New Medical Day Hospital at The Children’s improving patient care

“Can we improve the care we provide our patients and their families?” asked Josie Revuelta, when she conceived the idea of creating a Medical Day Hospital at The Montreal Children’s Hospital.

Josie, MCH interim nurse manager of 6C Pediatric Medicine, Short Stay Unit, Renal Clinic and of the Medical Day Hospital, knew that the outpatient services offered by a Medical Day Hospital would contribute to helping patients and families cope better. The goal was to maintain quality of care, safe care, and to make life easier. The Day Hospital would achieve this by offering a one-stop-shop type of service.

Basic tests would be provided in the Medical Day Hospital, like blood work; nurses would coordinate other appointments outside the Medical Day Hospital, such as x-rays; and specialists, such as physiotherapists, nutritionists, and physicians would come to the patient for evaluation and follow-up.

“It is ideal for patients who need to be followed by medical staff but who don’t need to stay in the hospital for the services they require,” says Josie. “The Medical Day Hospital prevents patients from having to be admitted as inpatients, therefore freeing up beds for the more acute cases.”

Children are also less stressed because they can sleep in their own beds. And parents are able to coordinate their lives better, especially with other kids at home. So this reduces the stress on the parents. Overall, it would be a win-win situation.

To establish if a Medical Day Hospital would be beneficial, Josie and her team looked at all the patients that left the hospital overnight (these mostly consisted of patients receiving IV antibiotics during the day or patients that were waiting for a test).  These patients did not fit the Intensive Ambulatory Care Service criteria.

They also looked at patients who were coming in for general evaluation and at the reason they were coming in. Most were complex patients who needed a lot of services and unique coordination. Josie and her team knew they could better serve all of this clientele.

To get it off the ground, Josie did a seven-month paper exercise with doctors that looked at which patients on the medical unit could benefit from the services a medical day hospital could offer. “Over this period we came to the conclusion that everyday there could have been two to three patients that could have been seen on an outpatient basis rather than as an inpatient,” she says.

In November 2005 the Medical Day Hospital opened. It contained two beds, the necessary equipment for basic care, including blood tests, blood pressure tests, and delivery of oxygen. At the time, Josie was the only nurse running this outpatient service.

Initially, most patients that were coming in were patients that were being admitted but then discharged with medical care follow-up required. But soon other services started to see the benefits of the Medical Day Hospital.

“Genetics took onto us fast,” says Josie. “This is because they have a lot of patients that require a lot of different services, such as dieticians and physiotherapists. With the Day Hospital these specialists come to these patients without the patients having to travel. We put all the care into a nice package.”

Soon two beds weren’t enough so they had to open up a room that gave three to four spaces. Their population went from about 95 per cent of the patients being inpatients, to 45 to 65 per cent inpatients and the rest from other services that come in for evaluation, tests or consultation. Or if a child seen by a certain service got sick at home, instead of sending him or her to the Emergency Department, the service sends the patient up to the Medical Day Hospital.

Here, these patients are assessed by the service that knows them best and the decision is then taken whether these patients go home with or without follow-up or need to be admitted. And for the services that are not open on the weekend they could send their patients to the Medical Day Hospital because it does have daytime hours Saturdays and Sundays.

“Everyday we are branching out and getting different types of patients,” says Josie.

“We are even doing work ups now for the patients from Northern Quebec. Complex patients are flown to the MCH once a year to get an A to Z workup. We are told ahead of time that they are coming so we book all of the appointments within two to three days. It used to take up to 10 days. We really speed up the process.”

In May 2008, the Medical Day Hospital got the green light that it had passed the “pilot project” phase. Today it has three nurses with Dr. Claudette Bardin helping Josie reach colleagues to recruit patients from other services.

Josie’s question was finally answered, and the answer was an astounding yes.