Advancing rehabilitation and enhancing quality of life
At Toronto Rehab, we strive every day to excel in delivering the best possible care to our patients. Exemplary models of care, leading-edge interventions and patient safety are the hallmarks of our seven clinical programs where we work hand-in-hand with our patients to help them rebuild their lives following debilitating illness or injury.

The privilege of working with these patients is what inspires us to do everything humanly possible to improve their outcomes. From exploring the benefits of partnering with others to moving research into practice, our resolve is unwavering as showcased through the following initiatives.


Improving patient care through innovative models of care
Among the new models of care generating interest throughout the health system is the Musculoskeletal Rehabilitation Program’s Fractured Hip Rapid Assessment and Treatment (FHRAT) service. This pioneering model was expanded to support patients with hip fractures and dementia symptoms who, in the past, would have typically been transferred directly from acute care following surgery to long-term care. Patients admitted to the service receive a comprehensive assessment followed by creative, sensitive and personally-tailored rehabilitation. Since implementing the model earlier last year, the outcomes have been compelling, with 90 per cent of patients treated at Toronto Rehab returning to independent living in their homes.

Forecasts predict that broader implementation of the model could save the provincial health system $17.7 million in the Greater Toronto Area (GTA) alone. The move to expand the model to 34 other hospitals and health care organizations has been swift. Through funding from the Ministry of Health and Long-Term Care, Toronto Rehab has already trained 550 rehabilitation practitioners across the GTA about working with patients who have cognitive impairments such as dementia and delirium.

Our new home-based alternative model of care for cardiac rehabilitation responds to the government’s call for action to support people with disabilities after they return to living in the community following discharge from hospital. Patients unable to attend our onsite Cardiac Rehabilitation and Secondary Prevention Program can now participate in a prescriptive exercise program at home with weekly telephone access to a rehabilitation supervisor who provides education, counselling and goal setting support. An online education component is available to those with computer access. The new model's increased flexibility has resulted in 10 per cent fewer program drop-outs than its onsite counterpart. The initiative won the top award in the category of Improving Quality and Patient Safety at Ontario’s Celebrating Innovations in Health Care Expo this past year.

Those whose lives have been affected by a severe neurological injury or illness or by a complicated medical illness, surgical procedure or trauma now have an alternative to traditional active rehabilitation programs which often can’t meet their needs. The introduction of a new Low Tolerance Long Duration (LTLD) rehabilitation service in our Complex Continuing Care Program offers patients a longer course of rehabilitation than more intensive programs. Therapy is adapted to meet patients’ physical abilities and stamina. Within its first 12 months, the initiative has shown promising results with many patients returning home or graduating to a regular rehabilitation program. Patients who cannot return home still benefit from a higher level of independent functioning within their assisted living arrangement.
return to top


Shaping new best practices
Reflecting our commitment to clinical best practice innovation in rehabilitation and complex continuing care, we introduced a new model of care for managing complex behaviours among patients with acquired brain injury. The approach has led to a decrease in repatriation to acute or crisis care due to challenging behaviors, fewer constant care hours, and no reported staff or patient injuries. Best practice initiatives to better manage the pain experienced by patients in our Complex Continuing Care, Musculoskeletal and Spinal Cord Rehabilitation Programs are also underway.

Volunteers are integral to Toronto Rehab's ability to provide high-quality patient care. To ensure our volunteers are making meaningful contributions to care and getting the most from their experience, we created a new best-practice model in which volunteers have become integrated members of our patient care teams. To date, these volunteers can be found in four of our seven clinical programs. The innovation has led to enhanced satisfaction levels all around: staff, volunteers and patients all say they would recommend the approach.
return to top


Addressing existing gaps through new and advanced partnerships
Working together with hospitals, academic partners and community-based providers further leverages our capacity as a rehabilitation centre to address existing gaps, improve patient care, and support the seamless transition of patients from one level of service to another. 

Through a rewarding partnership with Bloorview Kids Rehab, we’ve been able to address an identified gap for specialized adult rehabilitation services for those with childhood onset disabilities. As young people transition to adulthood, many of them continue to inappropriately access services from paediatric health centres, while others fail to receive the services they need.

LIFEspan (Living Independently and Fully Engaged) focuses on supporting the transition of young adults with childhood-onset acquired brain injury and cerebral palsy from the paediatric rehabilitation system to the adult health care system. Our interdisciplinary team approach to care makes the process of growing up easier for children as they become young adults and transition into the adult health system. Since its introduction, more than 25 patients have been transferred from Bloorview to the LIFEspan service at Toronto Rehab. Permanent funding from the Toronto Central LHIN means we will eventually be able to expand the service to meet the needs of a wider population of young adults with disabilities.

