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Making sure the right treatment happens at the right time

Three CHEO staff members, two women and one man, stand behind a hospital bed in a surgery recovery room.

A central line is a catheter inserted in a large vein, often in the neck or chest. They can stay in place for days or even weeks as they are needed for a variety of diagnosis and treatment. Oncology, in particular, often requires central lines for chemotherapy treatment.

Although CHEO’s new electronic health record (Epic) came ready to handle standard referrals, it did not include the specific complexities required in pediatric oncology. 

“When a child needs to start cancer treatment, an oncologist will make a referral to Surgery to have a particular type of central line inserted,” says Dr. Juan Bass, Chief of the Department of Surgery. “Putting safety first, there are a lot of things the surgeon will need to know like, what type of line is required, and whether a bone marrow sample or a lumbar puncture is required.”

Before Epic took effect on October 18, 2017, oncologists used paper forms to specify the exact type of line, as well as any other services required. Angela Haworth, Administrative Assistant, in the Department of Surgery, took up the challenge of adapting the old paper referrals into a safe, streamlined digital system.

Haworth enrolled in CHEO’s quarterly, in-house training on analyzing problems and building sustainable solutions. She brought the oncology referral problem up with her colleagues on the course, “How do we make sure surgeons have all in the information they need in time to ensure that the correct central line is inserted by the time the oncologist needs it.” 

Haworth and her colleagues designed a simple digital referral system and the CHEO Information Technology team built it into Epic. 

Now, when an oncologist makes a referral they are confident that the requested central line will be inserted in time for the child’s treatment to begin and the surgeon is confident that they have all the information they will need to provide the correct central line and other services. 

“Angela’s system helps all of the oncologists and surgeons relax because we are confident that every child will have the right central line by the right time and they will get the best treatment we can provide,” says Dr. Bass. 

Social Work wait times reduced from months to a single day or week

Seven members of the social work team, standing side-by-side, smiling.

CHEO Development and Rehabilitation, Children’s Treatment Centre (CTC), recently changed the way that client inquiries get answered. In some cases, this has shortened the wait time from several months to a single day.

In the past, a parent seeking counselling around their child’s needs would call the CTC, speak to an administrative staff member, and be placed on the counseling waitlist. This list included everybody from those seeking ongoing counseling services, to those with a simple question about community resources.

Now when a parent calls, they speak directly to an “on call” social worker who has the training to understand if this is a simple question which can be easily answered, sometimes on the spot or be placed on the counseling waitlist. Parents may even be invited to use the social work drop-in clinic (for clients registered with the CTC) held every Wednesday from 9 a.m. to 3 p.m.

“Between on-call and drop-in during the first four months, we met the needs of 33 clients on the very day they called,” says Christa Janes, Coordinator, CHEO Development and Rehabilitation. “It is a slightly increased workload for our social workers but the benefit to our clients — particularly those who have their wait time reduced to zero — is immeasurable.”

There are now fewer names on the counseling waitlist. Christa hopes that this will reduce the wait, not only for simple questions, but also for those waiting for ongoing counseling services.

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