The Ontario Senior Friendly Hospital Strategy:

Transcription

1 The Ontario Senior Friendly Hospital Strategy: Overview and Implementa0on of Indicators to Monitor Hospital- acquired Delirium and Func0onal Decline 33 rd Annual Scien:fic Mee:ng of the Canadian Geriatrics Society Senior Friendly Hospitals Workshop, April Ken Wong Regional Geriatric Program of Toronto

2 Context Major Components of Ontario Health Care Spending Older Adults in Ontario 14.6% of popula:on 20% of emergency dept visits 40.4% of all hospitaliza:ons 58.8% of hospital days (Ontario MOHLTC 2012) Community Care $2.66B (6%) Long Term Care $3.44B (7.7%) Prescrip:ons $3.45B (7.7%) Other $7.76B (17.3%) Hospitals $15.53B (35%) Doctors and other Prac::oners $11.91B (27%) Source: Ontario MOHLTC and MHP 2

3 RGP Senior Friendly Hospital Framework Processes of Care Emo:onal & Behavioural Environment Ethics in Clinical Care & Research Organiza:onal Support Physical Environment What we do How Who Why Where 3

4 The Ontario Senior Friendly Hospital Strategy PHASE 1 PHASE 2 PHASE 3 - ONGOING Objec:ve Iden0fy current state Plan Hospital self- assessments LHIN- level roll- up Provincial roll- up Provincial Summary Report Objec:ve Close the gap Plan Implement hospital improvement plans Develop key enablers SFH Indicators Objec:ve Monitor and sustain hospital and system improvements Future State Prevent func0onal decline Improve pa0ent experience Enable hospital staff Improve equity SFH Promising Practices Toolkit 4

5 Provincial Summary of SFH Care a collabora:on of all LHINs (14) and Regional Geriatric Programs (6) in Ontario a snapshot of SFH care across 155 Ontario hospitals iden:fies promising prac:ces these helped inform recommenda:ons for SFH care iden:fies priority areas for ac:on 5

6 Organiza:onal Support Processes of Care Emo:onal & Behavioural Environment Ethics in Clinical Care & Research KEY FINDINGS: 39% strategic plan commitments 30% board commitment 31% hospital commiyee for care of elderly 55% geriatrics educa0on for staff RECOMMENDATIONS: 1. Establish board and/or strategic planning commitments for a Senior Friendly Hospital 2. Designate a hospital lead for SFH ini0a0ves 3. Train/empower clinical geriatrics champions 4. Develop human resources via seniors- focused skills development Physical Environment 6

7 Organiza:onal Support Processes of Care Emo:onal & Behavioural Environment Ethics in Clinical Care & Research Physical Environment KEY FINDINGS: Frequent protocols and monitoring for: falls pressure ulcers adverse drug reac0ons Infrequent protocols and monitoring for: sleep con0nence hydra0on/nutri0on responsive behaviours func0onal decline delirium RECOMMENDATIONS: 1. Implement inter- professional protocols across hospital to op0mize the physical, cogni0ve, and psychosocial func0on of older pa0ents 2. Support transi0ons in care by promo0ng inter- organiza0onal collabora0on 7

8 Organiza:onal Support Processes of Care Emo:onal & Behavioural Environment Ethics in Clinical Care & Research KEY FINDINGS: 28% age sensi0ve considera0ons in pa0ent sa0sfac0on/quality improvement strategies RECOMMENDATIONS: 1. Provide all staff clinical and non- clinical with seniors sensi0vity training to promote a senior friendly organiza0onal culture 2. Apply a senior- friendly lens to quality improvement (e.g. pa0ent- centred care and diversity prac0ces) Physical Environment 8

9 Organiza:onal Support Processes of Care Emo:onal & Behavioural Environment Ethics in Clinical Care & Research Physical Environment KEY FINDINGS: 83% clinical ethicists or ethics team available 78% policy/procedure for advance care direc0ves (most were limited in scope to DNR decisions) RECOMMENDATIONS: 1. Provide access to a clinical ethicist or ethics team to support staff, pa0ents, and families 2. Develop formal prac0ces/policies to ensure autonomy and capacity of pa0ents are observed 9

