General information package

1. Purpose

The purpose of this information package is to provide a general overview of the CAF Ambulatory Care Delivery Model as it applies to accessing health care services at the CF Health Services Centre Ottawa (CF H Svcs C (O)).

2. Overview of CAF Ambulatory Care Delivery

The Care Delivery Unit (CDU) is at the core of the CAF Ambulatory Care Delivery model. The CDU is an interdisciplinary team of military and civilian health care providers who work collaboratively to meet the health needs of its CAF members and units, ensuring seamless continuity of care over time. Below are a few elements that constitute the CDU.

1. Rostering. All CAF personnel are rostered to a Care Delivery Unit (CDU) where a multidisciplinary clinical team provides care in a collaborative manner to our patients. Patients from certain units or groups are rostered together in the same CDU to allow specialized mission-focused care for that unit;
2. CDU Staff. The CDU core team generally consists of two uniformed medical officers, a civilian physician, a uniformed physician assistant (PA), a civilian nurse practitioner (NP), a primary care nurse (PCN) (military or civilian), three military medical technicians and two civilian administrative support staff. The team may be periodically augmented by in-house physiotherapists, pharmacists and mental health professionals who provide care either in collaboration with the team or through direct intervention;
3. Collaborative Care. Within the CDU, each patient with chronic or ongoing health care needs will be assigned to a primary clinician to maintain continuity of care but at different times the patient might be seen and treated by other members of the CDU care team. The goal of this collaborative team approach is to ensure the patient sees the “right clinician” at the “right time” to address their needs in a flexible, efficient, and holistic manner. Therefore, the patient may see a med tech, PCN, NP, or a PA instead of a physician, depending on the patient’s health issue(s). The CDU staff may refer directly to a pharmacist, a physiotherapist or a mental health provider following a brief triage, without requirement to wait for a physician prescription or referral;
4. Treatment Room. CF H Svcs C (O) has a Treatment Room consisting of one nurse, one physician, and two or three med techs who provide care for minor acute conditions which arise after sick parade hours and merit prompt attention but that do not require Emergency Department assessment or hospitalization. The Treatment Room is open from 0730 to 1500hrs. If a patient arrives after 1500hrs, staff will instruct him/her where to go (e.g., Walk-in Clinic, Emergency Department, follow up the next day, etc.);
5. Triage. The clinical team works collaboratively with patients to assess their needs, and to provide the best possible health care in a timely fashion. In order to attend to all patients according to urgency and priority, various triage and management mechanisms are required and must be respected. This will affect wait times to varying degrees. Non-acute issues which present to sick parade or the treatment room may be deferred to a subsequent booked appointment. Likewise, less pressing acute issues may need to wait until the more serious cases are looked after. Patients must respect the needs of others and the responsibility and prerogative of clinical staff performing triage; and
6. Choice of Clinician. Uniformed personnel must receive their care from the CFHS or from specific health care providers designated by the CFHS. Within their CDU, patients may request to be rostered to a certain type of provider (e.g. they may express a preference for an NP, PA or physician as their primary clinician.) Patients may make reasonable requests to meet certain personal preferences or special needs, for example:
   1. Male or female provider; and
   2. Provider with special skills (e.g. able to perform joint injections).

The CAF member will receive the service in his/her official language of choice, knowing that the CF H Svcs C(O) will have made an Active offer in accordance with the law.

Such requests will be met wherever possible, ideally within the CDU. Sometimes this may require a change of CDU. Exceptional requests may be forwarded through the CDU to the Base Surgeon. In all cases involving individual preferences, due consideration must be given to the collective needs of all patients. Requests for specific providers are often unmanageable and will not normally be considered. Likewise requests for “only military” or “only civilian” providers will not normally be considered. These principles apply to routine patient-clinician health care encounters.

3. Sick Parade/Walk-In

1. Sick Parade/Walk-In. Patients may present to sick parade, without an appointment, for an assessment of their acute health concern(s). The patient should only report to sick parade if their symptoms or concerns are of less than 48 hours duration and if their medical condition interferes with their ability to perform their daily work. Sick parade at CF H Svcs C (O) is conducted from 0730 to 1500hrs Monday to Friday (except on Holidays) in the Day Treatment Unit (DTU).
2. Except in cases of acute illness interfering with work, patients should contact their respective CDU to schedule an appointment instead of “dropping-in” to the clinic. To do otherwise may lead to a long wait time before being seen (unnecessary time away from work), may create delays for other patients, in addition to increasing the triage burden for staff.
3. Mental Health Access. Patients wanting to access services in the Mental Health Department may do so by:
   1. Obtaining a referral from their GDMO; or
   2. By walking in to the Psychosocial Program between 0730 and 1400hrs.

Appointments are not required for the Psychosocial Program. However, Patients may also book an appointment to be seen in the program without a referral from their GDMO if they prefer.

4. Deportment and Communication

1. The CF Code of Conduct applies at all times. Staff and patients shall behave professionally and respectfully at all times. Any disputes between staff and patients which cannot be resolved by the individuals involved should be brought to the attention of the CDU PCN, Section IC and/or Department Manager before leaving the clinic. Alternately, a patient may communicate their concerns through the Patient Comment Cards found in each CDU or through patientfeedback-commentaires@forces.gc.ca; and
2. All CF H Svcs C (O) staff has the right to a harassment-free work environment. To achieve this, the clinic shall not tolerate patient behaviour that is aggressive or threatening towards a CF H Svcs C (O) staff member, whether in person, by telephone or email communication, or by any other means. If such behaviour cannot be successfully addressed on the spot, then aggressive, harassing or other unprofessional patient behaviour will be referred to the member’s Commanding Officer for appropriate administrative or disciplinary action.

5. Process and Expectations

The remainder of this information package is to outline the process the patient is to follow to access care at CF H Svcs C (O).

1. Before 0715, patients shall present themselves to the Commissionnaires desk at the Main Entrance.
2. At or after 0715, patients may present directly to their CDU or the other department where they need to go and register. If a patient has not been rostered to a CDU, they may do so at the main reception desk at the 3rd floor;
3. Sick parade patients will be triaged by the med tech or PCN. Once the initial triage and vital signs are done, the best available clinician will be designated to see the patient, in keeping with triage and the clinician’s scope of practice. If a patient requests to be seen by a physician or by another specific provider, it may be necessary to refer the patient to the Treatment Room if the CDU cannot accommodate the request;
4. After being seen by the clinician, the patient shall report to the CDU desk clerk to check out. Any follow-up appointments or services shall be arranged at this time;
5. Patients sent to the Treatment Room may need to be triaged a second time by the Treatment Room staff;
6. Patients who have been prescribed Sick Leave or Medical Employment Limitations (MELs) are responsible to promptly deliver their “sick chit” to their supervisor or other appropriate unit staff;
7. If a patient has administrative requests for their CDU, the Health Records section or other clinic staff, they are recommended to call in advance. Most administrative requests cannot be immediately actioned by clinical staff. Every effort should be made to separate administrative requests from patients who are presenting for clinical care. Normally, initial replies to administrative requests made by telephone or email will be provided within 48 hours; and
8. Most administrative requests for release of health records will follow Access to Information regulations and associated timelines, which cannot be altered or accelerated.

6. Conclusion

This information package was designed to provide CAF patients with an overview of this clinic’s Ambulatory Care Delivery System, to communicate the process for receiving care, and to outline what is expected of each patient seeking care at CF H Svcs C (O). It is hoped that this will increase knowledge and understanding of our way of providing patients in the NCR with the care they need.