Breakout Sessions

WORKSHOPS | BREAKOUT A | BREAKOUT B | BREAKOUT C | BREAKOUT D | BREAKOUT E | BREAKOUT F | BREAKOUT G



WORKSHOPSW1 W2W3W4W5 W6


W1  Design Thinking

THURSDAY, MARCH 2 | 1000 – 1230

Let’s explore the powers of design thinking. We’ll share the latest knowledge on how design tools and methods can be used to foster innovation. This is an interactive session that starts with the people you’re designing with and ends in creative solutions that suit their needs. If you want to take your solutions and ideas to new heights then join us at this session!

Participants who attended in last year’s Innovation Lab are also welcome to register for this workshop as
a refresher.

Colleen Kennedy
Director, Innovation & Engagement
BC Patient Safety & Quality Council

Andrew Siu
Campaign & Engagement Specialist
BC Patient Safety & Quality Council

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W2  Game On! Using Gamification to Maximize Motivation and Engagement for Health Improvement

THURSDAY, MARCH 2 | 1000 – 1230

This workshop is designed to provide participants with an understanding of how motivational theory and game design can engage patients, families and those working within the health care system to improve care.  Gamification is the use of game elements and design in non-gaming contexts, and is rapidly spreading internationally as an exciting way to change behaviour patterns. This workshop provides an opportunity to explore how gamification could be used in your own improvement initiatives.

Shari McKeown
Director, Clinical Improvement
BC Patient Safety & Quality Council

Geoff Schierbeck
Quality Leader
BC Patient Safety & Quality Council

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W3  Striking the Balance: Approaches to Accountability and Quality Improvement to Achieve Results

THURSDAY, MARCH 2 | 1430 – 1650

Getting the right balance between accountability and quality improvement is a given, but is never easy. Health care systems around the world are facing increasing public and government scrutiny, financial pressures and growing complexity. Our experience has shown that a focus heavily weighted towards compliance and accountability is at risk of stalling improvement. This highly interactive session will focus on creating a dialogue as to how we might optimize the balance to achieve results.

Christina Krause
Executive Director
BC Patient Safety & Quality Council

Devin Harris
Clinical Lead
BC Patient Safety & Quality Council

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W4  You Had Me At Team-Based Care

THURSDAY, MARCH 2 | 1430 – 1650

Are you committed to advancing team-based care? Do you desire an opportunity to collaborate and share with others working in this area? Are you looking for an opportunity to learn in a participant driven session? If so, then this is the session for you! Join us for an interactive, dynamic experience where we will come together to co-create an agenda for an “unconference” to discuss, explore and create solutions to advance team-based care in the province.

Colleen Kennedy
Director, Innovation & Engagement
BC Patient Safety & Quality Council

Danielle Simpson
Leader, Innovation & Engagement
BC Patient Safety & Quality Council

Robin Speedie
Leader, Innovation & Engagement
BC Patient Safety & Quality Council

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W5  Primary Care and Behavioural Health: Southcentral Foundation’s Integrated Approach

FRIDAY, MARCH 3 | 0945 – 1215

Southcentral Foundation (SCF) is an Alaska Native customer-owned health care system responsible for providing health care and related services to approximately 65,000 Alaska Native and American Indian people in southern Alaska. A key component of the SCF care model is integrated behavioural health providers in primary care. Patients (called “customer-owners” at SCF) have same-day access to masters-level clinicians stationed in primary care clinisc, where these clinicians are able to meet the customer-owner’s needs through a brief intervention, coordination of care with a clinical associate or through a referral to specific services required. This process helps de-stigmatize behavioural needs, and enables behavioural health providers to be a part of the integrated care team that includes primary care providers. This interactive session will explore the organizational processes, roles and job responsibilities, and key results of integrated care teams.

April Kyle
Vice President of Behavioural Health
Southcentral Foundation (Alaska)

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W6  Making It Stick: Planning for Sustainability

FRIDAY, MARCH 3 | 0945 – 1215

How many times have we made improvements, only to have things drift back to the way they were before? Creating sustainable change is one of the biggest challenges for improvers, and changes that don’t stick can actually do more harm than good. This hands-on workshop will explore the key drivers of sustainability and introduce some tools to plan for the sustainability of your next project.

Presenter to be confirmed.

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BREAKOUT A A1 A2A3A4A5 A6

Thursday, March 2 ⋅ 1000 – 1100


A1  Let’s Talk About Chronic Pain

THURSDAY, MARCH 2 | 1000 – 1100

Chronic pain has a tremendous impact on the quality of life for 1 in 5 British Columbians, while driving health care utilization and posing challenges for clinicians. Join our exploration of the latest developments related to caring for patients with chronic pain. Participants will learn how chronic pain affects patients, the health care system, and society. We’ll share implications for care and service system design, and highlight emerging e-health and other innovations that are making a difference in the lives of people in pain.

Maria Hudspith
Executive Director
Pain BC

Jennifer Hanson
Director of Education & Engagement
Pain BC

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A2  Linking Ideas to Action with Driver Diagrams

THURSDAY, MARCH 2 | 1000 – 1100

Looking for a quality improvement tool that will help take your lofty aim and break it down into manageable change ideas? Need a method that will help move your team from vision to action? Searching for an approach that is agile and can change as rapidly as the complex, adaptive systems we work in? Then driver diagrams are the tool for you! In their simplest form, driver diagrams help link high-level improvement goals to specific project activities. In this interactive session, you will have an opportunity to learn more about this powerful tool and start to build the framework for your very own driver diagram.

Marlene Apolczer
Quality Improvement Lead
Northern Health

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A3 Better Together: A Hands-On Exploration of Family Presence Policies

THURSDAY, MARCH 2 | 1000 – 1100

Family presence enables patients to designate one or more family members – family as defined by the patient – as partners in care who are welcomed to be present with their loved one during hospitalization. Evidence shows this can improve patient experience and outcomes. This interactive session will provide the opportunity to learn from the Better Together Campaign and e-Collaborative, where the Canadian Foundation for Healthcare Improvement has been supporting teams across Canada in the adoption and implementation of family presence policies. Resources and lessons learned will be shared, in addition to the story of Providence Health Care’s own experience, the challenges and successes, with implementing family presence/open visitation policies and practices since 2013. We will explore current and future mindsets that will support this important work.

Kate McNamee
Practice Consultant, Care Experience Strategic Direction
Providence Health Care

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A4 The Right Place at the Right Time: Team-Based Care in the Community

THURSDAY, MARCH 2 | 1000 – 1100

RAPID FIRE

 

Collaborative Care of Psychiatrists and Family Doctors: Pit Consultation Appointments

In January 2014 at University Health Services, University of Victoria , patients were waiting 41 days (range 3-145) for psychiatric consultation. On survey, 100% of clinic staff were dissatisfied with wait times. In March, psychiatrists deemed that 60% of psychiatric consultations had not needed full consultations. Aiming to decrease psychiatry wait times without sacrificing care, our clinic staff collaboratively invented and implemented “pit consultation appointments” inspired by Gawande (TED talk, 2012, How do we Heal in Medicine) who suggests that a “pit crew” of care providers arrive where patients require care. A GP who identifies a question concerning a student’s mental illness schedules a Pit Appointment with the patient’s approval. In these 30 minute sessions, the family doctor, psychiatrist and patient work as a team to understand the troubling issues and decide on a treatment plan.

Average wait times to see a psychiatrist decreased from 47 days (May 2013) to 11 days for a pit consultation (May 2016). With decreased need, wait times for full consultation decreased to 15 days (May 2016). Unexpected benefits include family doctor learning and competence. We describe family doctor and patient satisfaction by survey and interview and how suggestions for improvement have been implemented. We review our findings about exclusion and inclusion criteria and when a full consultation is necessary. We describe what we have learned about requirements for successful pits and our attempts to collect tacit knowledge. Sustainability is illustrated.

With spread, this type of appointment could enhance knowledge and skills of family doctors, defer many patients from long consultation wait lists, treat patients faster, and decrease emergency visits. We are interested in participants’ ideas as we contemplate a trial of spread of pit appointments.

Marilyn Thorpe
Psychiatrist, Project Lead
University of Victoria, Student Health Services

Helen Monkman
Project Manager

 

John Barsby Community School Wellness Centre

Read about this Quality Award-winning project.

Erin Kenning
Public Health Program Coordinator;
John Barsby Wellness Centre Coordinator

Randal Mason
Family Physician

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A5  The Goldilocks Principle: Providing Care That’s Just Right

THURSDAY, MARCH 2 | 1000 – 1100

RAPID FIRE

 

‘More Is Not Always Better’ for Medical Imaging

While the vast majority of medical imaging (MI) are appropriate, inappropriate studies can cause harm through unnecessary radiation exposure, waste scarce resources, lengthen wait-times and frustrate physicians, patients and their families. Though research varies in the rate of inappropriateness (2-13.6%), it is widely accepted that healthcare expenditures are increasing at unsustainable rates and opportunities  to reduce unnecessary MI is necessary. Inappropriate ordering  is attributed to multiple causes but a national survey of physicians showed that one third of all physicians acquiesce to patient requests for tests even when they know they are not necessary. Other causes include poor communication, unclear referral parameters especially for newer MI techniques. Choosing Wisely is an initiative aimed at promoting conversations amongst various medical disciplines & their patients to help select care that is supported best by evidence. In alignment with the Choosing Wisely philosophy, Island Health’s Medical Quality Improvement & Shared Care co-led the establishment of a physician-led discussion panel involving family practitioners from South Island and Victoria Divisions of Family practice, radiology and emergency medicine. Three priority areas were identified by the physicians as CT for pulmonary embolism, CT brain angiography, and x-ray for lower back pain. Change strategies will be phased starting with Clinician education, patient and family education to build shared understanding of purpose and rationale with physicians and patients then audit and feedback of physician ordering practices and Point of Care alerts. The Choosing Wisely approach applied to MI ordering practices will improve physician experience through enhanced communication channels and clarity of ordering practices, patient & family experience through partnership in developing information material, reduce unnecessary patient radiation exposure and liberation of un-met capacity.

Jennifer Furtado
Consultant, Medical Quality Improvement
Island Health

 

Choosing Wisely in Pediatric Hospital Medicine

Unnecessary or inappropriate tests and treatments reduce the quality of care by potentially exposing patients to harm and additional tests, while also putting strain on the finite resources of our health care system.  At BC Children’s Hospital, our strategic action plan includes the core tenets of safety (eliminating preventable harm), access (providing the right care at the right time), and value (sustainable and fiscally responsible delivery of care without sacrificing quality).  However, in daily practice, the value-based proposition in care delivery remains an elusive goal.  The US Institute of Medicine estimates that 30% of medical spending does not add value to care, and Canadian estimates are similar (20-30%).

The Choosing Wisely campaign launched in the USA in 2012 and has since been adopted by more than 15 countries, including Canada.  It aims to empower physicians to assimilate, evaluate, and implement the ever-increasing amount of evidence into current best practice.  The basis of the campaign consists of developing lists of “Five Things Physicians and Patients Should Question” that are commonly used, not supported by evidence, and/or could expose patients to unnecessary harm.  While lists have been developed in many areas, the focus has generally been on the adult population and pediatrics has been under-represented.

This project will develop a consensus list of five items that may be unnecessary, inappropriate, or harmful that are specific to the inpatient pediatric population at BC Children’s Hospital.  Strategies to produce a sustainable reduction in the routine use of these items will be developed and implemented, with an impact analysis to ensure that these changes actually result in improvement.  This project will also involve pediatric trainees, offering residents an opportunity to take an active role in learning how to deliver high value, appropriate care while also gaining an understanding of improvement methodology.

Jennifer Smitten
Pediatrician
University of British Columbia, Department of Pediatrics

 

Improving Inpatient Advanced Care Planning: A Quality Improvement Study

Context- Research suggests hospital based health care providers (HCP) infrequently engage patients and families in end-of-life (EOL) planning conversations.  This care gap can lead to unwanted under or over treatment, conflict, family distress, and clinician burnout. The Vancouver Island Health Authority implemented a standard Medical Order for Scope of Treatment (MOST) placed at the front of admitted patient’s charts that outline adult patient’s code status in order to improve inpatient documentation of patient health care wishes.  To date, the MOST has not been proven to be more effective at documented goals of care than the standard “DNR” order.

Aim – Our objective is to track and optimize MOST implementation at St. Joseph’s General Hospital (SJGH) and see if it improves: 1) Inpatient ACP Documentation, 2) Concordance between ACP documentation, patient’s wishes and care delivery, 3) Patient and caregiver satisfaction with care, 4) HCP understanding of key ACP concepts and 5) Use of acute care resources.
Measures – Primary outcome was ACP documentation (% of admitted patients who had the MOST complete by the third day of hospitalization or before discharge). Secondary outcomes were: 1) Concordance between patient wishes and what is documented in the chart, 2) HCP ACP knowledge (HCP quiz), 3) Intensity of care, 4) Life expectancy and 5) Patient and caregiver satisfaction (CanHelp Lite).

Results- The proportion of patients with a completed MOST increased from 0 to 77%.  This was associated with improvements of: 1) 47% in ACP documentation, 2) 51% in concordance, 3) 7% in number of correct responses in HCP quiz and 4) 11% in patient satisfaction. We are still awaiting 90-day follow up data to measure intensity of care.
Lessons Learned – MOST implementation is associated with improvements in ACP documentation, concordance and patient satisfaction with care. MOST improves inpatient documentation of patient wishes when compared to the standard “DNR”.

Samuel Kohen
Critical Care Physician
St. Joseph’s General Hospital

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A6  Creating Comfort Through Innovations in Dementia Care

THURSDAY, MARCH 2 | 1000 – 1100

RAPID FIRE

 

Comfort Mitts for Patients with Dementia in Hospitals

Patients with dementia who are admitted to hospital for medical treatment may experience anxiety and being in an unfamiliar setting can further impair orientation and worsen behavioural symptoms.  Previous research suggests that the stress of being in a hospital often leads to responsive behaviours, which not only can cause distress for the patient with dementia but also place hospital staff and other patients at risk for injury. In the United Kingdom, nurses in the hospitals found comfort mitts useful for occupying patients who fiddle with, and pull at, intravenous lines, catheters and oxygen tubing. Comfort mitts offer visual, tactile, and sensory stimulations. They also seem to help relieve anxiety and provide conversation topics for promoting social interactions. This innovative project involves inviting hospital staff and citizens in communities to create hand-knitted comfort mitts that come in a range of textures and colours, and have various attachments such as beads, buttons, ribbons and zips sewed. In this presentation, we will report the processes of engaging hospital staff and citizens in the community in making the comfort mitts. Enablers and challenges will be discussed. This project has potential to contribute to preventing responsive behaviors and enhancing quality of care experience of patients with dementia. Useful tools will be shared with the conference audience. We will also report patient outcomes in the early stage of the project. Our findings will likely be transferable to other settings such as residential care and community care. This quality improvement project contributes to the knowledge base of using an art-based collaborative, participatory approach in supporting dementia care in acute hospitals. We believe the non-pharmacological intervention has potential to be a safe, easy and low-cost solution for supporting patient safety and quality of care, as well as reduction of staff injuries in clinical settings.

