Module 1: QBPs: New Ways To Improve Patient Care Quality Based Procedures (QBPs) Pathway Improvement Program
What are Quality Based Procedures (QBPs)? QBPs are groups of patients with similar diagnoses They are designed to provide consistent and standard care so patients receive the right care at the right time and place QBPs offer opportunities for health care providers to share best practices, improve patient quality of care, and reduce cost WRH is launching an innovative, creative and exciting new program to improve patient care as part of the QBP Pathway Improvement Program 2
What are Quality Based Procedures (QBPs)? There are over 20 conditions that are defined by the Ministry of Health as Quality Based Procedures (Patient Populations) WRH is focusing on the first 5 conditions this summer: Ischemic Stroke Congestive Heart Failure Hip Fracture Chronic Obstructive Pulmonary Disorder (COPD) Community Acquired Pneumonia More QBPs (conditions) will be added over time 3
QBPs are supported by research and best practices Literature reviews identify the benefits to patients by standardizing care practices: Standardizing and aligning clinical practices helps to provide high quality and efficient care Reduction in post-admission symptoms Reduction in re-admission rates Improved early mobilization and reduced mortality Reduction in acute length of stay by actively monitoring and reacting to discharge criteria 4
Including stakeholders in the work Cross functional teams have been working on developing the Pathway Improvement tools since January 2017 Teams have been engaging with: Patients and families (Focus groups, surveys and on-unit discussions) Over 40 patients involved Front Line Nurses Over 275 Nurses Consulted Physicians Attended sub-section meetings and involved Chiefs Teams have consulted with numerous stakeholders: Nurse Practitioners Unit Managers and Clinical Practice Managers Pharmacy, Allied Health, DI, Lab, Nurse Educators Community Partners (CCAC) 5
Learning from front line staff Using Lean methodology, the Order Set, Clinical Pathway, and Patient Experience Pathway were pilot tested with over 40 Ischemic Stroke patients Modifications were made based on feedback from physicians, staff, patients, and families Staff feedback helped to make the documents easier to use and helped to improve the communication and training material 6
The Pathway Improvement Bundle includes: Order Sets: Evidence-based orders that standardize diagnosis and treatment Clinical Pathways: A diagnosis specific guide to care, including interventions and outcomes that should be achieved along the patient journey towards discharge Discharge criteria are shared at care rounds and with the patient and family members Patient Experience Pathways: Encourages patients and families to be partners in the care plan Outlines the clinical pathway in patient friendly language Sets clear expectations regarding each day of the patient s stay 7
Pathway Improvement Bundle Order Set Clinical Pathway Patient Experience My Care Journey 8
What makes the QBP Bundle effective? For Patients: Patients can find communication difficult and are often scared to ask questions Patients are not always mentally or emotionally prepared for discharge Improved conversations will help them to understand today s goals and next steps as expectations of acute care are made clearer Discharge planning is incorporated throughout patient information and conversations with care team Criteria for discharge communicated consistently using In Room White Boards 9
What makes the QBP Bundle effective? For Staff: Clear guidelines, interventions, and outcomes for patients with conditions that may be unfamiliar to the nurse Part of the written Plan of Care for each day Used as a communication tool for the Multi-Disciplinary Team Sets clear focus for each day s goals Incorporates patients and family members into the care plan by setting expectations and encouraging partnership during the patient s hospital stay 10
What are the goals of the program? Improve the patient experience so patients: Receive care that is aligned with diagnosis and best practice Are informed and understand their care plan for each day Stay in hospital for the expected length of stay and are prepared and supported for discharge Reduce the readmission rates Create a standard process to guide care providers and help provide outstanding care 11
Comprehensive and Innovative Literature and benchmarking have shown other hospitals have pieces, but nothing as creative, innovative, and comprehensive The Patient Journey Order Sets Physicians Medical orders Clinical Pathways Care Teams Treatment and discharge planning Patient Experience Pathways Patient and family members 12
Changing practices at the bedside Shift To Shift Conversations with Patients and Families Care Rounds Collaboration with Physicians White Boards 13
Changing practices at the bedside Shift to Shift: Outcomes and discharge criteria are discussed to address barriers to progression towards discharge Care Rounds: Safe, efficient, and timely care by using Clinical Pathways Discharge Criteria In-Room White Boards: Clinical and Patient Pathways guide today s plan of care Conversations with Patients and Families: Pathways help to translate information into patient friendly language and to guide conversations and expectations starting on admission Collaboration with Physicians: Unmet discharge criteria is used to support discussions with the MRP 14
What s next? Module 2: Implementing QBPs On Your Unit will be delivered to you soon In that module, we will explain: How to use the Pathway improvement Program bundle Review Standard Work and changes Discuss common questions Provide additional resources 15