Excellent Care for All Quality Improvement Plans (QIP): Progress Report for 2016/17 QIP

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1 Excellent Care for All Quality Improvement Plans (): Progress Report for The Progress Report is a tool that will help organizations make linkages between change ideas and improvement, and gain insight into how their change ideas might be refined in the future. Health Quality Ontario (HQO) will use the updated Progress Reports to share effective change initiatives, spread successful change ideas, and inform robust curriculum for future educational sessions. ID Measure/Indicator from 1 ED Wait times: 90th percentile ED length of stay for Admitted patients. ( Hours; ED patients; January December 2015; CCO iport Access) Change eas from Last Years ( ) Maximize our partnership with Health Links Coordinator. Increase potential for admission avoidance We are forecasting that we will meet our stated 16/17 target. One of our challenges in 16/17 was the reduction of ten beds previously utilized by local patients. Because we have seen a decrease in overall LOS on inpatient units, patients admitted from the Emergency Department are pulled up to the appropriate level of care in a shorter period of time. Our ongoing focus on culture change in the Emergency Department lends to higher quality of care, while patients wait for an appropriate inpatient bed. When developing the 17/18 targets and initiatives we need to be cognizant of the actual number of funded beds. We need to set realistic targets based on realistic bed numbers. intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Change idea was intended. Health Links partnership is working well. The navigator in ER starts the discharge planning in Emergency Dept. We will continue to work with Health Links Coordinator to sustain and improve this important community partnership. Lessons learned include creating a culture change to support discharge with appropriate follow up in the community. Implement standardized response for Quality improvement on a daily basis. Continue with PDSA to enhance quality 1

2 management of surge in the ED of care for the patients and flow through the organization. Improve physician initial assessment time Focus on buy in by physicians for pathway use and on physician documentation / coding. Realign acute medical, complex continuing care (CCC) and Rehab bed allocation to ensure that the right patient is in the right bed within the shortest period of time. Corporate Bed Siting and Sizing initiative "right bed, right time". Launch of the new inpatient unit in Q3 of 16/17. We will need to evaluate the new unit and model of care to determine the impact. Improve Geriatric Syndrome management through the use of a Geriatric Medical Directive Change idea intended. Unable to measure direct impact on this indicator. The Geriatric Medical Directive has specific goals for the prevention of delirium and will positively impact overall length of stay in this patient population. Use visual management tools to communicate expected date of discharge (EDD)to patients and families Work has been done support discharge readiness on the inpatient units which has resulted in discharging patients in a timely manner. This work was led by our Medical Director for Medicine. 2

3 ID Measure/Indicator from 2 Medication reconciliation at discharge: Total number of discharged patients for whom a Best Possible Medication Discharge Plan was created as a proportion the total number of patients discharged. ( Rate per total number of discharged patients; Discharged patients ; Most recent quarter available; Hospital collected data) Change eas from Last Years ( ) Increase the number of care units completing medication reconciliation at discharge intended? (Y/N button) The transition from a paper based process to an electronic process in 2016 has resulted in data collection and data quality issues. We anticipate that electronic reporting issues will be solved in 17/18. In 17/18 our focus will be on the elimination of the current "Form 2814" and move to fully electronic documentation. Having a pharmacy team that is invested in the importance of this process is required. Keeping the focus on medication reconciliation in spite of challenges with the transition to electronic documentation will enable future success. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? We have not been as successful as intended with this initiative. Our target was to increase the number of units that receive med. rec. on discharge from 3 to 7 by February 28,. We currently have 6 of 7 units on board. With a plan to move next to our surgical inpatient unit. Our challenge is to engage interdisciplinary staff to enter Best Possible Medication History in our electronic system (Cerner). 3

4 ID Measure/Indicator from 3 Percent of patients with new pressure ulcer (stage 2 or higher) on Soldiers 1, Soldiers 2, C5, ICU and Complex Continuing Care. This will be a cumulative quarterly point incidence rate using the measure of: total number of patients with new ulcers divided by the total number of patients reviewed in the quarterly incidence survey. This indicator is reported cumulatively on a quarterly basis. ( total number of patients with new ulcers divided by the total number of patients reviewed in the quarterly incidence survey.; Adult inpatient; Q4 15/16 to Q3 16/17; In-house survey) Change eas from Last Years ( ) Maintain intended? (Y/N button) We forecast that we will sustain performance within our target range of 3.5 to 4.6% by March 31,. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Process and Practice modifications were necessary to facilitate a transition to our electronic medical record (EMR) in Q We anticipated that identification of hospital acquired pressure ulcers would increase as a result of the EMR implementation but felt that the improvement efforts and performance gains of the last 2-3 years would allow us to maintain our current performance. We were successful in maintaining performance within our stated target range. We will continue to monitor our performance on this indicator in outside of our formal Quality Improvement Plan. 4