Alison Lee
Clinical Educator
Vancouver Coastal Health

Jenifer Tabamo
Clinical Nurse Specialist
Vancouver Coastal Health

Lillian Hung
Clinical Nurse Specialist
Vancouver Coastal Health

 

The Mindful Garden — Proof-of-Concept Phase

The hospital environment can cause or heighten anxiety, agitation, and responsive behaviors in patients experiencing dementia/delirium. The Mindful Garden proof-of-concept (PoC) explores the feasibility and acceptability of interactive digital technology to prevent or de-escalate challenging behaviors in elderly hospitalized patients with hyperactive dementia/delirium.

The Mindful Garden is a large screen TV that illustrates a baseline image of flowers swaying in the breeze. There are motion and sound sensors that detect movements and sounds made by the patient. Based on the levels of both, more interactive layers of the garden (e.g., flowers blooming, butterflies fluttering) appear on the screen with the goal of distracting and calming the patient.

The PoC was implemented in the rooms of six patients on the 6 North Medical Unit at Peace Arch Hospital in White Rock. Measurements included direct observation data by the research assistant, use of behavioral logs by staff, and reported positive experiences for families and staff, via the completion of questionnaires.

The results are pending and data analysis will take place in September/October 2016, but based on the observations and initial feedback, the technology was very well accepted by patients, families, and staff. The results of the PoC will be used to continue making improvements to the technology in order to enhance dementia/delirium patients’ experience while in hospital.

Amy (Amandeep) Gill
Research Assistant
Fraser Health

Using an iPad to Promote Safety & Quality of Care in Older Adult Tertiary Mental Health

The changes associated with dementia can lead to mood alterations and behavioral and psychological symptoms of dementia (BPSD). BPSD are common, affecting up to 90% of persons with dementia over the course of their illness. BPSD can be viewed as responsive behaviors, means of communicating unmet needs, including the need to feel safe and supported. Not only do responsive behaviors cause distress for the patients with dementia, but also place hospital staff at risk for injury. This innovative project examines whether using an iPad to play a video purposively created for the patient by his or her family may contribute to preventing and reducing responsive behaviors of patients with dementia.  We asked the patient participant if he or she would watch a video of their family. The recorded video made by family includes a reassuring, comforting and supportive message to help the patient feel safe and allow staff to help with a specific care task. The process was examined by structural observations and with video-recording.  Also, we conducted staff interviews and video analysis to investigate contextual factors and staff experiences. Our preliminary findings support positive effects of the intervention. Staff described the benefits and barriers of integrating iPad into everyday care activities on the hospital unit. This research contributes to the knowledge base of using technology (iPad) as a non-pharmacological intervention in dementia care. The iPad has great potential to be a safe, easy and low cost solution for supporting patient safety and quality of care, as well as reduction of staff injuries in clinical settings.

Corrina Helmer
Unit Clerk
Vancouver Coastal Health

Lillian Hung
Clinical Nurse Specialist
Vancouver Coastal Health

Andy Au-Yeung
Occupational Therapist
Vancouver Coastal Health

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BREAKOUT BB1 B2B3B4B5 B6

Thursday, March 2 ⋅ 1130 – 1230


B1  Trauma Informed Practice: What Is It and How Do You Do It?

THURSDAY, MARCH 2 | 1130 – 1230

Learn some of the basic principles of Trauma Informed Practice (TIP) and how one site – an inpatient mental health care centre – implemented it in their setting. Discover how the successes, challenges and lessons learned may apply to your environment and population. Particular attention will be paid to how TIP applies to admission/intake processes, managing crises and providing education to staff. Join us to begin brainstorming and planning what TIP could look like for you – and how to get there.

Heather Fulton
Psychologist
Burnaby Centre for Mental Health and Addictions

Ayesha Sackey
Clinical Services Manager
Burnaby Centre for Mental Health and Addictions

Justine Dodds
Program Director
Burnaby Centre for Mental Health and Addictions

Patricia Doyle
Registered Psychiatric Nurse
Burnaby Centre for Mental Health and Addictions

Kristina Conger
Registered Nurse
Burnaby Centre for Mental Health and Addictions

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B2  Surgical Site Infection Prevention: How Are We Doing and What’s What in WHO’s New Guidelines

THURSDAY, MARCH 2 | 1130 – 1230

The prevention of surgical site infections has been a long standing focus in surgical improvement. This session will explore the current level of performance on SSI’s through the National Surgical Quality Improvement Program (NSQIP), share local stories of success and present the new World Health Organization surgical site infection guidelines released in November 2016. Participants will gain new tools to work on infection prevention that can be taken back to their sites and used immediately.

Kimberly McKinley
Surgical Quality Leader & Data Specialist
BC Patient Safety & Quality Council

Dave Konkin
General Surgeon
Royal Columbian Hospital

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B3  Meet BC’s Seniors Advocate and Join a Discussion on Improving Care for Seniors in BC

THURSDAY, MARCH 2 | 1130 – 1230

One of the toughest decisions faced by the frail elderly and their loved ones in British Columbia is whether to stay at home or move to a care facility. This interactive session will explore the work of the Office of the Seniors Advocate and will provide an opportunity to bring your voice to a discussion on the issues affecting the quality of seniors care in BC.

Isobel Mackenzie
BC’s Seniors Advocate

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B4  Our Commitment to Person- and Family-Centred Care

THURSDAY, MARCH 2 | 1130 – 1230

RAPID FIRE

 

Implementation of Bedside Shift Report in a Cardiac Intensive Care Unit

In nursing, report or “handover” is the process of transferring responsibility for patients’ care between nurses. These reports are frequent and occur at various transition points including shift changes, off-unit treatments and diagnostic activities, and unit/hospital transfers. Historically, cardiac intensive care unit (CICU) nurses at our quaternary teaching hospital have completed report outside patients’ rooms and patient/family input has been minimal, if any.

The integration of patient and family centered care (PFCC) and its foundational elements (respect, information-sharing, participation, and collaboration) is currently an emphasized strategic direction at our institution. One approach to promote the enactment of PFCC is the inclusion of patients and families in nursing handover.  Beside shift report (BSR), endorsed by the Institute for Patient and Family Centered Care, is conducted at the patient’s bedside and actively seeks inputs from patients and families.  BSR is a PFCC communication approach that is reported to achieve important positive patient/family outcomes including greater involvement of patients and families in care decisions, increased patient and family knowledge, and improved satisfaction with care.

In this session, we will discuss our experience implementing BSR in our CICU.  Practice change steps and strategies will be outlined including involvement of key stakeholders; pre-implementation preparations such as identification of significant nursing concerns (e.g. privacy and confidentiality); design and delivery of nursing education, methods of engagement; and support for nurses pre- and post-implementation. Outcomes that we have evaluated to date, and lessons we have learned from this practice change, will also be highlighted.

Dione Nordby
Registered Nurse
Providence Health Care

 

Brief Action Planning Leads to Patient-Centred Goals in Acute Care

Kitimat General Hospital (KGH) introduced patient room whiteboards as a communication tool between staff and patients/families in 2014.  Appointments were being written on the boards but patient “goals” were not developed collaboratively or written down routinely.  In 2015, site leaders and educators agreed to provide staff training in a type of goal-based motivational interviewing technique called Brief Action Planning (B.A.P.)  to facilitate goal-setting with patients.  This approach is consistent with a “rehabilitative care approach” being developed at Northern Health to optimize patient functional ability, as well as Northern Health’s new patient- and family-centredness strategy. The principles of B.A. P. are Compassion, Acceptance, Partnership and Evocation. There is a clear stepped algorithm for coaching patients to develop goals and plans to achieve them. B.A.P. is now proving to be a very successful approach despite initial doubts it could be used in an acute care setting. B.A.P. interviewing techniques required slight modification for the acute care setting.  In addition, rather than structured classroom training, the educator and B.A.P. trainer worked with staff on the floor to provide flexible training and coaching.  Staff practiced their interviewing skills with more well patients in the facility. Several staff stepped forward to become site champions and peer education and ongoing training support is being provided. Patients are now key actors in their goals and have made inspiring progress to achieve them.  For example, one long-stay patient (6-7 months) who was unable to barely roll over in bed created a goal to “walk again”.  Staff worked with the patient to develop smaller goals to reach that larger goal, beginning with sitting up, and then standing for trial periods.  Another palliative patient on significant pain medication had a goal to “drive my new car”, with coaching developed an alternate safe and achievable goal of “go for a car ride”.

Lee Cameron
Practice Support Coach, Care in the Right Place Coordinator
Northern Health

Jeanette Foreman
Quality Improvement Advisor
Northern Health

Natosha Correla
Clinical Nurse Educator
Northern Health

 

Assisted Peritoneal Dialysis: A Patient-Centred Approach to Support Self Management

Read about this Quality Award-winning project.

Micheli Bevilacqua
Nephrology Administration Fellow
BC Provincial Renal Agency

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B5 Healthy Workforce, Healthy Patients

THURSDAY, MARCH 2 | 1130 – 1230

RAPID FIRE

 

Dare to Care

IHI published a stimulating article in September 2016 promoting the idea of restoring joy in work for the healthcare workforce (Healthcare Executive SEPT/OCT 2016). One major premise of the authors is that healthcare is one of the few professions that provides the opportunity for people to profoundly improve others’ lives, and that caring and healing should be naturally joyful activities.
This piece articulates brilliantly the work that we are engaged in at PHC. Burnout, engagement and staff satisfaction is a constant in our work…and the impact on patients is palpable. Instead of trying to “fix” burnout, we wondered whether we could “nudge” people out of a sense of learned helplessness, improve morale, and restore joy in their work.

To that end, we put a call out for stories from staff of events in their worklife that demonstrate the spirit of “Daring to be Caring”. We were overwhelmed with the responses…and with our emotions reading them. From simple to sophisticated, these stories resonate with the innovation, creativity and compassion of our people. Our hypothesis is that staff cannot help but feel a swell of pride when these stories are told.

Three of these stories are being produced as video vignettes, initially for our annual Patient Safety Leadership Retreat, and then for broader distribution. At the Retreat, the videos will be the foundation for a World Cafe style exercise, where we can explore how we ensure our culture and environment supports and celebrates the people who made a difference in patient’s lives. We intend to continue to collect the stories, and preserve them as videos to be used for ongoing staff team building, Board presentations and public engagement.

At ten minutes each, we would not be able to share all of the videos in a rapid fire session. But we think even watching one would bring a great sense of communal pride to the Forum audience in the difference we make in our patient’s lives.

Camille Ciarniello
Corporate Director
Providence Health Care

 

Enabling High Quality, Sustainable and Accessible Services in Burns Lake, BC

Rural shortages of health personnel are a major issue not just in Burns Lake, but globally. One of the biggest challenges facing health policy makers is motivating health workers, particularly physicians to work in rural areas. To address this growing concern in the rural community of Burns Lake, a partnership between the Joint Standing Committee on Rural Issues, Northern Health, the Northern Interior Rural Division of Family Practice, the Village of Burns Lake and the First Nations Health Authority was formed to create a sustainable healthcare plan that would support the attraction, recruitment, and retention of healthcare providers. Success in Burns Lake and surrounding communities will mean achieving the following:

(1) Improved access to Primary Care Providers.
(2) An inter-professional team-based care model of practice.
(3) Clear pathways to specialized community services.
(4) Shared medical information via an electronic medical record (EMR).
(5) Data integrity and knowledge transfer

The work of implementing the Sustainability Plan in Burns Lake is still in its infancy; however key lessons are emerging. For example, physician leadership is vital to support significant changes such as EMR implementation, office efficiency principles, and a culture shift to measurement and accountability. In a busy rural practice accessing physician time outside of their clinical practice is a challenge. The presentation will discuss these challenges, strategies and solutions in rapid fire and engage the audience to share their experiences to build and transfer the knowledge.

Candice Manahan
Executive Lead, Medical Affairs
Northern Health

Karen Parent
Project Lead, Burns Lake Sustainability Plan
Northern Health

 

Making Mindfulness Accessible for Health Care Providers and Medical Students

Current estimates put burnout rates among North American nurses, physicians, and medical students at ~50%, and climbing. The annual cost of Canadian physician burnout is $213.1 million. Burnout is defined by three components: emotional exhaustion, depersonalization, and reduced sense of achievement. It is associated with increased medical errors, and decreased compassion, patient compliance and patient satisfaction.

Research suggests that mindfulness training among healthcare providers reduces stress and burnout, while heightening compassion. Mindfulness is the practice of bringing a gentle and accepting awareness to one’s present-moment conscious experience, and is now known to bestow an extensive range of mental, physical, and spiritual benefits. Despite evidence that these improvements in provider well-being translate to better patient care, opportunities to learn and practice mindfulness remain lacking.

Mindfulness and Meditation in Medicine at UBC (MMM@UBC) is a UBC Faculty of Medicine student-led organization founded in 2016. Through MMM@UBC, experienced meditation practitioners and mindfulness-based stress reduction instructors volunteer to provide free weekly opportunities for healthcare providers and medical students to learn and practice mindfulness meditation at the Vancouver General Hospital and Medical Student and Alumni Centre.

Organizers plan to evaluate the program in December. Participants will complete the Maslach Burnout Inventory and be interviewed with on their experiences. Preliminary results from completed interviews indicate that mindfulness meditation mitigates burnout and stress. Previous research demonstrates these changes may translate to enhanced patient care.

One challenge is maintaining consistent practice in the face of unpredictable work schedules, and organizers are collaborating to resolve scheduling issues. As mindfulness training may improve healthcare provider and patient wellness, MMM@UBC hopes to expand the program.

Matthew McAdam
Medical Student
UBC Faculty of Medicine

Jenifer Tabamo
Clinical Nurse Specialist
Vancouver Coastal Health

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B6 Reaching Out: Proactive Approaches to Primary Care

THURSDAY, MARCH 2 | 1130 – 1230

RAPID FIRE

 

Complex Care Management Project

Patients who have multiple chronic conditions or a high frailty score benefit from proactive primary care, including annual development of a complex care plan. Electronic medical records (EMRs) can be used to search for patients who are due for a complex care management visit, and set up reminders to call these patients; however, many North Shore family physicians and medical office assistants (MOAs) told us through surveys and discussion groups that they were not comfortable using these features of their EMRs. This discovery inspired us to develop the Complex Care Management Project (CCMP) in summer 2015.

The first CCMP cohort included 17 family practices. Participants attended an education session about complex care, and then received coaching in their offices from a Practice Support Coordinator and/or peer mentor. The physicians and MOAs reported that the support enabled them to approach complex care in a more organized way, and patients appreciated the proactive care they received. The CCMP also helped physicians increase complex care and chronic disease management billings, which provided an incentive to sustain the positive changes they had made.

