New program to Scarborough is helping physicians connect to hospital services

Across the province, hospitals have implemented new measures to help support their fellow health care practitioners, their patients, and their families during a global pandemic. One program that encompasses the key principles of connectivity and support is SCOPE.

SCOPE, which stands for Seamless Care Optimizing the Patient Experience, enhances primary care practitioners’ (PCPs) ability to connect to a team of providers through a single point of access. The program allows for community physicians to quickly and easily connect with hospital staff to get rapid insights, including opinions, referrals, and advice, as well as with community services.

Starting with a soft-launch in January 2020, SCOPE Scarborough is a joint collaboration between Scarborough Health Network (SHN) and Scarborough Centre for Healthy Communities (SCHC). Together, the two partners have come together to support their community primary care physicians.

When the pandemic hit in March 2020, SHN and SCHC began to look at how to best to grow the program to support their community partners. Thus, in October 2020, the program was relaunched to broaden the number of primary care physicians that were able to access the services. Since the relaunch in October, over 80 physicians have joined the program.

“With SCOPE, there is an ‘it takes a village to provide whole patient care’ approach which provides a more seamless patient experience,” noted Dr. Elaine Yeung, Corporate Chief and Medical Director of Medicine, Scarborough Health Network. “The program has proven to be extremely beneficial, especially during the COVID-19 pandemic, by allowing for hospital care at a distance, which has resulted in reduced emergency visits and transfers.”

Through a direct phone line, PCPs have access to consultations with an internal medicine physician at SHN for advice or to refer a patient for urgent work-up and assessment.

“The SCOPE Program provides timely access to specialist care, making it a great opportunity for family physicians to connect quickly with internists at Scarborough Health Network,” explained Physician Lead Dr. Avnish Mehta. “Through this service, primary care providers have direct and centralized access to a range of resources and providers, improving access to high-quality care, and enabling hospitals, community services and primary care physicians to strengthen their relationships.”

In addition, they have access to a nurse navigator, who supports their access to over 40 community resources and programs such as mental health, palliative care, adult-day, youth programs and more. The full list of programs can be found on the SCHC website. The Nurse Navigator helps PCPs find the most appropriate community programs to meet their patient’s needs.

“If primary care physicians require clarification about presenting symptoms or interventions, they have an internist they can easily access via the SCOPE telephone line,” highlighted Nash Hassan, Vice President, Community Health and Chief of Professional Practice, SCHC.

“SCOPE has allowed us to connect with patients in long-term care, with their care team and family to review care plans, and provide up-to-date evidence around expected course of treatment and current best practices without requiring transfer to emergency.”

SCOPE was originally developed as a quality improvement collaborative by Women’s College Hospital, University Health Network, the TC LHIN Home & Community Care and primary care physicians. The program expanded across Toronto, is affiliated with eight hospital and health care partners in the GTA, and has registered over 800 PCPs. SCOPE aims to improve care for patients with complex, multiple chronic conditions, who previously relied on the emergency department for care.