10 Organiza:onal Support Processes of Care Emo:onal & Behavioural Environment Ethics in Clinical Care & Research Physical Environment KEY FINDINGS: 34% use SFH resources in planning of physical environment (most con0nue to rely on building code and AODA guidelines) RECOMMENDATIONS: 1. U0lize SFH design resources in addi0on to accessibility guidelines to inform physical environment planning 2. Conduct regular audits of physical environment u0lizing SFH resources and clinical personnel and implement incremental environmental improvements 10

11 Three SFH Priori:es for Ac:on Func:onal Decline Implement interprofessional early mobiliza0on protocols across hospital departments to op0mize physical func0on Delirium Implement interprofessional delirium screening, preven0on, and management protocols across hospital departments to op0mize cogni0ve func0on Focus of Toolkit and Indicator Development Transi:ons In Care Implement prac0ces and developing partnerships that promote interorganiza0onal collabora0on with community and post- acute services 11

12 SFH Promising Prac:ces Toolkit Literature Review Shortlist of Clinical Tools/Resources - feasible in mul:ple hospital segngs - modest resource/training needs - encourages inter- professional care - enhances care for pa:ents 34 TOOLS/RESOURCES Ra:ng by Clinicians/Content Experts Across Ontario - 39 people par:cipated survey responses 19 TOOLS FOR INCLUSION IN TOOLKIT 12

13 SFH Promising Prac:ces Toolkit Visit the site at: 13

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15 I ndicator Development The SFH Indicators Report was approved by the TC LHIN in January

16 Delirium Indicators (All Hospital Sectors) PROCESS Rate of baseline delirium screening OUTCOME Rate of hospital- acquired delirium Data Source and/or Tool Exclusions Considera:ons Percentage of pa:ents (65 and older) receiving delirium screening using a validated tool upon admission to hospital Incidence of delirium in pa:ents (65 and older) acquired over the course of hospital admission Confusion Assessment Method (CAM), CAM- ICU, or Intensive Care Delirium Screening Checklist (ICDSC) Pa:ents with decreased level of consciousness (unresponsive or requiring vigorous s:mula:on for a response); pa:ents in pallia:ve care Minimum frequency of screening to capture incidence at least daily aner the ini:al baseline screen 16

17 Func:onal Decline Indicators (Acute Care Sector) PROCESS Rate of ADL func:on assessment at admission and discharge OUTCOME Rate of no decline in ADL func:on Data Source and/or Tool Exclusions Percentage of pa:ents (65 and older) receiving assessment of ADL func:on with a validated tool at both admission and discharge Percentage of pa:ents (65 and older) with no decline in ADL func:on from hospital admission to hospital discharge as measured by a validated tool Barthel Index Health Outcomes for Beoer Informa:on in Care (HOBIC) ADL Sec:on Alpha- FIM Tool Pa:ents in emergency department who are not admioed to hospital; pa:ents in pallia:ve care; pa:ents admioed for day surgery procedures; pa:ents with a length of stay <48 hours 17

18 N ext Step - Implementa:on F A sub- working group of the SFH Indicators group has designed an evalua:on phase for implementa:on. Components include: - data templates for the indicators - wriyen ac0on plans and progress reports - staff surveys (pre-, mid-, post- implementa0on) and interviews - monthly support and collabora0on teleconferences 41 hospitals across 9 LHINs will begin implementa:on of the delirium and/or func:onal decline indicators in April 2013 The evalua:on will determine feasibility, data quality, success/ challenges, and inform future use of the indicators in quality improvement or hospital accountability structures A provincial SFH Collabora:ve for ongoing knowledge exchange and peer support is proposed 18