Our work with the cohort 1 participants improved care for 2,555 complex patients; increased attachment continuity by 27%; increased EMR data quality, including use of problem lists and disease registries, by 9%; and enabled a potential 16% increase in income from complex care and chronic disease management fees. Due to the success of the project, we received funding to run two additional cohorts. We have adjusted our approach based on lessons from cohort 1; for example, we found that fall was an inconvenient time to start the project so we started cohorts 2 and 3 earlier in the year. We expect to have data from cohorts 2 and 3 before Quality Forum 2017.

Joanne Larsen
Family Physician

Dewey Evans
Epidemiologist and Evaluation Support
North Shore Division of Family practice

Candace Travis
Practice Support Program
Vancouver Coastal Health

 

Virtual Remote Primary Care Home

To sustain the healthcare system while simultaneously improving patient and provider experiences and patient outcomes, a new model of care is needed. Island Health’s draft model, Community Health and Care, is based on a patient/family/ community centred approach to improving quality of care, collaboration, and integration across the care continuum–from prevention and promotion to acute care and tertiary services.

A Primary Care Home supported by virtual models of care is a priority area for service redesign. Virtual care would provide clinical access to services in a patient centred approach in the rural and remote communities, increase continuity and coordination of care, and improve connection to its Primary Care Home. Broadly defined, virtual care is “Clinical Services and Care Collaboration delivered and received over distances, using a network of healthcare communications tools.” Anticipated benefits of virtual care at three levels includes: 1) individual – improve patient self-management, quality of life, keep patients at home/in community and prevent unnecessary travel for services; 2) provider – improve continuity of HHR skills in community, integration and sustainability; and, 3) health system – redistribute health and human resources, cut wait times, reduce unnecessary transfers, contribute to a paradigm shift healthcare – relative to proactive, and reduce economic burden of healthcare.

The anticipated outcomes of virtual care includes improved health and patient/community experience of care, improved quality of care and job satisfaction, and, improved system integration and sustainability. Virtual care will also enable timely access to clinical expertise as required by the patient, reduce unplanned admissions to hospital and provide better patient centred care. This work would focus on developing a virtual model to support a remote primary care home, specifically the remote communities supported by Port McNeil.

Alison Mitchell
Director, Rural and Remote
Island Health

Helen Truran
Strategic Project Lead
Rural and Remote Division of Family Practice

Margarita Loyola
Director, Virtual Health
Island Health

 

Improving Access to Health Care in BC’s Rural Communities

British Columbia’s health care context is changing as access and the increasing demand for services emerge as real challenges, compounded by the needs of an aging population. The resulting and potential impact to our health economy has inspired systems to investigate innovative ways to meet the needs of its patients in the community.

In partnership with the Ministry of Health, regional Health Authorities, First Nations Health Authority, Ambulance Paramedics of BC, and others, BC Emergency Health Services (BCEHS) is implementing an innovative program that seeks to facilitate better access to health care for BC’s rural and remote communities through an expanded role for paramedics.

The Community Paramedicine Initiative introduces community paramedics as integrated parts of the local health care team, focused on prevention, health promotion and primary health care in rural and remote communities. The initiative’s objectives are to bridge health service delivery gaps, with an emphasis on older adults living with chronic diseases, and to stabilize paramedic staffing in rural communities to augment BCEHS’ ability to respond to emergencies.

Inspired by the Triple/Quadruple Aim, an evaluation framework has been developed to support the development, assessment and improvement of the initiative over the multi-year project cycle.
The prototype phase announced in April 2015 served as a learning ground for developing, testing, and refining the initiative’s processes and practices. The provincial rollout announced in April 2016 includes an initial 73 communities, selected using evidence-based methodology and endorsed by program partners. BCEHS is now hiring community paramedics sequentially by Health Authority. All undergo a 14-week orientation to prepare them for providing primary care services to patients in homes and communities.

Lauren Allard
Project Coordinator
BC Emergency Health Services

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BREAKOUT CC1 C2C3C4C5 C6

Thursday, March 2 ⋅ 1430 – 1530


C1  Cultural Safety through Humility

THURSDAY, MARCH 2 | 1430 – 1530

In May 2011, BC First Nations leadership came together and collectively made the largest self-determination decision in the province of BC – to take control over their own health and wellness. Creation of the First Nations Health Authority (FNHA), a first of its kind in Canada, is an institution created by First Nations people for First Nations people. Working to change ‘the system’ from sickness to wellness, the FNHA champions a holistic view of health and wellness that acknowledges and includes an individual’s physical, mental, emotional and spiritual well-being. Given the current landscape in Canada around reconciliation, there is an opportunity to begin a journey together through a First Nations approach to transform the present, through learning from the past, for a better future – for generations to come.  Join us as we explore this journey together.

Joe Gallagher
Chief Executive Officer
First Nations Health Authority

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C2 Agile Health Systems: Aligning Financial, Operating and Prioritization Processes in Real-time to Drive Performance

THURSDAY, MARCH 2 | 1430 – 1530

Real-time predictive analytics is the foundation for patient-centred care and agile performance. Using predictive data to plan care, staffing and patient flow is key to better quality, planning and efficiency. It is a common approach in many industries, and one increasingly being looked to in health care to improve services. This session will explore the potential for agile performance and predictive analytics in health care, and will look at an example of how it has been used in Vancouver Coastal Health to improve staffing and operational planning.

Duncan Campbell
Principal Consultant
Craigavon Enterprises; and

Council Member
BC Patient Safety & Quality Council

Karin Olson
Chief Operating Officer
Vancouver Coastal Health

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C3  Translating Individual Goals into Excellence in Advance Care Planning

THURSDAY, MARCH 2 | 1430 – 1530

There are myriad benefits to integrating Advance Care Planning (ACP) across our province for patients, caregivers and their families, as well as the system as a whole. In collaboration with a growing number of partners, the BC Centre for Palliative Care is leading system-wide integration of ACP using an evidence-based, person-centred approach. Come learn how the organization is engaging the public using “Think, Talk, Plan” and how health-care providers can translate a person’s values and priorities into action through skilled Serious Illness & Goals of Care Conversations and Medical Orders for Scope of Treatment. Your feedback in this interactive session will help achieve the vision of a seamless system translating values and goals into excellent care.

Doris Barwich
Executive Director
BC Centre for Palliative Care

Rachel Carter
Research Manager
BC Centre for Palliative Care

Cari Hoffman
Provincial Clinical Lead
BC Centre for Palliative Care

Pat Porterfield
Public Awareness and Education Working Group
BC Centre for Palliative Care

Penelope Hedges
Patient Representative

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C4 Mission: Critical (Care)

THURSDAY, MARCH 2 | 1430 – 1530

RAPID FIRE

 

Improving Critical Care Intubation at a Community Hospital: A Prospective QI

Context-Critical Care Intubation (CCI) is a resource intensive emergency lifesaving procedure that is performed intermittently, often without notice. In contrast to patients who have fasted and optimally prepared for the procedure and then intubated in operation rooms (OR) by airway specialists following standard protocols, critically ill patients are often physiologically unstable and intubated under suboptimal conditions without standard protocols by physicians with limited airway training. These challenges are major contributors to poor documentation, processes, inefficiencies, frequent complications and health care worker (HCW) stress commonly observed within CCI in hospitals under almost all circumstances. One study performed at Vancouver General Hospital, observed that life-threatening complications affected 39% of CCI.

Objectives-This multidisciplinary quasi-experimental CCI quality improvement (QI) project was developed and implemented at St Joseph’s General Hospital to: 1) Improve appropriate documentation by 25%, 2) Reduce the complication rate by 50%, 3) Improve procedural efficiency by 50% and 4) Reduce HCW stress related to intubation by 50%.

Measures-This prospective study with a historical control outlines 20 pre-intervention CCIs performed in 2014 then 14 peri-intervention CCIs performed in 2015 at SJGH. Outcome measures included baseline demographics, CCI documentation, CCI complications and CCI process efficiency.

Improvement/ Innovation/ Change Ideas – There was a 17% improvement in appropriate CCI documentation, a 32% increase in the number of CCI between complications and a 39% improvement in process efficiency.

Lessons Learned-All improvements reached significance but fell short of our stretch goals of 25, 50 and 50%, respectively. We have failed to measure HCW stress and need to better understand staff concerns. Our approach and QI methodologies may be generalized to other centres to reduce the risk of dangerous life saving procedures.

Samuel Kohen
Critical Care Physician
St. Joseph’s General Hospital

 

Pain, Agitation and Delirium in ICU: Complex Processes Require a Complex Intervention

There is increasing evidence that a high proportion of critically ill patients experience pain, agitation, delirium and weakness, and that these conditions a) are often iatrogenically introduced, and b) lead to poor patient outcomes. One of the most important changes in critical care today is designed to address this by shifting from heavily sedating patients toward Awakening and Breathing trial Coordination, Delirium management, and Early mobility. This “ABCDE” Bundle has tremendous benefits for patients, but comprises a complex intervention that requires coordination and change at the levels of the health authority, hospital, ICU and individual practice. As a result, full implementation requires years of sustained quality improvement efforts.

In this presentation, we describe ABCDE Bundle implementation in six intensive care units in Interior Health. Beginning with the decision to adopt the Bundle as an IHA-wide priority in March 2013, through sequential management of each “letter” of the Bundle, we describe the steps we took, and challenges we faced over this 4-year journey.

We were fortunate to have joined the BC ICU Database just prior to Bundle implementation. As a result, we have extensive data on some quality indicators relating to the Bundle. Some successes include an increase in nursing documentation of patient sedation at one site from 0-73%, and a decline in ventilator length of stay at the same site by nearly 50%. Our setbacks include the slow adoption of common staging for patient mobility. Despite our setbacks we have become leaders in ABCDE implementation in Canada, and today all of our ICUs are participating in a national collaborative to sustain the progress we have made with the ABCDE initiative.

Lynne James
Clinical Nurse Specialist, Critical Care Network
Interior Health

Crystal White
Director, Critical Care Network and Clinical Nurse Specialist Services
Interior Health

 

The St. Paul’s Hospital ECPR Service for Out-of-Hospital Cardiac Arrest

Cardiac arrest is one of the leading causes of death in BC with survival rates ranging between 3-16%. On January 1, 2016 St. Paul’s Hospital commenced the Extra-Corporal Membrane Oxygenation (ECMO), CPR program for out-of-hospital cardiac arrest (OCHA) patients (E-CPR program) – the first of its kind in Canada. Historically, patients are treated with E-CPR after prolonged periods of CPR, usually between 45 and 75 minutes. Further, the process and coordinated efforts are done in an ad-hoc manner with no clear roles, responsibilities and expectations clearly communicated between multidisciplinary health care teams. Therefore, it was recognized that a highly organized and resilient system with close collaboration between pre-hospital and multiple in-hospital series would be required to identify appropriate OHCA patients and implement in a time-frame that could lead to favorable neurological outcomes.

The aim of the E-CPR project is to improve the survival of OHCA patients from 16% to ≥ 30% and to reduce the time taken to initiate E-CPR from the time of CPR to ECMO flow from 75 minutes to 60 minutes. To date, the median time taken to initiate E-CPR is 61 minutes, which is measured using statistical process control charts. Further, the survival rate for the patients treated this year is at 50%. PDSA cycles that led to changes implemented include explicit roles and responsibilities for all team members, room preparation and team huddles prior to patient arrival, and monthly simulation labs.

Challenges faced include management of a patient in the ED that is cared for by multiple health care groups, and family support in the resuscitation room. After each case a descriptive and quantitative event analysis is shared with stakeholders and those directly involved with the patient, which details lessons learned, challenges faced, and plans for change and sustainability.

Sarah Carriere
Leader, Patient Safety
Providence Health Care

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C5 Creating Culture… Bacteria Do It, So Can We!

THURSDAY, MARCH 2 | 1430 – 1530

RAPID FIRE

 

Building Culture

BC Cancer has undergone a series of organisational changes, and leadership handovers in the last 5 years. At Vancouver Centre we were having challenges with staff engagement, traction with improvement initiatives, and lack of connection across a large campus.

We made the decision to invest in our culture through a structured program. There are strong research links that those environments that foster team building, recognition and partnerships are also the ones that have the highest safety. With this in mind, we designed a program that built networks and relationships, and focused on contributors to culture according to literature. The 5C’s of Culture was developed by the Admin Leadership Team, and launched in Jan 2016. The 5 C’s stands for Continued Development, Committed to Quality, Conversations Matter, Celebrating Who We Are, and Community through Collaboration. The Program includes organized initiatives promoting healthy living, QI, development, recognition, community, and conversations between staff and leaders. The overall goal of the program is to create a cohesive community that values trust, respect, safety, and teamwork as vital to the heart of the organisation.

We are tracking a number of outcomes- the networks across campus, staff engagement, multidisciplinary meeting attendance, staff wellness, and patient safety events and feedback. There have been marked improvements in many of these areas.

I’d like to share the overall program, with a breakdown of costs (financial & resources), participation, and the successes and challenges with getting these going and in sustainment. I’ll focus on a few areas, with more details on the design, approach and measurement strategy of Song-cology (Collaboration through Community) and the Speaker Series (Conversations Matter). I’ll conclude with an evaluation- what we plan to continue, what the next steps are for us at BC Cancer Vancouver Centre, and what I’d suggest to others that are investing in this work.

Sophie Clyne-Salley
Manager of Clinical Services
BC Cancer Agency

 

Burnaby Hospital’s Care Champion Leadership Guide

In June of 2015, Burnaby Hospital began “The Care Champion Initiative” as an effort to support frontline caregivers who exhibit leadership qualities. These Care Champions were invited to the hospital’s biannual Leadership Forum and were acknowledged on placards at the entrance to their respective units. While these initial efforts were well received by our Care Champions, they lacked the tools and processes to support our hospital’s vision of developing frontline leadership. The Care Champion Leadership Guide was created to provide the tangible infrastructure for communicating the specific vision that we have for our Care Champions. Three central goals are highlighted in the Care Champion Leadership Guide: 1) Promote a culture of patient-centered care, 2) Promote frontline engagement and leadership in shaping the improvements within our hospital, and 3) Create a supportive culture at Burnaby Hospital where health care providers are given the tools they require to pursue quality improvement. The guide will be used as a Care Champion orientation tool. It discusses the importance of frontline engagement, role-modeling, and professional development. Opportunities for educational and practical learning experiences are suggested. Links are also provided to current Fraser Health leadership resources and workshops. The guide describes the importance of Care Champion involvement in assessing the challenges on the frontlines and accountability in assisting in the development of solutions. It is our belief that these efforts will offer two measures of benefit: 1) unit-based solutions will provide a positive impact on the quality of patient care, and 2) the shared-purpose realized in unit-based quality work will support the development of individual leadership and team collaboration.