5 ID Measure/Indicator from 4 Risk-adjusted 30-day allcause readmission rate for patients with COPD (QBP cohort) ( Rate; COPD QBP Cohort; January 2014 December 2014; CIHI DAD) Change eas from Last Years ( ) Improve the discharge process for COPD patients Improve patient management and care transitions across the continuum through cross sectoral collaboration Meet care pathway LOS of 5.4 days for COPD patients on a COPD order set and care pathway We anticipate exceeding our target by March 31,. We have improved the acute LOS, unplanned readmissions and crude death rate in hospital. When we consider our /18 Quality Improvement Plan, we should keep in mind a strategy of focusing efforts on smaller number of initiatives to ensure sustainability and traction, rather than focusing on a large number of initiatives and losing focus. intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Change idea led to measurable improvement. Change idea led to measurable improvement. We have met with our community partners three times over this fiscal year. Holding regularly scheduled meetings with community partners was our most successful change idea. Meetings resulted in cross sectoral action plans with accountabilities and set timelines. Change idea led to measurable improvement. Compliance with appropriate use of COPD patient order sets has been sustained. Celebrate and Share: We were able to engage a family physician to educate front line staff around COPD diagnosis and treatment Recommend continue with the 16-/17 actions to sustain and improve compliance with COPD Patient Order Sets and Care Pathways. We have successfully engaged a primary care physician to educate front line staff regarding COPD diagnosis and treatment. 5

6 ID Measure/Indicator from 5 Total Margin (consolidated): % by which total corporate (consolidated)revenues exceed or fall short of total corporate (consolidated) expense, excluding the impact of facility amortization, in a given year. ( %; N/a; Q3 FY 2015/16 (cumulative from April 1, 2015 to December 31, 2015); OHRS, MOH) Change eas from Last Years ( ) Continued and regular monitoring of budget variance. Set a contingency for unexpected/unknown costs and volatility of HBAM funding Year end forecast -0.63% Total Margin intended? (Y/N button) Unplanned/ unforeseen changes in revenues are having a significant impact. These are primarily related to CCO revenues. Planned expenditure controls were generally implemented effectively however severance and hydro costs are higher than expected. Ongoing expenditure control is expected to improve the forecast by year end. Ongoing discussions with the NSM LHIN and the MOHLTC are in process to improve the year end bottom line. Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? 6

7 ID Measure/Indicator from 6 Total number of alternate level of care (ALC) days contributed by ALC patients within the specific reporting month/quarter using near-real time acute and post-acute ALC information and monthly bed census data ( Rate per 100 inpatient days; All inpatients; July 2015 September 2015; WTIS, CCO, BCS, MOHLTC) Change eas from Last Years ( ) Maximize the effectiveness of current OSMH weekly alternate level of care (ALC) Rounds Provide OSMH leadership in the development and support of ALC working group. This cross sectoral working group includes representation from NSM LHIN, CCAC, Health Links, long term care, primary care and other partners. Improve communication between health service providers. (Adoption of geriatric best practices Assess and Restore NSM LHIN network project) We anticipate that we will exceed our stated target. We would like to celebrate and share that through this initiative our length of stay for stroke patients have been positively impacted. Our patients have more timely access to the appropriate level of care. As well, Alternate Level of Care Working Group meetings have strengthened community partnerships and shifted culture to one of truly shared accountability. intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What was your experience with this indicator? What were your key learnings? Did the change ideas make an impact? What advice would you give to others? Change idea was intended and has led to measurable improvement. ALC Rounds will continue in 17/18. Change idea was intended and has led to measurable improvement. Regular community engagement through ALC steering committee and ALC Standardization Task Force Group will continue in 17/18 and is seen as key to sustaining progress made on this indicator. Change idea was intended and has led to measurable improvement. the pilot for Behavior Success Agent was very positive in moving our care planning and capacity planning forward with our staff. Recommend continuation of external funding of the Behavioral Success Agent at the LHIN level 7

8 Reduce ALC days by improving the transition process between the acute phase of stroke care and the rehab phase Realign acute medical, Complex Continuing Care (CCC) and rehab bed allocation to ensure that the right patient is in the right bed within the shortest period of time Meet care pathway average LOS of 7 days or less for all admitted ischemic stroke patients Phased development and implementation of a comprehensive OSMH corporate discharge and transition of care policy and guidelines Improve information sharing at transfer between acute care and long term care homes Change idea was intended. Change idea was intended. Change idea was intended. This initiative has had a positive impact on the length of stay for our stroke patients. Change idea was intended. Change idea was intended. We have experienced a demonstrated commitment from our long term care homes. One challenge is out of region boundaries. Will continue to participate in Orillia and Area Transition of Care Committee in 17/18. In 17/18 we will continue to developing messaging to support the Nurse Led Outreach Team (NLOT) for all of the admissions to long-term care. 8