With 200 inpatient beds, the IM service is by far UHN’s largest. As UHN’s busiest on call service, our physicians are asked to assess and admit over 700 patients from the ED every month. The IM service is never closed and never turns away a patient in need. Our team admits or discharges a patient every 45 minutes, 24 hours a day, seven days a week.

Along with the ED, IM is one of a handful of services that have no limit to the number of patients it accepts. On an average day, the IM team has approximately 260 patients admitted to the hospital.  Unfortunately, our patients often wait in the ED, sometimes for many hours, and often in hallways – the so-called “hallway medicine” phenomenon. We see a significant role for IM in helping end hallway medicine. UHN IM physicians are all frontline doctors with firsthand knowledge of the day-to-day challenges of our health care system, and many are also experienced health care innovation researchers. They are uniquely poised to find innovative solutions to health care challenges like hallway medicine.

For example, the TWH Clinic designed a new referral pathway that streamlines patients from ED to our Rapid Discharge Clinic, often in under 48 hrs. This rapid referral pathway spares patients who can be safely discharged from the ED from prolonged hospital waits and streamlines their care to an IM specialist. This clinical pathway is housed within our larger TWH Clinic, whose mission is to provide seamless care for some of UHN’s most complex patients by relieving long ED waits, saving patients hospital admissions and getting patients home sooner.

We are grateful for UHN’s commitment to this priority with an infrastructure expansion in Fall 2024. Philanthropic support will transform the clinic’s space with design improvements and technology innovations to expand our reach with virtual clinic appointments and create an e consult service for family physicians to seek IM expertise and educational rounds. Providing protected research time for a medical lead, such as a Professorship or Chair in Innovations in Clinical Care, to demonstrate the impact of our Rapid Referral Programs would be transformative.

Currently, IM cares for a large number of patients with cancer at both TGH and TWH. But this team also plays a significant role in caring for patients in that critical time before the formal diagnosis of cancer is made and before patients are referred to our trusted colleagues at Princess Margaret Cancer Centre. The IM service admits an estimated 600+ patients a year for a possible cancer diagnosis. As patients face lab tests, CT scans and questions about what the future will bring, both they and their families face incredible uncertainty and stress. In the time surrounding a cancer diagnosis, we know days can feel like months.

This is why our vision for the future includes a transformative Rapid Cancer Diagnosis Program. By expanding the capacity of our outpatient IM clinic, cancer diagnostics can be transferred from the inpatient wards to the clinic setting. This allows patients to remain at home as they undergo the testing needed for a clear diagnosis and then seamlessly connects them to treatment – with the IM team overseeing every step along
the way.

IM is the central hub of the very complex health ecosystem that is UHN. The IM team cares for the largest number of patients at UHN (40% or over 260 patients daily). The sheer size of our program, coupled with IM patients’ acuity and complexity, results in a tremendous and immediate impact on all other departments. When IM is under stress, it is instantly felt across all of UHN. However, the reverse is also true innovation within IM quickly permeates into nearly every function and department at UHN, including radiology, pathology, surgical services, critical care, the ED and cancer care.

IM’s role in leading the acute COVID-19 response is proof of concept of an innovative model of care design having an immediate and widespread impact across UHN. Under extraordinary circumstances, IM swiftly designed and implemented the model for acute inpatient COVID-19 care. Every single one of our IM physicians became COVID 19 physicians and provided at the bedside care for 70% of all admitted patients with COVID 19 at UHN.

It is IM’s vision and mandate to do more. With our aging population and the ever increasing medical complexity of patients, our health care system will be further challenged in the future. There is an
urgent need for investment in research and the pragmatic innovations uniquely offered by our physicians. Philanthropic support would accelerate health systems innovation, recruit top talent and inspire visionary leadership. Investing in a vibrant IM Division (e.g. via protected health systems research time in the form of Innovation Chairs/Professorships for IM’s Division Head, and TG and TW Site Leadership) would allow for rapid design and implementation of new initiatives within IM and a better health care system for all.

Many UHN IM physicians are experienced health system innovators and researchers who design new models of care and evaluate outcomes. This scholarly work is powered by our research think tank, the TG Health Quality and Innovation Hub . The mandate of this IM research group is to create innovative, data-driven solutions to improve patient care. Key successes of this hub include the rapid mobilization of the COVID-19 response, evaluation of initiatives to ease transitions between hospital and home, as well as the design and implementation of pragmatic randomized clinical trials to improve inpatient care.

Program support (five years of seed funding) for the TG Innovation Hub would allow IM to meet a critical need to design, implement and evaluate new models of care to fix our most pressing healthcare challenges. Support for TG Innovation Hub research fellowships/Chairs in transitions-of-care research and health quality outcomes, as well as developing significant TG Hub research infrastructure, would launch this new Research Innovation Hub as a leading centre in innovative health systems transformation.

IM physicians are skilled at understanding complexity, whether it is medical complexity resulting from multi organ disease or from our patients’ unique circumstances. Patients are more than the sum of their parts and we consider our patients’ whole bodies and lived experience. This includes factors such as poverty, under housing, mental health issues and addictions. For example, several of our IM physicians have specialty expertise in Addictions Medicine, Health Equity and Women’s Health Issues, such as osteoporosis. Supporting the research of our team and their research initiatives in programs such as Addictions Consultation Services would launch transformative growth of these programs, and help balance inequities.

Health care system change starts with innovative thinking from the very beginning of physician training and IM physicians at UHN are leading teachers and educators in the art of diagnostic thinking and excellence in bedside care. The IM residency program is the launchpad for every medical subspecialty. IM trains every future cardiologist, respirologist, infectious diseases physician, gastroenterologist and endocrinologist at UHN, to name just a few. Much of this training is conducted at the bedside on our Clinical Teaching Units at TWH and TGH.

In addition, TWH’s Centre for Excellence in Education & Practice (CEEP) is our educational research institute and think-tank whose mandate is to create change and foster new approaches to patient care by improving medical education at the bedside through innovation and scholarship.

Philanthropic support of this educational research institute will fund educational research, fellowship programs and education innovations in our training programs – and lay the foundation for training the next generation of physician leaders.