Ryan MacKay
Patient Navigation Team, Licensed Practical Nurse
Fraser Health

Johanes Santos
Registered Nurse
Fraser Health

Sheryl Fernando
Licensed Practical Nurse
Fraser Health

 

Increasing Quality of Care through Staff-Led Quality Initiatives

Engaged staff provide quality care. The question is how to engage staff in quality initiatives in healthcare, an industry that is known to be overburdened, overcapacity and where staff members often feel unable to make change happen. At Cara Centre, a psychosocial rehabilitation program for adults with long-standing chronic mental health conditions, staff members are involved in quality initiatives. Not only are the staff engaged, the measures for quality care are exemplary (Patient and Family Satisfaction Surveys, Accreditation Canada results, BC Client and Family Engagement Summary Report). Cara Centre opened 5 years ago. After 2 years there started to be discussions about how some clients “didn’t fit the program”. This was the opportunity to create a quality improvement culture and a program that is responsive and flexible to meet all of our clients needs. For past 3 years annual planning meetings occurred with the staff, using the Psychosocial Rehabilitation Core Principles from PSR Canada as the model to ground these discussions. To our surprise we realized there were a number of principles we weren’t meeting, and some progress was needed. 28 new clinical processes were implemented to improve care. Quality initiatives were informed by research and best practice. Staff champions were identified for the initiatives, based on interests identified through staff performance reviews. Daily monitoring of initiatives was provided by the on-site supervisor. Quality of care was measured through chart audits and PSLS [patient safety learning system) reports. Clinical outcomes were measured through Health of the Nation scores, a measure of health and social functioning. Staff engagement was measured through sick time, staff position vacancy rate, required education completed and worker feedback survey. Lessons learned include engage as many staff as possible, daily coaching, and celebrating our successes.

Colleen McEwan
Manager, Tertiary Mental Health
Interior Health

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C6  Mind the Gap: Improving Access to Care

THURSDAY, MARCH 2 | 1430 – 1530

RAPID FIRE

 

Improving Access to Cystic Fibrosis Care Outside of Clinic Time

This quality improvement initiative was undertaken by BC Children’s Hospital Cystic Fibrosis Clinic (CF).  Our aim was to improve the process of arranging an out of clinic visit (OCV) for patients with an increase in their respiratory symptoms who needed to be assessment by health care providers outside of our twice weekly CF clinic. By working on the process, we expected: increased efficiency of workforce; better patient and staff satisfaction; improved community education; patient empowerment; and timely and easy access to families who really need it.

It was important to work on this process because: number of OCVs were increasing and time taken to arrange each visit was quite lengthy, staff were busy and needed to manage their time more effectively, patients often ended up coming to the emergency or respiratory departments and encountered long waits to be seen. It influenced the other respiratory staff, and infection control practices.

Intervention: The process began by creating a data collection sheet and a flow sheet capturing: time it takes to arrange an OCV; where and when the patient was seen; and number of steps to complete a visit. In addition, both staff and family satisfaction questionnaires were completed for OCVs. A change idea was to create a dedicated Rapid Access Clinic (RAC) with reserved pulmonary function slots and physician/physiotherapy time for these OCVs.

Measurements: Time taken to arrange an OCV has not changed, but number of steps have decreased. The majority of visits for patients seen at OCV changed from taking place in the respiratory or emergency department 12/22 visits, to occurring in the RAC or added to clinic visits 40/45 patients.

Lessons learned: The introduction of a RAC has led to improved communication and organizational efficiency.  We are now planning to re-do the staff and families satisfaction surveys post intervention.

Maggie McIlwaine
Physiotherapist, Cystic Fibrosis Clinic
BC Children’s Hospital

 

Improving Outcomes by Redirecting Care to Rapid Access Internal Medicine Clinics

Patients with complex, multisystem health conditions can be seen by a general internist or subspecialist in internal medicine.  As a result, the Rapid Access Internal Medicine Clinics (RACs) at St. Paul’s, Vancouver General, and Mount Saint Joseph’s Hospitals in Vancouver, British Columbia, treat a variety of patients with a myriad of symptoms.

Historically, these clinics have evolved and operated independently, with separate processes for intake, triage, and management.  Furthermore, there is little awareness of the service by family physicians, despite the fact that effective use of internal medicine RAC clinics have been shown to reduce unnecessary emergency department visits and improve access to specialist opinion.  In addition, internal medicine RAC clinics offer the potential for a ‘soft landing’ for earlier discharge of complicated inpatients and unattached patients that do not have a primary care provider. As a result, a group of specialists, emergency room physicians, family physicians, support staff, and clinical and administrative leaders from all three sites have collaborated to streamline, standardize, and simplify the intake, triage, and referral process.  This includes a single, common referral form, a mechanism to choose a specific specialist or site, and a process to acknowledge the referral so the primary care provider and patient know the referral process is underway.  Evaluation is currently taking place with specific metrics and outcomes being measured to determine the effect on redirecting emergency room visits, reducing inpatient volumes, and ensuring that urgent referrals are seen as quickly as possible.  Over time, this novel approach to collaborative teamwork and information sharing across health authorities and teaching sites will be key learnings to be analyzed and potentially leveraged to other areas of patient care.

Moe Baloo
Project Lead, Patient Transitions
Providence Health Care

Robert Levy
Respirologist and Professor
Department of Medicine, University of British Columbia;

Specialist Lead
Shared Care Steering Committee

 

North Shore General Practitioner Orthopedics Initiative

North Shore Family Physicians and Orthopedic Surgeons identified long wait times for orthopedic consultations, difficulty with timely communication, and an inefficient referral process as areas for improvement. Supported by Shared Care, we developed a centralized referral system, musculoskeletal screening clinic (ROCC – Rapid Orthopedic Consultation Clinic), and telephone advice line.
The centralized referral system introduced a standardized referral tool that could be triaged to the most suitable consultant along with proper investigations (medical imaging). Referral acknowledgements with wait time estimates are delivered to family physicians. Orthopedic surgeons (locums) and trained physicians conduct initial assessments in the ROCC and direct patients for the most appropriate nonsurgical or surgical care.

We also established a telephone advice line, where a dedicated surgeon discusses patient management with family physicians. This provides timely access to advice and avoids unnecessary referrals. A monthly average of 10 phone calls is received on the advice line.

Evaluation of the ROCC and advice line is conducted through manual and EMR tracking as well as satisfaction surveys. From June 2013-Dec 2015, ROCC received 6557 referrals. The new system has reduced wait times for consultation from 18-24 months to 3-4 months. 72% of patient survey respondents were very satisfied with their experience. Moreover, 94% of family physician respondents expressed satisfaction with the screening clinic.

From the surgeons’ perspective, efficiency improved with 60% of their time spent seeing operative cases compared to 10% pre-ROCC. In addition to improved efficiencies, patient and provider satisfaction and decreased wait times, there are also benefits such as avoiding unnecessary investigations, and family physician and ER visits.

Our successes are cultivating interests from neighbouring communities, such as Sunshine Coast, in implementing the process. Time and effort required for the integration of the referral form in EMR has proven the importance of early EMR vendor engagement.

Alan Baggoo
Pacific Orthopedics & Sports Medicine

Lisa Gaede
North Shore Division of Family Practice

Victor Jando
Pacific Orthopedics & Sports Medicine

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BREAKOUT DD1 D2D3D4D5 D6

Thursday, March 2 ⋅ 1530 – 1630


D1  Clearing Your Change for Takeoff

THURSDAY, MARCH 2 | 1530 – 1630

How do you ensure operational integrity, product delivery, and safety while introducing technological
and construction-based transformation in a 24/7 operational environment that is constrained by multiple simultaneous stakeholders? The team at the Vancouver Airport Authority has had to introduce a tremendous amount of change to accommodate growth and address aging infrastructure. Learn how they addressed these essential questions and reflect on how we can borrow these insights within health care.

Amy Allan
Director, Technology Services, Baggage
Vancouver Airport Authority

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D2 Building a Measurement Plan… Where Do I Start?

THURSDAY, MARCH 2 | 1530 – 1630

Improvement initiatives need a measurement plan to guide progress, inform the changes being tested and to tell us when we have met our objectives. This interactive session will cover the components of an effective measurement strategy and how to define indicators to that will guide our progress. The skill building workshop is a great fit for anyone leading an improvement initiative, or wants to brush up on their measurement skills.

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D3  Medical Assistance in Dying: Early Experiences in BC

THURSDAY, MARCH 2 | 1530 – 1630

Patients and their families have many decisions to make when faced with end-of-life care or intolerable suffering. Medical assistance in dying (MAiD) provides patients, who may be experiencing intolerable suffering due to a grievous and irremediable medical condition, the option to end their life with the assistance of a doctor or nurse practitioner. This interactive panel will provide an opportunity to explore the early experiences with MAiD in British Columbia from the policy, regulatory, health care provider and family perspectives.

Harsh Hundal
Acting Executive Medical Director, Residential and Community Care; and
Community Medical Director
Interior Health East

Brendan Abbott
Executive Director, Acute and Provincial Services
Ministry of Health, Health Services Policy Division

Heidi M. Oetter
Registrar
College of Physicians and Surgeons of British Columbia

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D4 Beyond the Call: Connecting with Patients in the Mobile Age

THURSDAY, MARCH 2 | 1530 – 1630

RAPID FIRE

 

BC Centre for Disease Control Email and Text Guidelines for Communicating with Clients

In our connected age, it is increasingly time-effective and convenient to contact and communicate though text/email instead of more traditional methods, such as by phone/in person. At our BCCDC clinics, we have seen an increase in recent years in the demand for email/text communication, particularly with youth. Prior to our initiative, email/text communication with clients was used without clear operational guidelines for staff or leadership, presenting challenges in consistency, quality and privacy.

Responding to need, the BCCDC developed guidelines for the use of email/text to communicate with clients, supported though a grey literature review of existing documentation within the PHSA, materials form other health authorities and BC privacy legislation requirements. These guidelines were trialed and updated following a pilot study in the BCCDC’s Sexually Transmitted Infection Clinic. The following staff were involved in the development and implementation: STI clinic nurses, leadership, and resource nurse, the BCCDC Privacy Lead, and Quality Director. In October 2015 BCCDC proceeded with a pilot of the guidelines in the STI Clinic for four months.

Quantitative: 64% of clients accepted to receive negative test results by email, 70% of clients who accepted to receive negative test results by email contacted BCCDC to receive the results, 0 adverse events reported.

Qualitative: Client survey: 75% of respondents reported a positive experience, Staff survey (post-pilot): 85% of respondents reported they were interested in helping clients receive results by email/text.

The pilot helped identify practical issues involved in this type of communication such as, the importance of distinguishing between official results that display client identifiers and email/text results, that don’t include identifiers. The sustainability plan includes reviewing and updating the guidelines as necessary with implementation in other departments as needed.

Sara Camano
Director, Quality, Safety and Accreditation
Provincial Health Services Authority

Lauren Collins
Clinical Coordinator Resource Nurse, Clinical Prevention Services
BC Centre for Disease Control

Claran Aiken
Lead, Access, Privacy & Governance, Public Health Analytics
BC Centre for Disease Control

 

Understanding Perceptions and Use of Digital Health in Surrey’s South Asian Community

The South Asian (SA) community, one of the most rapidly increasing minority populations in Surrey, BC, faces socio-cultural barriers in using technology to manage their health. The SA community members are two to three times more likely to develop chronic diseases like cardiovascular diseases, diabetes and strokes along with issues of obesity than other ethnic groups in Canada especially seniors aged 65 year or more.

A community-based participatory research project, Health Education Action for Life (iHEAL) was initiated as part of Intercultural Online Health Network initiative at UBC. iHEAL aimed to better understand SA community’s access of reliable, language-appropriate, and culturally relevant health information using digital health tools.

A purposive sample of 197 Punjabi, Hindi, Urdu and Tamil speaking participants engaged in 24 focus group discussions in Surrey, BC from March 2015 to June 2016. The consent process and focus group discussions were facilitated in their native SA languages or English language according to their preference. Data were audio recorded, translated and transcribed in English.

Qualitative analysis software (NVivo-10) was used to develop codes and summarize themes from the data. Needs of the SA community regarding use of digital health tools were identified.

Initial recruitment of the Urdu and Tamil groups was more challenging than the Punjabi and Hindi groups. The Tamil group reported using more of digital health tools than the other three communities. Most of the participants expressed enthusiasm to learn use of digital health tools. Their preference was to be trained in a group format at familiar community locations. Language, age, gender and educational status were identified as important factors that need to be considered when developing digital health literacy among SA community.

Humaira Mohsin
Researcher, Digital Emergency Medicine
Department of Emergency Medicine, University of British Columbia

Kaitlin Atkinson
Researcher, Digital Emergency Medicine
Department of Emergency Medicine, University of British Columbia

Elizabeth Stacy
Research Coordinator, Digital Emergency Medicine
Department of Emergency Medicine, University of British Columbia

 

Using Automated Texting and Email to Engage Patients and Track Surgical Site Infections after Surgery

Read about this Quality Award-winning project.

Victor Leung
Medical Director, Infection Prevention and Control
Providence Health Care

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D5 Rethinking Acute Mental Health Care

THURSDAY, MARCH 2 | 1530 – 1630

RAPID FIRE

 

“That’s Not a Problem at Our Site”: Developing a Sexual Activity & Safety Policy

Although sexual activity between clients is often ignored or prohibited (Buckley & Robben, 2000), 88% of US psychiatric institutions surveyed reported problematic sexual activity (Buckley & Hyde, 1997), it is a major source of anxiety and stress for staff (Dobal & Torkelson, 2004) and can negatively affect patient outcomes (Kastner & Linden, 2014). Psychiatric facilities must have a clear policy on sexual activity to inform and protect clients and to ensure ethical and legal staff responses (Dein & Williams, 2008). We will present our process and challenges in developing a policy on client sexual activity at a tertiary concurrent disorders facility (stays up to nine months). Policy examples (informal and formal) were collected from the literature and local mental health facilities. Focus groups and surveys are currently being completed with clients and staff to assess key needs and barriers to implementation. With the exception of residential (long-term) facilities and one closed psychiatric facility there were no formal, written sexual activity policies at any local psychiatric facilities. In the greater literature, policy recommendations were specific to acute psychiatric units. Development of such a policy will help inform clients and provide clear expectations for behavior, facilitating informed decisions about their treatment. It will also help to ensure client safety in terms of provision of education to both clients and staff, and guidelines for reporting and responding to incidents. Given prevalence reported in the US, it is likely that staff and managers in BC also encounter the difficulty of how to respond regarding client sexual activity. However, few formal policies exist to provide guidance on how to respond to such behavior. This presentation will address ethical, legal and practical issues (based on literature and experience) relevant to the development of sexual activity policies for psychiatric settings.

