The Transitions in Care initiative has its roots in the need to improve communications between acute and community care settings. We began in 2013 by developing our eNotification system in collaboration with Island Health, which provides automated notifications via physicians’ office EMRs.
Ongoing work has included strengthening relationships with emergency department physicians, hospitalists, and specialists as well as continuing to build on our foundation with Island Health in order to develop new systems that enable communication. This work has included piloting methods of transferring information to and from the hospital on admission and prior to discharge so that community GPs can contribute to planning and follow-through instead of reacting after discharge occurs, most notably our Patient Summaries Project. We have also leveraged our relationship with the health authority to ensure that the community GP voice is heard in implementing strategic priorities such as IHealth.
The Transitions in Care project is funded by the Shared Care Committee, and is a joint initiative of the Victoria and South Island Divisions of Family Practice. Our sister committee, Partners in Care is operationally led by the South Island Division of Family Practice. More information can be found on their website.