19 Par:cipa:ng Hospitals South West Grey Bruce Health Services St Joseph's Health Care (London) St Thomas Elgin General Hospital Hamilton Niagara Haldimand Brant Brant Community Healthcare System Hamilton Health Sciences Joseph Brant Memorial Hospital Niagara Health System Norfolk General Hospital St Joseph's Healthcare (Hamilton) Toronto Central Baycrest Providence Healthcare St Michael's Toronto East General Hospital University Health Network Toronto Western Hospital University Health Network Toronto Rehab Central Markham Stouffville Hospital North York General Hospital Southlake Regional Health Centre Stevenson Memorial Hospital Central East Campbellford Memorial Hospital Lakeridge Health Northumberland Hills Hospital Peterborough Regional Health Centre Ross Memorial Hospital The Scarborough Hospital South East Brockville General Hospital Quinte Health Care Champlain Bruyere Con0nuing Care Deep River District Hospital Monhort Hospital The OYawa Hospital North East Blind River District Health Centre Espanola Hospital & Health Centre Health Sciences North Kirkland District Hospital St Joseph's General Hospital (Elliot Lake) Manitoulin Health Centre North Bay Regional Health Centre Sensenbrenner Hospital West Nipissing General Hospital West Parry Sound Health Centre North West St Joseph's Care Group (Thunder Bay) Summary of Implementa:on: Delirium 41 pa0ent care units Func0onal Decline 27 units 19

20 Appendix B of the 2013/14 Hospital Quality Improvement Plan Guidance Document, released November 2012, lists SFH indicators as op:ons for inclusion. It refers to: The Senior Friendly Hospital Framework Indicators to monitor Delirium and Func:onal Decline Accessible at: hyp:// qualityimprove/update.aspx 20

21 A cknowledgements TORONTO CENTRAL LHIN Camille Orridge Vania Sakelaris Janine Hopkins Teresa Mar0ns Rose Cook Stephanie Smit Sharon Navarro Nathan Frias Georgia Whitehead RGPs OF ONTARIO Dr Barbara Liu Dr David Ryan Marlene Awad Ken Wong Kelly Milne David Jewell Dr Sharon Marr Eleanor Plain Dr John Puxty Rosemary Brander Elizabeth McCarthy Kim Rossi LHIN REPORT AUTHORS Ken Wong Dr Barbara Liu Cal Martell Erin Finley Elizabeth McCarthy Dr Michael Borrie Kelly Milne Dr Stephanie Amos Cathy Sturdy- Smith Dr Amra Noor Dr Gagan Sarkaria Anne Pizzacalla Dr Sharon Marr Rosemary Brander Dr John Puxty Martha Auchinleck Kim Rossi ONTARIO SFH LHIN LEADS Alec Anderson Init Trivedi Nancy Lum- Wilson Brian Laundry Lisa Kitchen Aaron Gordon Perry Coma Chris0ne Gagne- Rodger Sabrina Mar0n Heather Willis Julie Girard Rebecca McKee Elizabeth Salvaterra Sandra Easson- Bruno Shirley Stewart Vania Sakelaris Teresa Mar0ns Nathan Frias 21

22 Provincial Working Groups SFH PROMISING PRACTICES TOOLKIT Dr Barbara Liu (Co- Chair), RGP of Toronto Dr Gary Naglie (Co- Chair), Baycrest Ken Wong, RGP of Toronto Dr John Puxty, RGP of South Eastern Ontario David Jewell, RGP Central Anne Stephens, Toronto Central CCAC Sharlene Kuzik, North West LHIN LineYe Perry, Stevenson Memorial Hospital Maria Boyes, Cambridge Memorial Hospital Susan Franchi, St. Joseph s Care Group (Th. Bay) Karyn Popovich, North York General Hospital Dr Monidipa Dasgupta, St Joseph s Health Care (London) Bruce Viella, North East LHIN Susan Bisaillon, Trillium Health Centre Emily Christoffersen, Hamilton Health Sciences SFH INDICATORS Dr Barbara Liu (Co- Chair), RGP of Toronto Rhonda Schwartz (Co- Chair) Baycrest Ken Wong, RGP of Toronto Ada Tsang, RGP of Toronto Michelle Rey, Health Quality Ontario Rebecca Comrie, Health Quality Ontario AnneYe Marcuzzi, Central LHIN Marilee Suter, Central East LHIN Brian Putman, North Simcoe Muskoka LHIN Minnie Ho, Ins0tute for Clinical Evalua0ve Sciences Dr Carrie McAiney, St Josephs Healthcare (Hamilton) Dr John Puxty, RGP of South Eastern Ontario Dana Chlemitsky, University Health Network Dr Sharon Marr, RGP Central Kim Kohlberger, Halton Healthcare Services Catherine CoYon, St Joseph's Health Centre (Toronto) Kelly Milne, RGP of Eastern Ontario 22