Heather Fulton
Psychologist
Provincial Health Services Authority

Heather Baltz
Psychologist
Provincial Health Services Authority

 

Enhancing Patient Experience in Acute Mental Health with the Integrated Care Pathway

An Integrated Care Pathway (ICP) is a patient-centered and evidence-based framework which provides all members of the interdisciplinary team and other stakeholders with the expected trajectory for a patient throughout their care journey. In acute psychiatry, variances in delivered care have been reported to increase readmissions and Average Length of Stay (ALOS). The high demand for acute psychiatric care and the limited number of available beds demonstrates the need to attend to this alarming trend. Utilization of the ICP will facilitate the integration of evidence-based assessment, treatment and practices into inpatient care and expedite the collaboration between acute, community and other specialized mental health services. The first known ICP for mental health patients in British Columbia is being developed at St. Paul’s Hospital (SPH) with a focus on Early Psychosis (EP) care. Patients aged 17 to 25 years old who have experienced psychosis in the 5 years prior to admission will be eligible to join the EP-ICP. The process of developing the ICP involved a comprehensive retrospective chart review of 165 EP patients who since April 1, 2014 and March 31, 2016 received acute psychiatric care at SPH. Additionally, current state mapping of care delivery to identify gaps and variance in care was completed. Utilizing evidence-based literature, an interdisciplinary collaborative care team has developed the ICP for EP. The goals of the ICP are to reduce variance in care delivered to EP patients and improve patient experience and care outcomes. Despite financial and administrative challenges, the ICP for EP will go live on September 26th, 2016. As part of the EP ICP evaluation plan, surveys will be used to collect data on patient experiences and staff satisfaction. Other quality improvement metrics such as readmission rates and ALOS will be collected to further inform the development of the EP ICP and provide data on its efficacy.

Kofi Bonnie
Clinical Nurse Specialist
Providence Health Care

Brenda Vaughan
Providence Health Care

Jeffrey Danielson
Providence Health Care

 

Forensic Psychiatric Hospital Long Term Seclusion Pilot Project

Research shows that it is important to reduce use of seclusion whenever possible by using a variety of least restrictive techniques. Seclusion poses a high degree of risk to both patients and staff and has little to no proven therapeutic value. The Forensic Psychiatric Hospital (FPH) has a small group of patients who have been in seclusion long term, and re-integration plans have been unsuccessful thus far. The Seclusion Working Group (SWG) was tasked with developing and implementing clinical interventions with the goals of safely increasing time out of seclusion as well as improving activity tolerance and overall health for these patients.

The SWG is comprised of four recreation therapists, two occupational therapists and one physiotherapist, working with nursing staff and the treatment team. Initial interventions were conducted through the seclusion room door as the team developed therapeutic rapport with the patients. Sessions included ward-based leisure and recreation activities such as exercising, playing cards, and horticulture. As safe engagement increased, we introduced more activities of daily living skills, and, as privileges allowed, new off-unit environments.

A number of assessments were used for level of disability, ADL skills, leisure interests and competence, fitness, and occupational functioning. Adverse behaviours, such as self-neglect, physical aggression and sexual inappropriateness, were also measured. Initial results demonstrate increased time out of seclusion, increased physical health, endurance and posture, and increased social engagement.

The main challenge has been maintaining a consistent approach and managing differing priorities of the interdisciplinary team. Rehabilitation has to be a team effort and there has to be buy-in from all levels. Working with different patients taught the team to identify specific strategies for different patients. Positive risk taking is an essential component to this process.

Joey Fong
Occupational Therapist
BC Mental Health and Substance Use Services

Ibrahim Abubakar
Recreation TherapistBC Mental Health and Substance Use Services

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D6 Practice Safe Meds

THURSDAY, MARCH 2 | 1530 – 1630

RAPID FIRE

 

Canadian Deprescribing Network: Let My People Know!

The term “polypharmacy” refers to taking many drugs simultaneously. We know that too many seniors take multiple drugs often without clear knowledge of the reason or the benefits versus harms. This leads to adverse reactions, which increase the chances of ending up in hospital and, as well, can be the cause of a deteriorating quality of life. A family doctor, asked under what circumstance he would do a medication review, stated: “if the patient asked for it”. We will talk about some of the work we have done to inform and empower patients and the public to be aware of potential medication problems, to advocate respectfully but persistently for their elders and themselves, and to feel confident in requesting a medication review.

Presenters Janet Currie and Johanna Trimble are co-leads of Sub-Committee 1: Public Awareness, Engagement and Action of the Canadian Desprescribing Network. The network began 1 ½ years ago and brings together a growing number of health professionals and patient advocates who are concerned about patients, especially elders, who are on multiple drugs, often with multiple prescribers. Yet, nobody is really in charge of the list. Critical and ongoing reviews of these medication lists are few, far between, and in our experience as patient advocates, hard to get. How can we accomplish culture change in healthcare to invite open discussion about benefits and harms, decrease discomfort for patients about questioning their prescriptions, and raise public awareness about the frequency of adverse drug events — a major cause of harm in healthcare?

Johanna Trimble
Co-Lead, Public Awareness Subcommittee
Canadian Deprescribing Network

Janet Currie
Co-Lead, Public Awareness Subcommittee
Canadian Deprescribing Network

 

An Investigation into Factors that Contribute to Medication Administration Errors

Despite the introduction of safety measures such as the Pyxis medication system and best practice medication policies, medication administration errors continue to occur in the Fort St. John Hospital inpatient unit. An investigation into the causes of medication errors was initiated, with the goal of discovering how they might be prevented in the future. Nurses were interviewed with regard to their personal practices, and medication administration errors. The culture of the unit, the level of tolerance for at-risk behaviours, the level of support provided before and after the occurrence of an error, and issues that if resolved would improve medication safety were also identified. Furthermore, patient charts were reviewed to determine the variance between the procedures in practice and the intended hospital policy procedures. Causes of medication errors included a culture of a seemingly constant state of rush exacerbated by the frequent understaffed nature of the unit. This lead to the occurrence of at-risk behaviours such as minimally completing chart and medication administration record checks, and not signing for medications. A lack of leadership, accountability, and feedback on the unit was also a contributing factor, alongside a lack of nurse education, orientation, and experience. Transcription was also a large cause of medication errors. Possibilities for improving medication administration safety were identified and proposed as a result of the investigation. While factors such as short-staffing are inherent in the healthcare system and require funding to address, factors such as distractions and interruptions, messy handwriting, forgotten signatures, and lack of nurse education can be addressed through solutions such as computerized charting, visual reminders, in-services and orientations, and providing feedback. Each solution has benefits and challenges that would be faced upon implementation, and investigation into practical, efficient solutions is ongoing.

Naomi Smith
Student

 

Impact of Deprescribing Rounds on Outpatient Prescriptions: An Interventional Tool

Polypharmacy has become a growing concern and is associated with outcomes such as impaired cognition, falls, disability, and mortality. With the rise of polypharmacy, the role of “deprescribing” – an intentional effort to rebalance medication risk/benefit – is an emerging practice. Hospital pharmacists have observed prescribers are less inclined to stop home medications despite a pharmacist noting they may be potentially inappropriate, particularly if those drugs did not contribute to the admission. These medications are typically left for the outpatient physician to manage but a reluctance to stop medications untouched in hospital perpetuates polypharmacy. In an internal medicine clinical teaching unit (CTU) at a tertiary care hospital, pharmacist-led deprescribing rounds were implemented to assess the impact on the number of discontinued home medications and patient outcomes. Two CTU teams each consist of an internist, medical residents / students, and a clinical pharmacist. Each team cares on average for 15 complex patients daily to assess progress and optimize care. To determine the impact of pharmacist-led deprescribing rounds, one team set aside dedicated time during daily rounds to assess home medications. Changes to home medications were communicated to the patient and ambulatory healthcare providers via discharge documents. The other team had usual care. Discharge documents and patient interviews were used for data collection (patient demographics and changes made to home medications). Deprescribing rounds resulted in greater discontinuation of medications (58% vs 33%; p=0.001) and significant cost savings ($100/patient year) without impacting readmission rates or emergency department visits. The majority of physicians reported deprescribing rounds were beneficial and should be implemented as standard practice. We learned having a project champion within each profession involved really propelled the project forward.

Rachel Edey
Clinical Pharmacist
Island Health

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BREAKOUT E E1 E2E3E4E5 E6

Friday, March 3 ⋅ 0945 – 1045


E1  Welcoming our Transgender Populations into Care

FRIDAY, MARCH 3 | 0945 – 1045

There is a growing awareness of transgender populations throughout British Columbia. With this comes a recognition of the challenges in accessing care faced by many individuals who do not fit neatly within the gender binary of female and male. This interactive presentation will explore opportunities to truly welcome transgender clients into our services through addressing gender-based accessibility, safety and privacy.

Lorraine Grieves
Provincial Director, Trans Care BC
Provincial Health Services Authority

Gwen Haworth
Education Project Manager, Trans Care BC
Provincial Health Services Authority

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E2  Social Media 202: Sparking Engagement and Change

FRIDAY, MARCH 3 | 0945 – 1045

Previous Quality Forum sessions have provided overviews of various social media tools. Now let’s dive into how they can help take your work to the next level. We’ll start with how to identify the people you want to reach – from team members and patients to allies around the world. Next we’ll review the various social media tools that are available to you, how we’ve seen them used to improve quality of care, and how you can use them to engage people in change. Finally, we’ll discuss how to use your time on social media strategically and how to measure your efforts. This interactive session is open to social media users of all levels.

Michelle Cyca
Communications Specialist
BC Patient Safety & Quality Council

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E3  Responding to a Public Health Emergency: The Opioid Crisis in BC

FRIDAY, MARCH 3 | 0945 – 1045

In the last several years, the emergence of illicit fentanyl and other powerful opioids has given rise to a public health emergency in British Columbia. Many of you will be familiar with the staggering human costs of opioid misuse – but you may not know how your health system is responding to the challenge. This session will share the very latest provincial and regional developments in addressing the opioid epidemic and highlight some of the leading practices that will light the way through this public health crisis.

Presenter to be confirmed.

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E4 A Pathway to Healing: Enhanced Recovery After Surgery

FRIDAY, MARCH 3 | 0945 – 1045

RAPID FIRE

 

Impact of Adherence Levels to ERAS Protocol for Elective Colorectal Cases

Prior studies have shown adherence to an Enhanced Recovery After Surgery (ERAS) protocol is associated with improved outcomes. We studied the impact of the adherence level after implementing our ERAS protocol for elective colorectal surgery. (CRS).

A multidisciplinary team implemented an ERAS protocol at our centre in November 2013. The charts of 369 consecutive elective CRS performed since implementation to December 2015 were audited. Twelve ERAS process measures were assessed: pre-operative counselling, anesthesia consultation, carbohydrate loading, maintenance of normothermia, timely administration of antibiotics, multimodal analgesia, adequate PONV prophylaxis, goal-directed fluid therapy, mobilization on POD 0 & 1, introduction of fluids on POD 0 & solids on POD 1. American College of Surgeons National Surgery Quality Improvement Program defined post-operative 30 day complications, length of stay (LOS) were determined. The complication rate was compared between two cohorts, those that had a > 75% compliance and those that had 75% compliance to the ERAS protocol process measures. >75% adherence resulted in a significant decrease in LOS, mean 5.81 vs 8.46 days (p 48 hours 0.6% vs. 3.3%, re-intubation 0.0% vs 4.7%, Univariant logistic regression analysis demonstrated pre-operative counselling was an independent predictor of ” no complications” OR 2.18, 95% CI 1.058-4.496

Kelly Mayson
Director of Quality Assurance and Patient Safety, Department of Anesthesia and Perioperative Care
Vancouver Coastal Health

 

Involving Family Physicians in Preoperative Preparation for ERAS Colorectal Surgery

Enhanced Recovery after Surgery (ERAS) protocols improve care and decrease complications of surgery. Intrinsic to these care protocols should be preoperative optimization prior to hospitalization (Prehabilitation). This is not done in our institution as generally the patients are seen in preadmission clinics within 1 to 2 weeks of surgery. To achieve optimal medical ‘prehabilitation’ requires a minimum of 4 – 6 weeks. We have established a plan wherein gastroenterologists and/or surgeons identify the likelihood of surgery as early as possible – typically on identification of a possible surgical lesion at the time of colonoscopy – and inform the referring physician of the likelihood of surgery. These family doctors are asked to engage with patients in the optimization of four specific surgical risk factors: smoking cessation, anaemia management, enhancement of physical fitness, and assessment and management of nutritional deficiencies.

Smoking cessation, physical fitness, and nutrition/dietary advice and resources have been identified and collated. Anemia management has been facilitated with a diagnostic pathway tool and enhanced access to intravenous iron therapy for appropriate patients through the IV Therapy resources of RCH & ERH.

The ERAS team and the Fraser Northwest Divison of Family Practice have developed notification forms, ERAS pathway materials, and educational materials for the Family Doctors and the patients in addressing these risk factors. These resources are hosted on FNWDiv Pathways, the online resource site for physicians. We intend to review and report on the effectiveness of those tools.

Richard Merchant
Staff Anesthesiologist
Fraser Health

Brenda Poulton
Nurse Practitioner
Fraser Health

 

Patient Satisfaction Prior to Implementation of ERAS for Gynecology Oncology Surgery

Prior to the formal implementation of an Enhanced Recovery After Surgery (ERAS) program at Vancouver General Hospital, our multidisciplinary ERAS team wished to assess overall patient satisfaction with our existing “fast-track” care pathway for gynecology oncology surgery.

We contacted 35 eligible patients undergoing surgery between June-August 2016 up to three weeks post-discharge. A maximum of five attempts to contact each patient were made, and our response rate was 88.6%. Patients were asked to participate in a voluntary 10 question phone survey. Scores between 1-3 on a 7-point Likert scale were considered satisfactory. Additional comments were also recorded.

The majority of patient responses (93.6%) indicated a high level of satisfaction with their overall care. Satisfaction was particularly high regarding care from the anesthesia (96.8%) and surgical teams (100.0%). Patient dissatisfaction with their pain management increased comparatively upon discharge (9.7%) than when in hospital (3.2%). Additionally, 12.9% of patients were dissatisfied with their pre- and post-op education. Although 90.3% of patients felt comfortable asking questions prior to their surgery, many indicated an uncertainty in knowing which questions were pertinent at that stage. The predominant area of concern was an increased need to clarify discharge instructions and prescriptions.

We were encouraged that the majority of patients felt satisfied with their experience. Decreased satisfaction upon discharge, in addition to patient concerns surrounding discharge instructions, suggests that improving patient teaching and expectations should be a priority moving forward. We are developing a patient education booklet that will highlight common questions and concerns and address the use of analgesic agents and venous thromboembolic prophylaxis. We also suggest investigating avenues that permit patient inquiries to be efficiently directed to a member of their care team following discharge.

