Niagara.

Connected Care Newsletter – June 2023

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Stay current with Connected Care, the Niagara Ontario Health Team’s quarterly newsletter.

In this edition:

  • NOHT-ÉSON and Ontario Health representatives meet in Fort Erie
  • NOHT-ÉSON launches Resource Navigator
  • Connecting doctors with specialists benefit patients
  • Patient/client and family/caregiver profile: Olga McNeill
  • Improving access to cognitive assessments

Click here to download your copy.

Engagement Opportunity: Emergency department as the first point of contact for mental health and addiction-related care

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As part of our commitment to meaningful partnerships with our various communities, we are seeking engagement from community partners to participate in the project below. Community partners can be patients, clients, family members, caregivers, people with lived experience, and other citizens who interact with health and social services. Please note that this opportunity is voluntary.

Project description: Emergency department (ED) as the first point of contact for mental health and addiction-related care

The project aims to understand the current gaps in accessing community services and to develop a system solution to address the ED being the first point of contact for MHA-related care. Our preliminary data shows a high percentage of 18 to 25-year-olds who have visited the ED or an Urgent Care Centre (UCC) as the first point of contact for MHA-related care in the last year or two. This pilot project focuses on the Fort Erie area to understand possible gaps in the system. You may be asked to sit on a project team, attend bi-weekly meetings, participate in a focus group, or share your journey navigating the health system to help develop system solutions.

Who and what are we looking for:

  • Patients/clients and family members/caregivers 18 to 25 years of age
  • Fort Erie residents who have accessed the ED/UCC as a first point of contact for MHA-related care in 2022-2023
  • People willing to share their lived experience and journey accessing services in Fort Erie
  • Desire to help improve health and social services
  • Respect for others and their perspectives
  • Non-judgmental and positive attitudes
  • Ability to maintain confidentiality

Roles and responsibilities may include:

  • Participate as an active member of the project, focus group, surveys, or interviews
  • Attend meetings as required
  • Share your lived experiences and your point of view
  • Advocate for patient, family, and caregiver needs from a broad perspective
  • Participate in the development of new processes, programs, and services
  • Objectively listen to and appreciate the views of others
  • Contribute ideas and suggestions that will enhance community involvement in health system planning and decision-making
  • Promote improved collaboration and relationships between community members and staff
  • Commit to participating in the project for a specific timeframe (minimum 1 hour and up to 4 months)

Our commitment. We will:

  • Explain internal processes and terminology as needed for clarification and understanding
  • Help orient you to virtual meeting software as needed
  • Provide a safe space for you to contribute and be respected for your insights and suggestions
  • Work with you to address any questions or concerns related to your involvement
  • Provide initial orientation and training, as well as ongoing training (where required), to ensure you are well-equipped and comfortable to participate actively

Application process

If you are interested in this engagement opportunity, please email the NOHT-ÉSON’s Engagement Specialist, Josie Faccini, at engagement@noht-eson.ca or call 905-933-4149 by June 30, 2023.

To reflect the cultural and social diversity of the people who access health care and social services in Fort Erie, we encourage patients/clients and families/caregivers 18 to 25 years of age and all backgrounds to consider this engagement opportunity.

The NOHT-ÉSON is committed to providing accessible and barrier-free engagement opportunities. Please forward accommodation requests, questions, or concerns to engagement@noht-eson.ca.

NOHT-ÉSON seeking Niagara residents to join Planning Table

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The NOHT-ÉSON is seeking Niagara residents with lived experience accessing health care or social services to join the organization at the Planning Table and provide their perspectives and input on the standard of care have they received.

A recruitment campaign is under to identify people who may wish to become Patient/Client and Family/Caregiver (PCFC) representatives. The aim is to grow the number PCFC representatives at the Planning Table to seven.

PCFC representatives offer direct input into policies, programs, and practices affecting care and service delivery in Niagara, as well as play a vital role in transforming health care and social services in Niagara. In turn, PCFC representatives receive honorariums as part of their contributions.

Click here for the role description in English and here for the French version.

To reflect the cultural and social diversity of the people who access health care and social services in Niagara, people of all backgrounds and ages are encouraged to consider becoming a PCFC representative.

Applications will be accepted until May 31. For further information please contact Josie Faccini, Engagement Specialist, at engagement@noht-eson.ca or by phone at 905-933-414.

Ontario Health and the NOHT-ÉSON meet in Fort Erie

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St. Catharines, ON – NOHT-ÉSON partners and staff gathered at the Fort Erie Native Friendship Centre on April 3 to meet with Ontario Health’s President and Chief Executive Officer Matthew Anderson.

He was joined by Susan deRyk, Chief Regional Officer for Ontario Health Central and West Regions, Ontario Health West’s Kris Bannerman, Director of System Strategy, Planning, Design, and Implementation, and Kelly Cimek, Director of Capacity, Access, and Flow.

Following an official opening and smudging provided by the Fort Erie Native Friendship Centre, the NOHT-ÉSON’s Director of Planning, Sabrina Piluso, provided an overview of the organization and its structure, as well as highlights from recent initiatives, including Seamless Care Optimizing the Patient Experience (SCOPE Niagara), Let’s Go Home, and the COVID, Cold, and Flu Care Clinics.

Partners who were present took the opportunity to share the successes and challenges facing health care and social services in the NOHT-ÉSON’s catchment area.

Some representatives emphasized the organization and its work have allowed for greater partnerships and collaboration on various initiatives that would not have occurred five years ago. Others stressed the importance of sustainability to keep the work moving forward.

A challenge cited was the quick turnaround time required for some projects, which sometimes does not allow for meaningful engagement or processes to be fully explored before implementation.

Partners also stressed the importance of continuing with the NOHT-ÉSON’s consensus decision-making model as the organization looks to become incorporated.

Anderson and deRyk were impressed with the work achieved to date and appreciated the challenges faced, recognizing the importance of local-level planning.

Land Acknowledgment

We would like to begin by acknowledging that the land on which we gather is the traditional territory of the Haudenosaunee and Anishinaabeg. This territory is covered by the Upper Canada Treaties, is within the lands protected by the “Dish With One Spoon” wampum agreement and is directly adjacent to the Haldimand Treaty territory. Today, this land continues to be the home of many Indigenous Peoples. Acknowledging ensures we reflect on our past and what changes can be made going forward to further the reconciliation process, and it reminds us that the great standard of living that we enjoy in Niagara is directly related to the resources and friendships of the Indigenous People who make up this community.

Wampum Belt

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