23 I ndicator Implementa:on Planning Group Dr Barbara Liu (co- chair) RGP of Toronto Carol Anderson (co- chair) Baycrest Ken Wong (study coordinator) RGP of Toronto Ada Tsang (study coordinator) RGP of Toronto Alisha Tharani Toronto Academic Health Sciences Network Elaine Murphy University Health Network Sherry Anderson Brockville General Hospital Charissa Levy GTA Rehab Network Kelly Milne RGP of Eastern Ontario Dr Stephanie Amos RGP of Eastern Ontario Nancy Lum Wilson Central LHIN Carol Edward Central LHIN Ryan Miller Orillia Soldiers Memorial Hospital Dr Monique Lloyd Registered Nurses Associa0on of Ontario Ella Ferris St Michael s Emily Christoffersen Hamilton Health Sciences Susan Franchi St Joseph s Care Group (Thunder Bay) 23

24 Vo:ng Members and Par:cipants 34 par:cipants with a spread of exper:se par:cipated in the Delphi panel and consensus mee:ngs: VOTING MEMBER ORGANIZATION Clinician: Front- Line Clinician: Expert/ Educator Health Care Research Data/ Decision Support Admin. Leader Area of Exper:se or Prac:ce WORKING GROUP MEMBERS: Dr Barbara Liu RGP of Toronto Rhonda Schwartz Baycrest Dana Chmelnitsky University Health Network Rebecca Comrie Health Quality Ontario Catherine Cooon St Joseph s Health Centre (Toronto) Minnie Ho ICES Kim Kohlberger Halton Healthcare Services Anneoe Marcuzzi Central LHIN Dr Sharon Marr RGP Central Dr Carrie McAiney St Joseph s Health Care (Hamilton) Kelly Milne RGP of Eastern Ontario Brian Putman NSM LHIN Dr John Puxty RGP of South Eastern Ontario Michelle Rey Health Quality Ontario LHIN Urban Semng Rural Semng Teach- ing Hospital Comm- unity Hospital Sabrina Mar:n South East LHIN Marilee Suter Central East LHIN Ken Wong RGP of Toronto Nathan Frias Toronto Central LHIN Acute Care Rehab Complex Cont. Care 24

25 Vo:ng Members and Par:cipants (con:nued) VOTING MEMBER ORGANIZATION Clinician: Front- Line Clinician: Expert/ Educator Health Care Research Data/ Decision Support Admin. Leader Area of Exper:se or Prac:ce ADDITIONAL VOTING PARTICIPANTS Elaine Murphy UHN Toronto Rehab Sherry Anderson Brockville General Hospital Shelby Poleg St. Joseph s Care Group Karen Truter Northumberland Hills Hospital Charissa Levy GTA Rehab Network Ryan Miller NSM LHIN North East Specialized Geriatric Dr Jo- Anne Clarke Services, Health Sciences North, Northern Ontario School of Medicine Elliot Lake Family Health Team/St. Dr James Chau Joseph s General Hospital Mary Wheelwright Headwaters Healthcare Centre Dr Arlene Bierman St. Michael s Hospital Dr Stephanie Amos Regional Geriatric Program of Eastern Ontario Josie Santos Registered Nurses Associa0on of Ontario (RNAO) Dr Kathy McGilton UHN Toronto Rehab Addi:onal Contributors: Gail Dobell (mee:ng moderator), Health Quality Ontario Dr Monique Lloyd, Registered Nurses Associa:on of Ontario (RNAO) Alisha Tharani, Toronto Academic Health Science Network (TAHSN) LHIN Urban Semng Rural Semng Teach- ing Hospital Comm- unity Hospital Acute Care Rehab Complex Cont. Care 25

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