Jordan Lewis
Medical Student; BC Patient Safety & Quality Council Summer Student
Vancouver Coastal Health

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E5 The Golden Years: Exceptional Care for Seniors

FRIDAY, MARCH 3 | 0945 – 1045

RAPID FIRE

 

CARES: Delaying Frailty Through Stakeholder Engagement and Technology

CARES is a partnership between Fraser Health, the FH Divisions of Family Practice, CFHI, the University of Dalhousie in Nova Scotia and the University of Victoria in British Columbia. The CARES project is based on emerging research outcomes that demonstrate it is possible to prevent and/or significantly delay frailty by engaging primary care providers earlier in the assessment of the at risk pre-frail senior’ and then partnering the pre-frail senior with a Self-Management BC volunteer health coach for a period of up to 6 months to enhance their “natural protective factors” to frailty. It is based on the research of Canadians Dr. Ken Rockwood in Dalhousie, N.S. and Dr. Patrick McGowan in Victoria, B.C. Early results have been positive and show a statistically significant shift in the frailty scores of participating seniors.

CARES innovation comes not only from its call to improve geriatric care in the primary care setting and in the community by ensuring evidenced based assessment and coaching of pre-frail seniors, CARES also aims to advance the electronic sharing of information between health care providers and patient. It begins with the translation of the CCGA assessment form into primary care EMRs with the added ability to generate a frailty index for each patient. It is now working to enhance the potential of technology sharing by mapping the CCGA to the RAI assessments in communities, thereby allowing more efficient and effective sharing of patient information between health care providers. CARES is involved with scoping out the development of a Frailty Portal which will allow families, seniors and care givers to begin their frailty assessments earlier at home and to be able to share that information with primary care providers EMRs in the future. CARES looks to improve the quality of geriatric care for seniors in communities and through the support of innovation in technology.

Antonina (Annette) Garm
Director, CARES Project
Fraser Health

 

Measuring the Impact One Year In: Gateway to Home Convalescent Care Program

As part of a focused effort by Northern Health to improve capacity challenges in Prince George’s acute care setting, a 5-bed, community based convalescent care program was opened in the spring of 2015. The goal of the Gateway to Home (GTH) was to provide clients who no longer require acute care services with a short-term care environment for reactivation and recuperation prior to discharge home (Ministry of Health, HCC Policy Manual, Chapter 6, section A).

An implementation team oversaw the renovation of a Long Term Care wing and the operationalization of the program within a 3 month timeframe. The core philosophy of the program is to follow a “do with” rather than “do for” approach to care to empower clients, maintain function, and promote optimal independence for success at home. Focus was also put on developing strong interprofessional relationships with primary care homes and acute care providers and implementing a “pull” system rather than maintaining a waitlist.

One year into operation, results indicate that GTH has saved an estimated 1673 acute bed-days. This was achieved maintaining an expected length of stay (LOS) of 5 weeks and achieving 92% bed utilization. Further, 75% of individuals attending the program returned home in comparison to a similar program benchmark of 50%. A pairwise comparison between GTH participants and an acute care cohort did not result in a statistical significance for 28-day readmission rate (p = 0.07) and ALC designation (p = 0.16), however post participation surveys have indicated relative success at home. Additional qualitative results has identified environmental factors, interprofessional team aspects, home visits, and resident/family inclusion as key success factors.

Ongoing effort is being made to expand community integration components to build on current success. Consideration to future capacity is also being considered as 1st year results show an additional 35% unmet demand for services.

Gregory Marr
Manager, Residential Programs
Northern Health

 

Releasing Time to Care: The Acute Care for Elders Unit Experience

Research suggests higher direct nursing care hours are associated with lower rates of patient falls, pressure ulcers, patient complaints and mortality. Inefficiencies in unit and hospital design, organization, and technology divert valuable nursing time away from direct patient care. By addressing these inefficiencies, quality and safety in patient care can be significantly enhanced. Releasing Time to Care (RT2C) is a rigorously tested quality improvement program that was developed by National Health Services (NHS) in 2007 and since implemented across BC and Canada. It is based on Lean principles which involve simplifying processes, improving workflow and reducing waste. Over the last year point-of-care staff from Vancouver General Hospital Acute Care for Elders (ACE) Unit, led the implementation of RT2C program. Mixed methods were employed in assessing baseline information such as patient and staff satisfaction surveys, patient safety indicators and nursing time-task analysis. Data revealed that on average, ACE nurses spend 26% of 12hour shift towards direct patient care. Recommendations were integrated around RT2C four core objectives and ACE philosophy of care. Care staff, with patient and family’s engagement, successfully implemented various initiatives including daily staff huddles, streamlined handovers, labelling and designation of equipment, standardized utilization of patient whiteboards, geriatric-appropriate equipment and visiting policy. This presentation provides an overview of outcomes of RT2C one-year post-implementation. Initial results suggested improved patient and staff satisfaction, decreased falls and increased nursing time spent in direct patient care. As RT2C program is led by point-of-care staff, it has empowered the ACE team to influence the way they organize, tailor and deliver care to the specialized needs of geriatric population. It has also shaped the unit’s culture into one of continuous quality improvement where changes are sustained.

Haydee Mones
Registered Nurse, Patient Care Coordinator ACE Units
Vancouver Coastal Health

Lisa Kelly
Registered Nurse, Ward Leader for RT2C ACE Units
Vancouver Coastal Health

Stacy Johnson
Registered Nurse, Ward Leader for RT2C ACE Units
Vancouver Coastal Health

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E6 Care from a Distance

FRIDAY, MARCH 3 | 0945 – 1045

RAPID FIRE

 

Mobile Maternity: Taking Obstetrics to the Patient

The challenges in accessing health care for patients living rurally are compounded for pregnant mothers, especially those who are at high risk and need specialist care. Dr. Shiraz Moola is leading an obstetrics telehealth project aimed at mitigating the poor health outcomes associated with rural living. The project uses mobile devices (tablets and phones) to host telehealth consultations in any location throughout the region, including patient’s homes. Emerging evidence indicates physiologic morbidities and substantial cost for both mothers and newborns who need to travel significantly to access care. Further, rural family physicians and midwives have expressed the need for a more collaborative maternity-care infrastructure, whether or not they do planned local deliveries. Key to the pilot project for Dr. Moola is to have tripartite consultations inclusive of primary care providers and the patient for shared care planning and transfer of knowledge.This session offers the opportunity to share learnings from the data collected on the project and lessons learned such as:

• Success of videoconferencing as assessed by patients and providers;
• Savings to the patient and family;
• Does the model of care actually increase access for women?
• Primary care providers’ (family physicians and midwives) satisfaction levels with the service;
• Impact on specialist physician workload with the new model of care.

The team will present emerging data from the project and provide an opportunity for facilitated discussion on project goals and outcomes.

Mona Mattel
Project Manager, Mobile Maternity
Centre for Rural Health Research

Shiraz Moola
Physician
Obstetrics and Gynecology;

Co-Lead Mobile Maternity

Jude Kornelsen
Researcher, Centre for Rural Health Research
University of British Columbia;

Co-Lead Mobile Maternity

 

RACE — Lessons Learned to Assure Successful Spread… It’s Not Peanut Butter

Despite the best of intentions, promising innovations in health care delivery often remain isolated pockets of excellence. In fact fewer than 40 percent of health care improvement initiatives successfully transition from prototype to sustained implementation that spreads to more than one area.

RACE is an innovative model of shared care established in Vancouver in 2010 where family physicians can call one number, choose from a selection of specialty services and be connected directly to the specialist’s cell phone usually within a few minutes. Data demonstrates 80% of calls are answered within 10 minutes, 60% of calls avoid a face-to-face consult and 32% avoid an ED visit. Estimates of direct cost-avoidance suggest savings of up to $200 per call. RACE has logged over 25,000 calls and now encompasses 25 specialty areas. With demonstrated successful outcomes, this model has spread provincially and has gained national and international interest.

RACE began in one health authority and through extensive engagement, collaboration and partnerships, the model of care has spread provincially across British Columbia to all health authorities. More recently, Providence Health Care/Vancouver Coastal Health, the Canadian Foundation for Healthcare Improvement, the Shared Care Committee (a joint committee of the BC Ministry of Health and the Doctors of BC) and the Canadian College of Family Physicians have joined forces to collaborate on a national spread initiative of RACE.

Strategies for engagement, mitigating challenges and lessons learned for successful spread will be shared. The importance of organizational sponsorship, alignment with broader health care objectives, and leveraging strategic enablers will be discussed.

Margot Wilson
Director, Chronic Disease Management Strategy
Providence Health Care

Garey Mazowita
Family Medicine
Providence Health Care

 

TeleMS Virtual Consultations

More than 1800 patients living with Multiple Sclerosis (MS) live in Vancouver Island. The number of patients has doubled in the last ten years. The challenges associated with travel for MS patients are significant; including exacerbation of symptoms, financial burden, difficulty finding parking, mobilizing long distances and anxiety about the road conditions in winter. Patients report that after a trip to see their neurologist, they were presenting clinically worse by the time of their appointment, than their normal baseline as a result of the arduous travelling. Adherence to drug therapy diminishes the further the patient lives from the MS Clinic in Victoria.

Island Health embarked in a TeleMS virtual consultation program funded by Doctors of BC. A virtual satellite MS clinic opened in Parksville in December 2014, using Telehealth equipment and an MS Nurse Clinician to connect patients to their Neurologists, closer to their home communities.

Patient appointments with their neurologist takes place from the virtual clinic with the MS Nurse clinician who performs advanced practice Neuro exams. The Telehealth equipment enhances the Neurologists ability to see finer detail assessments and to share MRI images with the patients.

TeleMS virtual consultations have demonstrated important benefits and outcomes by increasing access to specialists for this population of patients. Patients get local neurological assessments, education, and a care plan created in a timely manner while avoiding exacerbation of the MS symptoms due to travel and financial burden. Island Health’s goals include creating programs based on patients’ identified needs and to assist patients in moving smoothly throughout the “health care system”. TeleMS positively contributes to those goals. In a patient own words: “Travel to Victoria is exhausting, up to 10 hrs. It is painful on joints ravaged by MS. Telehealth is a godsend.”

Margarita Loyola
Virtual Care, Telehealth Manager
Island Health

Amber Holden
Registered Nurse
Island Health

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BREAKOUT F F1 F2F3F4F5 F6

Friday, March 3 ⋅ 1115 – 1215


F1  Change the Way We Change: Harnessing Brain Power for Better Improvement Adoption

FRIDAY, MARCH 3 | 1115 – 1215

When Sarah embarked on a significant change in the Intensive Care Unit, she hadn’t heard of neuroscience applied to the way successful changes are made. While she followed her instincts and Quality Academy training, Ann was struck by how Sarah’s actions aligned with how our brains function, creating an environment where people could more easily adopt the changes. In this session Ann will highlight these key learnings from neuroscience and Sarah will link them to practical application in improvement work. Join them to discover ideas and tips that will help you with your own projects and future plans.

Ann Brown
Director, Learning and Organizational Change
Providence Health Care

Sarah Carriere
Lead, Patient Safety
Providence Health Care

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F2  Paying for Quality — Using Incentives to Improve Health Care?

FRIDAY, MARCH 3 | 1115 – 1215

There is ample evidence that health care providers respond to financial incentives. Are the current policies achieving what the health system needs to improve? Provinces use several approaches to pay for health services, including global budgets for hospitals and fee-for-service for specialty care. New policy efforts include paying for performance and value based purchasing. The different methods create incentives for certain behaviors and outcomes – some are predictable, while others have been unexpected. This session will discuss ways that governments have used incentives and funding policy in health care, where they have proved effective at improving quality, and some of the pitfalls that can result.

Jason Southerland
Associate Professor, Centre for Health Services and Policy Research
University of British Columbia, School of Population and Public Health; and
Scholar
Michael Smith Foundation for Health Research

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F3 Improving Care of Older Adults with Challenging Responsive Behaviours

FRIDAY, MARCH 3 | 1115 – 1215

This interactive case-based session will provide direct care providers with practical evidence-informed strategies to improve the quality of life and care older adults. The session will focus on the identification of challenging behaviour, the triggers, and the development of an interprofessional care plan that is proactive to enable care providers to prevent and/or decrease the impact of challenging responsive behaviours in the acute care setting.

Marcia Carr
Clinical Nurse Specialist
Fraser Health

Patricia Roy
Clinical Nurse Specialist
Fraser Health Frail Elder, Older Adult Network

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F4 Patients Paving the Path

FRIDAY, MARCH 3 | 1115 – 1215

RAPID FIRE

 

Rethinking “Patient Engagement” Evaluation: A Mixed Methods Approach

CFHI identifies proven innovations and accelerates their spread across Canada by supporting healthcare organizations to adapt, implement and measure improvements in patient care, population health and value-for-money. In 2014, CFHI launched Partnering with Patients and Families for Quality Improvement, a 16-month Collaborative that included patient and family advisors as core team members, partnering in designing, delivering and evaluating healthcare services on the 22 teams that formed the Collaborative.

The evaluation plan was structured around two hypotheses: 1) involving patients and families in identifying and designing improvements to care leads to different insights and better results; and 2) partnering with patients and families improves team effectiveness.

Survey results highlighted the commitment required of patients and family members to undertake improvement; a need for articulated and shared expectations of roles and participation; and a process to deal with disagreements. SNA identified differences between teams in network structure and interaction patterns, which impacted project outcomes. The interviews provided qualitative data on how participation in the Collaborative impacted organizational activities, culture and leadership and highlighted the importance of these in successfully engaging patient and families in QI.

The Collaborative was designed to test hypotheses and understand in quantitative and qualitative terms how engaging patients and family members in care design impacts quality improvement. It generated rich learnings about organizations’ readiness to engage with patients/families in care design, how care team members can be most effectively engaged and motivated to work collaboratively; and how data can facilitate momentum and act as an effective catalyst for improvement. The Collaborative also demonstrated that effective partnerships between patients, families, providers and administrators can achieve improved results.

Jessie Checkley
Senior Improvement Lead
Canadian Foundation for Healthcare Improvement

Maria Judd
Senior Director
Canadian Foundation for Healthcare Improvement

Kaye Phillips
Senior Director
Canadian Foundation for Healthcare Improvement

 

The Feasibility, Viability and Effectiveness of Peer Coaches

Persons with diabetes experience difficulty managing health and their condition on a daily basis and obtaining ongoing assistance from health professionals clinicians can be challenging. In a partnership between University of Victoria (U Vic) and 11 Diabetes Centres (DCs) in Fraser Health, a pilot was conducted to investigate the feasibility and effectiveness of peer coaching. U Vic recruited and trained 100 coaches who had type 2 diabetes and had taken a self-management program. Training included information on type 2 diabetes, behavioural change strategies, and navigating the healthcare system.

One hundred-fifty subjects with type 2 diabetes were recruited. A one-way repeated-measures analysis of variance was used with 14 measures (A1C, activation, empowerment, self-efficacy, self-reported health, fatigue, pain, depression, communication with physician, medication adherence, health literacy, emergency department visits and nights in hospital in previous six months) obtained at baseline, and at 6 and 12 months. Grounded theory qualitative research methods were used to gather perspectives and opinions from subjects, coaches, diabetes educators and members of a Community Advisory Committee.

