TORONTO — A Toronto hospital has opened a free-standing clinic where paramedics can drop off alcohol-intoxicated homeless people so they can recover and then access services.
Early results show dramatic improvements in ambulance offload times and beds freed up in the hospital emergency department.
Three weeks ago, the University Health Network launched a “stabilization and connection center” near its Toronto Western Hospital with several partners, including Toronto Paramedic Services.
Inside the 24-hour operation there are 11 beds staffed with harm reduction workers, peer helpers, social workers and a doctor on call.
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“This is how we can provide preferential care and options for people who are out of the system, who are intoxicated by alcohol and who do not need urgent or acute medical care,” said Dr Andrew Boozary, executive director of the social medicine network. and clinical manager of the project.
“The reality now is that we can’t separate the shelter and housing crisis from the hospital bed crisis, so that’s one way to solve the problems of the system.”
The center had a quiet launch, seeing 22 patients in its first two weeks. This is by design, with strict eligibility criteria in place: alcohol intoxication, no signs of drug use, normal vital signs and blood sugar levels, no recent trauma and no aggravating medical factors.
It only took five weeks to open the clinic, Boozary said.
The hospital worked with the Ministry of Health and Ontario Health – which oversees the healthcare system – to determine how they could board ambulances. Legislation says ambulances only go to emergency departments, but the province relaxed those rules this year in a bid to divert some patients to better locations.
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The hospital was able to designate the new site as an extension of its emergency department, Boozary said.
Organizations involved in the effort include the hospital, city, paramedics, charity The Neighborhood Group and Parkdale Queen West Community Health Center.
Toronto paramedics say early results from the program have been “almost unbelievable.”
“What’s really encouraging is that through this site, our paramedics can get there and basically offload patients in real time, literally,” said Leo Tsang, assistant chief of operations for Toronto Paramedic Services. .
“We can transfer care in 8-10 minutes so our ambulances can get back to the streets to respond to community calls. It has been phenomenal.
Ambulance offload delays have long been a problem, but it has worsened in recent months as parts of Ontario have experienced numerous “code zeros,” where no ambulance is available for a call. The problem has affected both large cities and rural areas.
Tsang said the average drop-off time for ambulances citywide was around two hours. But it increases depending on the hospital and the day and time of the week. Paramedics can be with patients inside hospitals for more than eight hours until a bed becomes available and the patient’s care can be transferred to the hospital, he said.
“Paramedics are a limited specialist resource and we need our doctors on the ground,” Tsang said.
When paramedics drop off a homeless patient at the new clinic, the person is taken to bed by a harm reduction worker who completes their admission.
“We meet them where they are and we don’t judge them,” said Mario Telles, a Neighborhood Group overdose prevention personal support worker who was assigned to the new clinic for a month.
They check for injuries and drug use — signs of opioid use, especially fentanyl, are a priority for Telles. If he discovers these problems, they contact the doctor on call – Boozary is one of the doctors – or call for help.
There is a “red phone” with a direct connection to the ambulance dispatch team, Tsang said.
“Otherwise we just keep an eye on them and let them rest,” Telles said.
Once they begin to feel better, patients can shower, shave, and have a bite to eat. The hospital also has a program to give prepaid cell phones to patients so staff can keep in touch with them.
Nerissa MacLean is a case manager with The Neighborhood Group who has worked with a mobile team for several years, going to shelters and on the streets.
She recently helped a patient move into supportive transitional housing for an alcohol use disorder. She has helped others apply for ID and get into the full shelter system. The City of Toronto has reserved five beds in its system for those entering the new stabilization center.
MacLean can also help patients enroll in Ontario Works or the Ontario Disability Support Program. She will lobby housing workers to help find permanent housing. She will also set patients up with another program that distributes clothing.
“Essentially, my job is to help manage someone’s life,” MacLean said.
The center plans to expand its strict eligibility criteria. Most important: opioid use, which is far more prevalent and deadly on the streets than alcohol.
“The overdose crisis is something we just need to look at different solutions for and that might be one way to help,” Boozary said.
For now, they are fixing the flaws and sprucing up the place with native art to make it less institutional.
“I believe this integration of health and social care is the new way to better care for these patients,” Boozary said.
“And it’s helping to free up space in our crowded emergency departments and get paramedics back on the road where they belong, helping people.”