Recently, there was a mock trial of a new Emergency Measures Code - “Code OB.” This code is called when an Obstetrical Emergency requires specialty personnel to respond. The mock trial gave the team a chance to practice moving an obstetrical patient to a main operating room to access anaesthesia.
“The mock was very successful and highlighted gaps in the process. Final revisions are being implemented,” says Stephanie Pearsall, Director Maternal Newborn. “Thank you to all who willingly participated as we strongly believe this type of response will improve access to emergency obstetrical care in which every minute is critical.”
The fact that the Code OB is an important new initiative was quickly brought home when Stephanie received an email shortly after the exercise. It was from Maureen Lunshof who is a Ward Clerk in our Emergency Department.
“I feel compelled to share with you how excited I am that you are initiating this program,” wrote Maureen. “Many years ago while at another hospital I lost a baby girl due to a lack of timely care while suffering from a placental abruption. Thank you for putting this program in place Stephanie. It is sure to save the lives of many infants and decrease the number of mourning parents.”
|Lab Technologist Kristine Wellman inserts a sample into the GeneXpert machine.|
In June 2014, our lab introduced new technology for the rapid detection of C. difficile. Over the last few months this technology has been successfully used to quickly confirm the presence C. difficile bacteria in patients. Of equal importance, the test can also rapidly rule out C. difficile in patients with symptoms suggestive of C. difficile infection. Rapidly ruling out C. difficile means patients no longer have to be placed in isolation while waiting 1-2 days for results performed by conventional testing. In December 2014, the lab added testing for Methicillin Resistant Staph Aureus (MRSA) to the platform.
To date, performing these tests on the GeneXpert platform has resulted in the avoidance of 174 “isolation days”. Based on a Canadian study that determined the incremental cost of isolating a patient at $172.80 per day, the introduction of the GeneXpert system has resulted in avoided isolation costs of over $22,000. Rapid detection of C. diff and MRSA also has a positive impact on infection prevention and control and bed management.
The GeneXpert is capable of rapidly detecting other bacteria and viruses. Our lab is currently assessing the impact of adding additional tests such as Vancomycin Resistant Enterococci (VRE).
Welcoming back our new I.T. lead
Dale Maw recently joined Guelph General Hospital as Senior Director eHealth Solutions and Information Management. Prior to joining us, Dale was an Independent eHealth Consultant providing consulting services to the Centre for Family Medicine Family Health Team in Kitchener. In his current and past roles, Dale has developed strong partnerships with local health service provides and system leaders to develop and implement local eHealth solutions.
Some remember Dale from his time here at GGH as Manager Information Technology (1994 to 2002). After GGH, Dale went to the Niagara Health System as Regional Director Information and Communication Technology where he gained experience with leading the implementation and management of a multi-site IT solution. In 2009, Dale joined the Waterloo Wellington LHIN, and as eHealth Lead Dale built relationships and liaised with eHealth Ontario, Canada Health Infoway, MOHLTC and many health service providers both within our LHIN and other LHINs.
“I’m very happy to rejoin the GGH family. Even though I have been away for 12 years, many familiar faces have chatted me up about ‘back then’,” says Dale. “It feels very much like coming home, with a whole new bunch of family members. It’s obvious that the best of the culture from back then lives on to today. Thanks for the warm welcome.”
As our Senior Director eHealth and Information Management, Dale will use his experience to provide strategic leadership to the Information Management department as we work together with the Wellington Health Care Alliance (WHCA) in advancing an integrated IT service across our site and the three WHCA sites. Dale will also assist with developing relationships with our local and regional partners in a manner that supports the objective of the GGH/WHCA IT partnership:
- To improve patient experience and outcomes
- To enable our healthcare providers to deliver the highest quality care
- To optimize the use of IT solutions to gain the greatest efficiency and best use of our money
- To integrate key applications through joint planning and building capacity
- To become an IT leader in expanding the quality of care to our patients, hospitals and community partners
Improving Hip and Knee Replacement Wait Times at GGH
Using reliable data to support problem solving and innovation
Includes excepts from an article appearing in “Access to Care Executive Update, Cancer Care Ontario” Spring 2015
Used with permission
During 2012, the combined wait time for hip and knee replacement surgery at GGH began to rise. In order for our patients to receive hip or knee replacement surgery within clinical best practice timelines, GGH needed a fresh approach to Operating Room scheduling. What transpired was a multi-pronged, team-based effort to develop strategies which would address long wait time issues.