The research found improvements in outcome measures and obtained valuable information on recruiting coaches and participants, training coaches, pairing coaches with participants, length and intensity of the intervention, liaising with diabetes health professionals and monitoring and supporting coaching integrity.
The pilot demonstrated that peer coaching is a viable and effective public health intervention and has a role in the spectrum of ongoing diabetes care. The lessons from the pilot also provided valuable information for the spread of peer coaching for other chronic health conditions.

Patrick McGowan
Professor
University of Victoria

Frances Hensen
Regional Clinical Nurse Specialist, Primary Health Care
Fraser Health

Sherry Lynch
Research Associate
University of Victoria

 

Stroke Services BC Stroke Rehabilitation Collaborative – The Journey of a Hero

Stroke rehabilitation occurs across a variety of settings, over variable periods of time, and involves a variety of team members. Each stroke is unique to the patient; therefore our system must deliver consistent to care that involves the patient in their own recovery. Prior evaluations indicated high variability in the best practice rehabilitation care available across BC. The SSBC Stroke Rehabilitation Collaborative aimed to transform stroke recovery through an integrated approach to best practice care and patient, care partner, and support network involvement.

An IHI– style Collaborative facilitated this transformation. 17 teams from across all five geographic health authorities participated in the year-long quality improvement initiative. The planning committee created a detailed framework to focus our improvement efforts in three key areas – engaging patients in their recovery, delivering best practice care, and optimizing the system. Teams prioritized their local activities within this framework and completed PDSA cycles to implement rapid change.

Teams completed periodic surveys for each area of improvement. Results show statistically significant improvements in behaviour for almost all elements of the patient directed goal-setting framework. Significant changes were also seen in the best practices survey notably in the management of post-stroke depression, spasticity, shoulder pain, and communication. Optimizing the system was measured non-traditionally through a series of exercises where each team mapped the current system of care and created consensus on consistent principles for both identification of patients, and access to rehabilitation in the most appropriate setting.

The biggest positive influence throughout the Collaborative was our inclusion of patient partners as planning group members, panel or plenary speakers, and team members. The patient perspective shaped the conversation and guided our focus on the most important elements of implementation.

Katie White
Manager, Stroke Services BC
Provincial Health Services Authority

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F5 Improving Care for Indigenous Peoples through Cultural Humility

FRIDAY, MARCH 3 | 1115 – 1215

RAPID FIRE

 

Policy Statement on Cultural Safety and Humility

First Nations people have a right to access a health care system that is free of racism and discrimination and to feel safe when accessing health care. The First Nations Health Authority (FNHA) envisions a future where First Nations people have respectful and meaningful relationships with health care professionals. To support this vision, FNHA has developed a Cultural Safety and Humility Policy Statement. Its purpose is to build a common understanding of cultural safety for FNHA staff, communicate FNHA’s views with health partners, and provide recommended actions to embed cultural safety into the health system across multiple levels.

In keeping with First Nations teachings, the statement begins with a story about culture in conflict with care. Following this, it describes FNHA’s vision, how First Nations protocols and teachings relate to practices of cultural safety and humility and provides FNHA’s view on how health literacy, quality, and relationship-based care are related.

This policy statement will be released in early fall 2016. Potential impacts include a shared understanding of concepts and recommended actions across FNHA, First Nations, Ministry of Health and Health Authorities. This creates a platform to build innovative and culturally grounded initiatives, thereby improving access for First Nations to health services and ultimately improving health outcomes. It provides a foundation for the implementation of the Declaration of Commitment: Cultural Safety and Humility in Health Services for First Nations and Aboriginal People in BC that each health authority CEO and the Ministry of Health Deputy Minister signed in July 2015.

Everyone, whether a health care professional, staff, manager, leader, First Nations person or family member, can be a part of achieving the vision for a culturally safe health care system for First Nations in BC. The policy statement describes how all can be a part of this change.

Melanie Rivers
Senior Advisor, Strategic Policy
First Nations Health Authority

Katie Procter
Quality Care and Safety Manager
First Nations Health Authority

 

Increasing Indigenous Cultural Safety at Vancouver Coastal Health

The Truth and Reconciliation Commission calls upon all levels of government to provide cultural competency training for health professionals. The commission recognizes the value of Aboriginal healing practices and elders in clinical settings. In 2015, VCH’s senior executives endorsed the Aboriginal Cultural Competency Policy, which states that a key strategy to decrease health inequities for Aboriginal peoples is to provide culturally safe and responsive services using an organizational approach to enhance patient experiences strengthen partnerships and improve service delivery and outcomes. The VCH Aboriginal Health team has developed a multilevel strategic approach to facilitate knowledge exchange and increase cultural competency of acute staff through various training modalities paired with Aboriginal Health Team support. This approach will initially be implemented, tested and evaluated at one acute site. The approach will include a baseline assessment, the creation of communications tools and curriculum resources in collaboration with local Nations, development of elders in residence programming, development of cultural safety training curriculum, re-orientation of the VCH Aboriginal Patient Navigator role from patient support to cultural safety advisors, and the evaluation and planning for spread to other facilities. Project outputs include a cultural protocols manual created with First Nations knowledge keepers from the communities served, a discharge guide which can be used in any ward, an in-person cultural safety training curriculum, and self-directed learning resources. Processes will be developed for continued engagement with local communities and support systems for existing Aboriginal Health champions within the site. Expected outcomes of this study include: an increase in allies and culturally competent staff, and a reduction in the number of complaints and concerns expressed by Aboriginal patients.

Leslie Bonshor
Aboriginal Health Executive Advisor
Vancouver Coastal Health

 

Improving Quality through an Organizational Indigenous Cultural Safety Framework

Indigenous people are thriving as the fastest growing population in BC, yet continue to experience the greatest inequities in health and access to care. This is often because of the many barriers that interfere with quality of care Indigenous people receive, including interpersonal and structural racism and discrimination. There is a growing awareness of the need to improve cultural safety in health care, which increasingly has been recognized as an issue related to quality. BC initiatives such as the Transformative Change Accord and the Declaration of Commitment to Cultural Safety and Humility have created a policy window for advancing organizational policy and practice to foster Indigenous cultural safety and improve quality of care for Indigenous people.

Despite this increased recognition, organizations often lack insight as to how to address these structural inequities that impact quality of care for Indigenous people. A few frameworks aiming to increase cultural safety have been developed by health authorities in Canada, however, evaluative studies on the impacts or outcomes are lacking. In addition, structural transformation takes time and long term health outcomes can be difficult to measure. Recognizing the urgent need for improving Indigenous peoples’ health and access to quality care, the Provincial Health Services Authority is taking action to develop and implement an Indigenous Cultural Safety Framework, and to share lessons learned along the way.

This presentation will share lessons learned from the process of developing an Indigenous Cultural Safety Framework with Indigenous and non-Indigenous organizations and leaders. The presenters will draw on their experiences in an organizational context to identify existing challenges and opportunities for improving quality of care for Indigenous people in BC health organizations. The insights shared are intended to inform ongoing work on improving cultural safety in other organizational settings.

Alycia Frydkin
Policy and Research Analyst
Provincial Health Services Authority

Cheryl Ward
Interim Director, Indigenous Health;
Director, San’yas Indigenous Cultural Safety
Provincial Health Services Authority

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F6 Enhancing Care for Young Minds

FRIDAY, MARCH 3 | 1115 – 1215

RAPID FIRE

 

Patient-Centred Care: Addressing Complex Youth Mental Health Needs in Primary Health

Context and Relevance: Family physicians working at a community health center in downtown Vancouver expressed a need to better address complex mental health needs of the inner city youth population they serve. Specifically, ADHD within the context of substance use, Trauma Informed Practice, PTSD, resiliency based suicide prevention and Bipolar Disorder.
Intervention: A pilot learning collaborative addressing these issues was created and is currently in progress.

To constructively engage in quality improvement, participating physicians have been asked to continuously reflect on the ways they conduct clinical conversations through both a Trauma Informed Practice and resiliency based lens in order to produce a practice change.

Measurement: Qualitative evaluations were collected from participants and facilitators between each of the three learning sessions in the areas of tool value and impact, key learning and clinical applications. Feedback for improvement and sustainability ideas are also being included in the planning process of this pilot and will be shared.

Lessons Learned: Clinicians know what their needs are; being able to work outside established parameters actually led to the promotion of one of the Ministry of Health’s top priorities: Patient Centered Care. In Setting Priorities for the B.C. Health System, Patient- centered care is a foundational driver in the planning and implementation of all strategic actions in the health system, which is health care built around the patient, not the provider or the administrator.

We suggest that this collaborative process promotes the use of Trauma-Informed Practice in Primary Health Care settings, realizes aspects of patient-centered care, bridges the gap between theory and practice, and is in line with the IHI Triple Aim Initiative: improving patient experience of care, improving the health of the population, and reducing the per capita cost of health care.

Daniela Milea
Practice Support Coordinator
Practice Support Program, Vancouver Coastal Health

Kassandra Hamilton
Practice Support Coordinator
Practice Support Program, Vancouver Coastal Health

 

Risk Management in Adolescent Inpatient Psychiatry: An Interdisciplinary Approach

Children and youth in mental health treatment can experience elevated risk for harm to self or others. Rapid alterations in mental status or psychosocial circumstance can contribute to parallel changes in such risks. Inpatient mental health programs at BC Children’s Hospital have identified a need for improved interdisciplinary monitoring and decision making around risk for adverse outcomes, including harm to self, harm to others, elopement, and deterioration. By having more opportunity for collaborative interdisciplinary team discussions and documentation of risks as they change over time, we will be able to adjust management strategies, and communicate more effectively during transitions in care. This is expected to lead to reduced incidence of adverse outcomes.

A Risk Triage Tool developed by ProActive Resolutions has been adapted for multiple risks in the inpatient care context. This adaptation has been initiated by a quality improvement team consisting of psychiatry, nursing, and allied health professionals and is being piloted in adolescent inpatient psychiatry. A challenge identified by front-line staff is the risk of duplicating efforts and documentation. The testing phase of the process will be essential in developing an interdisciplinary process without redundancy. We plan to build a process and documentation tool to be used at regular points in each patient’s inpatient stay: intake, admission, rounds and discharge. Further, a team will revise the care plan at the request of any team member, or whenever a safety incident has occurred. Family members will be invited to provide information on risks and changes they are noticing as well. We will include consultation by patients and families in the evaluation and final design of the tool to ensure they feel that communication and planning for risks has been effective. Lessons learned in interdisciplinary collaboration for care planning for risk of adverse outcomes can be shared widely throughout healthcare.

Trudy Adam
Child and Adolescent Psychiatrist
BC Children’s Hospital

 

Vulnerable Youth: Pediatric Emergency Department, RICHER Program, Community Partnership

An intersectoral working group was formed following concerns raised by Emergency Department and Community Physicians regarding the ability to secure follow up and ensure a safe discharge for Vulnerable Youth.

The Vulnerable Youth Committee was formed and membership extended to include the Emergency Department, Division of Adolescent Health and Medicine, Mental Health Services and Social Work at BC Children’s Hospital, the Ministry for Child and Family Development, Vancouver Aboriginal Child and Family Services Society, Network of Inner City Community Services Society and other community agencies.

Confidential case reviews of youth known to the community agencies, who had presented frequently to the Emergency Department, were done to determine challenges, gaps in care and provided a framework for the Committee to work within. Inadequate communication was identified between community supports and the Emergency Department.

Baseline data from a community generated youth cohort demonstrated that community agencies were routinely identifying vulnerable youth who present frequently to the Emergency Department.
The SHARED (Situation, History, Assessment, Recommendation, Disposition) Script for Community-Emergency Department Communication was developed by the Committee. The format of the tool is based in SBARD (Situation, Background, Assessment, Recommendation, Decision) follows the sequence of the Physician Assessment and has 12 questions. The information is provided to the Emergency Department via a phone call, directly from the Community Worker to the Physician or Charge Nurse prior to the patient arriving. Community Agencies and Workers have a laminated card sized copy of the tool and questions to ensure all relevant information is shared effectively. Training sessions have been facilitated for Community Agencies regarding the use of this tool and an evaluative process established.

This initiative has been implemented recently and evaluative data is limited.

Caroline Chilvers
Quality, Safety and Accreditation Lead
Provincial Health Services Authority

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BREAKOUT GG1 G2G3G4G5 G6 G7 G8

Friday, March 3 ⋅ 1330 – 1430


G1  One Year Later: The Story of Partnering in Primary and Community Care Integration

FRIDAY, MARCH 3 | 1330 – 1430

A Primary Care Home is the place where people establish a long-term relationship with a primary care provider and interprofessional primary care team to receive seamless, coordinated, and longitudinal care. People are supported in managing their own health. In partnership with the Northern Divisions, Northern Health is on a multi-year journey to restructure its services to support Primary Care Homes through the creation of inter-professional primary care teams. These teams are embedded in a health community and health promotion and prevention is an integral part of the work. One year later, these presenters will describe the vision and realization of the idealized system of services, the experience to date and the lessons learned across a range of communities.

Co-Presented by Northern Health and the Northern Divisions of Family Practice

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G2  Finding and Building Digital Stories to Engage, Inspire and Drive Action

FRIDAY, MARCH 3 | 1330 – 1430

Stories move people. Since day one, humans have used them to connect, to relate, to persuade, to convince, to educate. You, too, can harness the power of story – and digital tools make it easier than ever to tell and distribute your messages. But what stories are most effective and how do you find those stories? Once you’ve found them, how do you shape them to best engage your audience, and how do you know which digital tool is best for the job? This interactive session will answer those questions by examining best practices and compelling narratives in health care and beyond.

Amanda Lee Smith
Principal
Coterie Creative Co.;

Director of Marketing
Pendo

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G3  Practical Optimism in Difficult Times

FRIDAY, MARCH 3 | 1330 – 1430

“Plus ca change, plus c’est la meme chose,” or so it seems to those of us who have endured over the years. Staying sane, surviving and then learning to thrive through these difficult times is a skill that we all should master. In this session David Galler will share some of the practical initiatives that have repeatedly fuelled and replenished his optimism throughout a long career in public service.

David Galler
Clinical Director
Ko Awatea

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G4 Demystifying Authentic Patient Engagement: Practical Tips & Tricks

FRIDAY, MARCH 3 | 1330 – 1430

Want to engage patients in your health care improvement work, but don’t know where or how to start? Come learn effective and practical strategies to incorporate authentic patient engagement in your work, including how you can prepare your team to collaborate with patient partners, meeting facilitation strategies to encourage patient contributions, and other valuable skills. Join us as we share some helpful tips and skills that will let you and your team maximize the benefits of working alongside patients.