Another partnership reaping great rewards is a community-based initiative that provides evidence-based fitness instruction at select community centres in Toronto for people with stroke, acquired brain injury or multiple sclerosis.  Together in Movement and Exercise (TIME) is a joint initiative between Toronto Rehab’s Neuro Rehabilitation Program and the City of Toronto’s Department of Parks, Forestry and Recreation designed to address the ongoing fitness needs of neuro patients following discharge from hospital. Toronto Rehab developed a specialized exercise program with varying levels of difficulty for participants. Our physiotherapists then provided education and mentoring for the city fitness instructors assigned to supervise the classes. A rigorous evaluation of a 12-week pilot conducted in 2007 with funding from Toronto Rehab Foundation showed the program to be safe and effective. We're now conducting a more advanced pilot with funding from Parks, Forestry and Recreation. Our ultimate goal is to establish permanent funding that will enable us to expand the program across the city.

Partnerships come in many forms, and one can’t underestimate the value of external funding in enabling innovation. With the financial support of EMD Serono Canada Inc., our Neuro Rehab team was able to develop an exercise DVD for people with multiple sclerosis to use following discharge from the hospital. It features several routines of different durations, levels of difficulty and types of exercises to challenge all aspects of fitness. Distributed to multiple sclerosis clinics across Canada, additional copies of the DVD are available through Toronto Rehab’s website. A pilot study funded by York University confirmed that people using the exercise DVD improved their balance and gait, as well as overall physical activity.

One of the greatest challenges facing health care today is the alarming number of patients in hospital beds throughout the system waiting for more appropriate placement in other facilities that can best meet their needs. As one of 31 hospitals participating in the province’s Flo Collaborative, we have partnered with Mount Sinai Hospital to improve the timeliness and effectiveness of patient transfers between their general internal medicine units and our Geriatric Rehabilitation Program. With funding from the University Health Network, we are also working with Toronto General and Toronto Western Hospitals to increase the number of timely referrals from their general internal medicine and neurology units to our services.

At an organization-wide level, by streamlining our inpatient admissions process from six business days to two across our clinical programs, patients are now experiencing shorter waits for admission, resulting in more timely access to care.
return to top

Enhancing the patient experience
We want every patient who comes to Toronto Rehab to have a positive experience. The feedback that patients and families share with us through patient and family satisfaction surveys, results of which are published in Hospital Report, are used to help us focus our improvement efforts in those areas that will have the greatest impact on the patient experience.

In Complex Continuing Care, we used that feedback as a tool for enhancing the patient meal experience. Patients have responded favourably to improvements in serving temperature of their meals and to the increased amount of time provided to enjoy them. Patient and family input about the living environment in the E.W. Bickle Centre for complex continuing care has played a significant role in helping to shape our $10 million renovation plans for the facility. Their insights have been instrumental in identifying where changes will have the greatest impact on the patient experience.

Patients and families who experience our rehabilitation programs report high satisfaction levels with the care they receive: 86 per cent of inpatients and 95 per cent of outpatients says they would recommend Toronto Rehab to others.
return to top


Delivering safe care
Patient safety remains a top priority at Toronto Rehab. A research project involving adaptation of the S-BAR (Situation Background Assessment Recommendation) tool in a rehabilitation and Complex Continuing Care environment is leading to improved communication about patient conditions between health care team members. We subsequently developed a patient safety toolkit for use by other rehabilitation hospitals and webcast our findings to more than 100 organizations across the country. Based on our results, we have since secured additional funding for a 20-month S-BAR study into the issue of patient falls.

The implementation of an organization-wide falls prevention and management strategy — Stop Adverse Fall Events or SAFE—and the trending of incidents will help us to minimize the future risk for serious patient falls. We will continue to monitor other safety trends and key safety indicators through our new patient safety scorecard. Senior leaders now make regular visits to patient units and hospital departments to promote dialogue about patient safety, keeping it top of mind for everyone from clinicians to support staff.

Other initiatives contributing to a safer healthcare environment include participation in the MOHLTC’s hand hygiene research project, improvements to our automated incident reporting system and the introduction of a unit-dose pharmacy system to reduce medication errors. We have also revamped our infection control practices and are ready to meet the requirements of mandatory reporting for the MOHLTC.

All of our efforts to improve the patient and family experience at Toronto Rehab rely on a strong partnership with the individuals who seek our care and with the family members who support them. In the year ahead, we will continue to seek every opportunity to engage patients and families so that we can help shape the best possible future for those recovering from and living with disabling illness and injury.
return to top