Access to Care and Timing

What is the Access to Care and Timing Project?

Providing expert and timely specialized care results in better patient outcomes, but knowing how to make this a reality remains a constant challenge in health care management.

This is why RHI embarked on the Access to Care and Timing (ACT) project, which is a national, multi-centre research study describing the processes of health care delivery for persons sustaining a traumatic spinal cord injury (tSCI) in Canada. The investigators on this project include Drs. Marcel Dvorak (Vancouver General Hospital), Michael Fehlings (Toronto Western Hospital), Anthony Burns (Toronto Rehabilitation Institute), Derek Atkins (UBC Sauder School of Business) and Vanessa Noonan (RHI).

The first phase of the ACT project produced a computer simulation model of the national tSCI continuum of care using information related to patient flow, resources and processes of care as well as data from Rick Hansen Spinal Cord Injury Registry sites across Canada. The ACT model is a tool designed to inform clinical and administrative decision making that optimizes patient outcomes for persons sustaining a tSCI. Through the development of the ACT model, we obtained a national perspective of tSCI care and insight into important similarities and differences, trends over time and opportunities to optimize care. In addition, we identified important gaps in the measurement and reporting of patient flow throughout the continuum of care for persons sustaining a tSCI, which led to the development of some proposed recommendations to enhance existing data sources.

For more information on the ACT project, download this fact sheet.

Developing a national action plan to improve patient flow, access to services, and monitor health system performance in spinal cord injury care

To accelerate the translation of knowledge obtained through the ACT project into improved patient outcomes and care, RHI, in partnership with the Canadian Institutes for Health Research (CIHR), the Ontario Neurotrauma Foundation (ONF) and the Ontario Spinal Cord Injury Research Network (OSCIRN) hosted a one-day workshop on April 25, 2014 in Toronto, Ontario. With over 85 participants from across Canada, the workshop brought together multiple stakeholders including persons with SCI, clinicians, administrators, policy-makers, researchers, community partners, health economists, SCI-affiliated organizations and national organizations to discuss the development of a national action plan to improve patient flow, access to services and monitor health system performance in SCI care.

ACT TITLEDownload the ACT Proceedings here.

The objectives of the workshop were to:

> Share lessons learned from the ACT project, "Time is Spine", benchmarking in Quebec centres of expertise, and SCI Ontario Client Services in the areas of patient flow, access to services, metrics and their impact on patient and system outcomes;

> Identify ways for the ACT model, RHSCIR and other data sources to compare (benchmark) and optimize SCI patient flow;

> Discuss the adoption and operationalization of indicators related to patient flow and access to services through the SCI continuum;

> Identify key partners and create a national working group for the implementation of the national action plan.

Although there are a number of initiatives to advance SCI care at a system level (e.g. ACT, SCI Ontario regional services coordination), fragmentation still exists and work is needed to ensure all Canadians with SCI receive optimal care. The major take home message from this workshop is the need to look at SCI care in Canada from a system point of view. To improve overall care for persons with tSCI, it is not sufficient to view each phase of care as a separate entity. Accurately measuring performance across the continuum of care and determining the impact on short-term and long-term outcomes will help to drive policy and/or practice change.

Incorporating existing standards of data collection

During the workshop, the Accreditation Canada Trauma Distinction Program indicators were proposed for measuring the SCI system of care (pre-hospital through to the community). These indicators were selected since they monitor flow at a system level and could build from the extensive work done to date in trauma (Santana & Stelfox, 2014; Stelfox et al., 2013), as tSCI is a "special population". Following the workshop, the national working group (see more on this below) will revisit the proposed indicators to see if all indicators are still relevant and appropriate to include in the ACT project.

Collection of indicators could help facilities meet the requirements for acute and rehabilitation SCI designation through Accreditation Canada's Qmentum Program.

Developing a National Action Plan

The diverse perspectives and opinions of the workshop participants led to rich discussions and provided valuable insight on how to advance SCI care. It also generated a long list of recommendations to move SCI care in Canada forward. Immediate next steps following the workshop is the development of a National Action Plan that will inform decision-making and optimize SCI patient flow. This National Action Plan will be guided by a National Working Group which will act as a steering committee to move the National Action Plan forward in efforts to improve the efficiency, efficacy and effectiveness of care along the SCI continuum. Outcomes from the ACT Workshop and the National Working Group will also help to inform a number of manuscripts that will be published as part of a focus issue devoted to the topic of optimizing care for tSCI.

The vision, objectives and scope of the National Action Plan is:

> Vision: To optimize patient flow and access to services throughout the SCI continuum.

> Objectives To measure national health system performance and to monitor patient flow across the SCI continuum with appropriate indicators.

> Scope: Adoption and operationalization of selected indicators at pilot sites in the first year.

Membership of the National Working Group will consist of representatives from a number of stakeholders including, but not limited to:

Consumers/persons with SCI

Clinicians from all phases of SCI continuum


SCI community organizations (e.g. SCI Canada and provincial affiliations and chapters)

SCI-affiliated organizations (e.g. ONF, RHI)

Database & registry holders (e.g. Canadian Institute for Health Information)

Administrators & policy-makers

Trauma partners

Evaluation bodies

Accreditation bodies

Health economists

Get Involved!

If you would like to get involved or learn more about the National Action Plan, please email Christiana Cheng at act[at]rickhanseninstitute[dot]org. 

Funding and support for this workshop provided by: Canadian Institutes of Health Research, Ontario Spinal Cord Injury Research Network, Ontario Neurotrauma Foundation and the Rick Hansen Institute