Cathy Almost
Engagement Leader (Northwest), Patient & Public Engagement
BC Patient Safety & Quality Council

Jami Brown
Engagement Leader (Fraser Valley), Patient & Public Engagement
BC Patient Safety & Quality Council

Anthony Gagné
Engagement Leader (Northern Interior), Patient & Public Engagement
BC Patient Safety & Quality Council

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G5  Addressing Appropriateness: Exploring the “How to” Essentials for Implementation of a Choosing Wisely Initiative

FRIDAY, MARCH 3 | 1330 – 1430

Appropriate care is evidence-based and specific to the individual’s clinical needs – it is about avoiding underuse, overuse and misuse. Increasingly, health system professionals are turning to the growing Choosing Wisely campaign to effectively reduce the use of precious health care resources for treatments and diagnostics that don’t provide benefits to patients, can sometimes be harmful, and which can lead to the expensive downstream testing. This interactive session will explore the ways that we can address this dimension of quality, using several medical imaging interventions that have been shown to be successful as examples. Join us as we share some helpful tips and explore how you can shape them to best engage your audience.

Bruce Forster
Professor and Head, Department of Radiology
University of British Columbia;

Regional Medical Director, Medical Imaging
Vancouver Coastal Health;

Regional Department Head, Radiology/Diagnostic Imaging
Providence Health Care

Vivian Chan
Quality Assessment and Clinical Associate
Vancouver Coastal Health

Jeffrey Coleman
Professor, Department of Emergency Medicine
University of British Columbia;

Consulting Physician Advisor, Advanced Imaging Strategy
Ministry of Health

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G6  I Spy Something That’s… Infected!

FRIDAY, MARCH 3 | 1330 – 1430

RAPID FIRE

 

Developing a Dynamic, Integrated, Web-Based Surveillance System for Fraser Health

Surveillance of patients with antibiotic resistant organisms is critical to assess the burden of illness and to implement interventions to prevent healthcare-associated infections. To facilitate surveillance, Infection Prevention and Control (IPC) Practitioners manually enter required surveillance data into a database, which increases workload and decreases data quality. The IPC surveillance team aimed to increase efficiency by utilizing electronically-available information to develop a surveillance system that will provide accurate and timely data for mandatory reporting and for action. Practitioners gain valuable time to engage with stakeholders and pursue initiatives to uphold quality and patient safety.

The surveillance system centralizes pertinent data from 12 acute care facilities. The system retrieves both Methicillin Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococci (VRE) lab results and integrates admission and location details and clinical indicators, which are visible in a dashboard in real-time. This eliminates the need to run manual reports and scan pages for positive lab results and related information. The integrated system utilizes business rules to assess the data and determine the epidemiologic source in alignment with the MRSA/VRE surveillance protocol.

The project time frame is 16 months, including planning, design, requirements gathering, framework set-up and development (first 9 months). The remaining time is for enhanced development, creation of resource materials, user testing, training sessions, data conversion and system launch by November 2016. Ongoing evaluation covers system usability, training and ongoing support to ensure sustainability.

The greatest challenge was balancing the needs of surveillance, case management, and technical requirements.  Working with end-users early on contributed to the success of the system development. Next steps; report creation and integration of other organisms of interest.

Louis Wong
Epidemiologist, Infection Prevention and Control
Fraser Health

Vladlena Abed
Infection Prevention & Control Practitioner
Fraser Health

 

Patient-Centred, Island Wide: Microbiology Innovation Enables Real-time Intervention

CONTEXT: In 2014, Island Health implemented BD Kiestra™ Total Laboratory Automation (TLA) in the Department of Microbiology Laboratory Medicine. Measurable goals for the project include improvements in sample processing standardization and accelerated turnaround time (TAT) for results. These key performance indicators impact the patient experience and antimicrobial stewardship. PROBLEM: Consolidation of lab services, decreasing recruitment of technologists, variable standardization secondary to human factors and long TAT were driving factors for adopting centralized automation. Traditionally, microbiology results confirmed medical practice rather than providing a trigger for meaningful interventions such as starting, discontinuing, or altering antibiotics.

INTERVENTION: Many test results are received by physicians after antimicrobial treatment has begun and are often ignored if patients are improving despite contrary diagnostic information. Introduction of BD Kiestra™ TLA and lean laboratory workflow changes is enabling availability of faster results. Antimicrobial pharmacists, hospitalists and the infection control team have adjusted practice to actively anticipate results through electronic notification. Results prompt modification of treatment, including cessation of unnecessary antibiotics. Adverse events expected to be impacted include antibiotic associated diarrhea, Clostridium difficile infection, and delay in isolation for antibiotic resistant organisms.

MEASUREMENT: Measurable outcomes include test TAT, sample handling errors, time to appropriate antimicrobial therapy, and number of adverse events.

RELEVANCE: Innovation in lab practice can be achieved through the adoption of technology and workflow optimization. Improved standardization and decreased TAT for results bring together interdisciplinary team members across care delivery areas. Adoption of the BD Kiestra™ TLA system provided the catalyst for improvement in microbiology quality in Island Health.

Pamela Kibsey
Division Director, Microbiology
Island Health

Catriona Gano
Director, Department of Laboratory Medicine
Island Health

 

Improving Post-Discharge Surveillance of Surgical Site Infection Following Caesarean

BC Women’s Hospital (BCWH) handles over 7000 deliveries annually, approximately 30% of which are caesarean sections (CS). Women undergoing CS have a 5-20 times greater risk of surgical site infection (SSI) compared with vaginal deliveries. Prior to this initiative, surveillance of SSI rates at BCWH was based on SSI occurring before hospital discharge and patients that are readmitted; this did not account for infections occurring post-discharge, which are diagnosed and treated in the community. The pilot project for this surveillance initiative showed an increase in SSI rates from 0.5% to 6%. Given this large discrepancy and rising CS rates, a clear need exists for improved surveillance and follow-up.

The quality improvement initiative was launched in April 2016 to monitor rates of CS SSI using patient surveys and provider follow-up. Patients are sent an online survey 30 days post-delivery to assess if they had any symptoms of SSI. Patient’s providers are contacted by fax for any women reporting symptoms of SSI to confirm any diagnoses.

The survey is a highly successful method of surveillance in our project, with only 9% of women declining to be followed up, and survey completion rates of 78% within 4 weeks. 49% of women completing the survey report one or more symptoms of SSI. Completion of the provider follow-up form is also high, with 76% of providers completing the form within 4 weeks. To date, providers have confirmed SSI in 5% of women; an additional 2% of women have reported SSI but these have not been confirmed by providers.

The initiative’s main challenge is ensuring that all women who have undergone CS are approached to request email addresses for follow-up. We are working on both increasing the number of women being approached prior to hospital discharge, and following-up with providers of women who were not approached.

Emma Branch
Research Assistant
BC Women’s Hospital + Health Centre

Julianne van Schalkwyk
PhysicianBC Women’s Hospital + Health Centre

Melissa Glen
Nurse Practitioner
BC Women’s Hospital + Health Centre

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G7 A Compassionate Goodbye

FRIDAY, MARCH 3 | 1330 – 1430

RAPID FIRE

 

Living Well, Dying Well: Active Decision Making

Context and Relevance: North Okanagan Hospice Society identified the need for community education and awareness about palliative care for individuals living with a life-limiting illness and their family caregivers (FCG). It is not uncommon for people to access necessary palliative resources very late in their illness and often long after the resources are needed. This is due to a lack of awareness of resources, late referral to palliative care, reluctance to access services, and varying availability of resources depending on where they live. FCGs are dedicated and committed; however they struggle with being unprepared and inadequately supported. They have difficulty identifying caregiving decisions they must make or how to go about making those decisions. Interventions that support this vulnerable population are needed.

Intervention: An interactive workshop designed to support an upstream palliative approach to care was developed. The target audience was FCGs although anyone from the public could attend. The workshop introduced the concept of a palliative approach to care, a guide that supports active decision making for caregivers for someone with life-limiting illness, and introduction to available local resources. The workshop was held in urban and rural locations.

Measurement: Evaluation of the project measured FCGs’ knowledge of caregiving issues and options; awareness of both desired and available local resources prior to and after the workshops. Preliminary evaluation indicated the workshop to be valuable and informative. The guide, along with an understanding of available resources, was a useful planning tool for caregiving.
Lessons Learned: FCGs proved to be elusive and difficult to find but we did find them. There were differences between the expectations of urban and rural participants. A partnership with UBC Okanagan and Interior Health, and administrative and volunteer support was essential for success of the project.

Loriane Topf
Learning and Effectiveness Leader
North Okanagan Hospice Society

 

Improving Access to Quality Palliative Care for Homeless People in Victoria, BC

The life expectancy of homeless people in BC (40-49 years) is half that of the general population. Homeless people and those experiencing structural vulnerabilities (e.g., poverty, racism, stigma around mental health issues, and criminalization of substance use) are being diagnosed too late, when treatment is not available or less effective. They are not being identified as in need of palliative services and often die in places where they do not receive adequate care — on the street, in shelters, and in acute care. Service providers and caregivers of structurally vulnerable individuals experience distress as they try to help people who are dying too young, without adequate care or support. The UVic Institute on Aging & Lifelong Health, UVic Nursing, and the Palliative Outreach Resource Team (PORT) have been engaged in research since 2014 in Victoria, BC to understand barriers to palliative care for this population, and to create recommendations for policies and practices to improve access and quality of care. To conduct our research, we observe and interview homeless and unstably housed people at end-of-life, interview their support people (e.g., street family) and service providers, and key decision makers. Our study also looks at promising models and practices of end-of-life care for homeless people in North America that can be applied in the local context. PORT is a group of service providers who work to improve quality and access to palliative and bereavement services for dying homeless people in Victoria, BC. They work to bridge, coordinate, and strategize access to services that homeless people need and deserve. While barriers to palliative care are complex, we will propose and solicit feedback on a model to improve access to quality palliative care for people who experience structural vulnerabilities in Victoria based on existing literature, promising practice models, and preliminary research findings.

Kellie Stajduhar
Professor
University of Victoria

Kristen Kvakic
Palliative Outreach Resource Team
AIDS Vancouver Island

Ashley Mollison
Project Coordinator, Equitable Access to Care
University of Victoria

 

ICU Wishing Well: Helping Patients and Families Create Meaning at the End of Life

The Wishing Well Project is a multi-disciplinary, palliative care initiative aimed at helping patients and families create meaning during the dying process. The intensive care unit (ICU) at Vancouver General Hospital (VGH) provides end-of-life care for approximately 140 – 150 patients per year. In this busy, high-technology setting end-of-life care can become de-personalized for patients, families, and care providers. Inspired by a similar project in Hamilton, Ontario, this project was initiated in response to a perceived opportunity to humanize death, increase meaning, provide personalized support, reduce grieving, and increase staff engagement.

Since April 2016, the team has worked with more than 20 patients and families and new requests come in regularly. The team itself has grown to be a truly multidisciplinary group who have all made a commitment to help out with whatever needs arise.

In our initial experience, patients’ and families’ wishes are remarkably diverse. Wishes have included: bringing a beloved pet in to the bedside, having a toast to the patient prior to or just after removal of life support, special music, holding a last birthday party with a loved one, obtaining a religious item, getting food for visiting family, manicures and pedicures, organizing a small wedding ceremony at the bedside.

The response to this project has been immediate and heartfelt. Family members have expressed a great deal of appreciation and gratitude for the efforts made on behalf of their loved one. Wishing Well members and care providers have found that working together to elicit and implement wishes increases inter-disciplinary collaboration, encourages positive feelings about care and, for some, has given the chance to re-connect with the humanistic impulses that led them to choose a career in the health professions. Current challenges include team communication and planning for sustainability.

Allana LeBlanc
Clinical Nurse Specialist, Intensive Care Unit and High Acuity
Vancouver Coastal Health

Julie Lockington
Staff Nurse, Intensive Care Unit and Emergency Department
Vancouver Coastal Health

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G8  Engaging Students in High Quality Care

FRIDAY, MARCH 3 | 1330 – 1430

RAPID FIRE

 

Engaging Students in a Quality Improvement Movement

In September 2016, medical students at the University of British Columbia Okanagan began working to establish a Chapter of the Institute of Health Improvement (IHI) Open School. The Chapter aims to bring together an interdisciplinary group of students to develop knowledge and skills in patient safety, quality improvement (QI) methodology, person and family-centered care, leadership, and resource allocation. We are joining a national and international movement in the areas of quality improvement and high value care.

Our IHI Chapter has created a strong partnership with Interior Health in British Columbia to create development opportunities and projects for members to take part in. Through their involvement in QI and Lean initiatives, members will become student leaders, gaining practical knowledge and transferable skills from the collegial and experiential exposure, and furthermore, will be able to implement these skills in important and immediate ways.

In addition, this Chapter will help engage a greater number of physicians in QI by planting essential seeds within the healthcare community to grow coalitions, build meaningful collaborations, and establish lasting partnerships. While the initiative is predominantly student-led at this time, the partnership with Interior Health will provide a unique opportunity for engagement among physicians and other health professionals in an innovative environment that is characterized by mentorship, mutual learning, and sustained improvement in our health system. This is a long-term strategy on a path toward meaningful change.

Future directions for the Chapter include recruiting like-minded students, faculty, and professionals. We aim to develop an IHI community that can help individuals share ideas, best practices, feedback, and outcomes. By supporting an interdisciplinary membership, the UBCO IHI Chapter aims to create momentum for these future change agents to excel at QI and significantly advance patient safety.

Sarah Fraser
Student
University of British Columbia, Southern Medical Program

James Chan
Manager, Quality & Patient Safety and Accreditation
Interior Health

Brandon Evtushevski
Student
University of British Columbia, Southern Medical Program

 

Innovative Student-Led Clinic Tackles Waitlist for Rural Rehabilitation Services

Northwest BC includes rural and remote communities with a high prevalence of chronic diseases. Chronic diseases are best managed by a team-based care approach; however, a lack of health care resources in this region results in long waitlists for rehabilitation for people with chronic disease. The rehabilitation department of this regional hospital developed an innovative model to address these issues and improve quality of care.

The aim of this project was to improve timely access to rehabilitation services without increasing the burden on existing services. A partnership between UBC, UNBC and Northern Health was formed to support the interprofessional student-led model to provide team-based care and opportunities for rural training. With a primary health care approach, we consulted with stakeholders to develop a new referral form recognizing risk factors and allowing for broader referral sources. To evaluate the impact of the model, we tracked referrals, wait times, service delivery, patient outcome measures and satisfaction, with a focus on individuals with chronic disease.

Since opening in November 2013, Occupational Therapy and Physical Therapy students have seen 392 patients from 476 referrals. Referrals were from a range of general practitioners, specialists, interprofessional health care providers, and from individuals themselves.  Wait times for people with chronic disease (from referral to first appointment) decreased substantially from before the clinic was established (> 200 days) to present (< 25 days).

Our evaluation has improved our responsiveness to community needs and opportunities for improvement. One area highlighted for improving quality is linking patients to other services in the community. This initiative demonstrates new ways to improve care and training when health authorities and academic partners work together. We hope that this model could be used in other regions to increase timely access to care and rural interprofessional training.

Jessica Inskip
Postdoctoral Fellow
University of British Columbia

 

I-CAN Project


Maura MacPhee

Professor and Associate Director, Undergraduate Program
University of British Columbia, School of Nursing

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