"We know that the quality of hip and knee replacement surgeries being performed at GGH has always been exemplary,” said Eileen Bain, Vice President of Patient Services and Chief Nursing Executive, also noting the revision rates in the Orthopaedic Quality Scorecard for GGH were less than half the provincial rate. “We needed to find a way for patients to spend less time waiting to have their surgery done.”
The measuring of wait times for getting a replacement hip or knee is consists of two parts. “Wait 1” is the time a patient spends waiting to be seen by a surgeon after a referral. “Wait 2” measures the time from decision-to-treat date to surgery date. Although surgeons were managing to see their patients shortly after receiving the referral form (Wait 1), a closer look at ways to decrease Wait 2 times was required.
The process began with examining Wait Time Information System (WTIS) data to ensure it reflected clinical practice. The data was then scrutinized for historical patterns of volume completion to inform future decision-making.
Senior administration then met with our orthopaedic surgeons to share the data findings, to better understand practice trends and to discuss potential solutions for reducing wait times. The Hospital identified an opportunity to schedule more cases early in the fiscal year to avoid seasonal bed pressures (such as influenza outbreaks) that occur typically during the fall and winter. This approach would also allow GGH to be responsive if additional volumes funded by the Waterloo Wellington Local Health Integration Network became available.
“In collaboration with surgeons, anesthetists, OR staff and GGH support staff, we were able to perform more hip and knee replacement procedures starting in January 2013,” said Joyce Rolph, Senior Director of Patient Services. “We then maximized our use of available beds and OR open time from April to August to improve access to these surgeries for our patients.”
|The graph clearly shows the intervention's dramatic impact. After two years of increasing wait times, the intervention managed to significantly reduce them to below the WWLHIN's target (click on chart to enlarge).|
The results were extraordinary. At the beginning in January 2013, our wait time was 348 days - more than twice as long as the Waterloo Wellington LHIN’s local target of 166 days. Since then our wait time has been reduced to 145 days and we've been able to sustain it (see graph). At the same time, wait times for other types of surgeries have not increased.
Communication and collaboration were instrumental in making this initiative successful. This work highlighted the important role clinicians play from the onset of any problem-solving process.
“We have a dedicated group of clinicians who are committed to providing their patients with the best care possible,” said Jenny Griffin, Clinical Director of Intraoperative Services. “There are many stakeholders involved in acting in the best interests of our patients’ health and well-being so it is important to consider different clinical and administrative perspectives in order to improve patient access to surgical procedures.”
For Dr. Ken McKenzie, an orthopaedic surgeon at GGH, having access to high quality data is important for decision-making. “Utilizing WTIS data has supported improved communication between my office and hospital staff to improve the prioritization of surgical cases, to monitor the number of days patients wait for hip and knee surgery and to support the allocation of OR time based on wait time results.”
With a focus on continual quality improvement, our team at GGH partnered with the Waterloo Wellington LHIN to participate in the first cohort of the “Improving & Driving Excellence Across Sectors” Advanced Training Program where our results were shared. The learning from this initiative helped to inform a subsequent quality improvement change idea that improved communication between primary care, orthopaedic surgeons and GGH around surgical service delivery and wait time information.
At the centre of all of GGH’s quality improvement efforts was reliable data that was used not only to identify challenges and opportunities, but also to inform innovative thinking.
In and around GGH
|Members of the Guelph Quilting Guild presented beautiful, handmade quilts to our Sexual Assault and Domestic Violence program for primarily giving to their paediatric clients. The quilts come with a sewn tag on the back that reads, "This quilt is has been made to bring comfort and warmth to someone special."||Chemotherapy patients had their spirits lifted thanks to the efforts of some students from King George Public School. Their teacher is the daughter of Holly Rietveld, RN, who works in Ambulatory Care. The students brought almost 100 cards such as the one above for handing out to patients.|
In what seems to becoming an annual tradition, dozens of new teddy bears for our paediatric patients were donated by through a special program of The Guelph Mercury.
This year, in addition to the bears, we received a gift of close to $10,000 in free advertising space in the Mercury to help us share some of the wonderful things that go on at GGH.
Breakfast With Santa wouldn't be the same without a visit from Old Saint Nick himself and Mrs. Claus. It's not sure what was the cause of the merriment with Bob Clayborne, Director Laboratory Services (above left, middle). Perhaps Santa was discussing whether or not Bob was on his naughty list.
Later, the Claus' helped out with the drawing of the door prize tickets. Apparently Mrs. Claus was quite thrilled with whomever had won the most recently drawn prize.
Thanks to Fran Hood and Mike Sharma whose secret identities are safe with us.
GGH was recognized with a Silver Award by the Ontario Hospital Association’s Quality Healthcare Workplace Award 2014. Accepting on behalf of GGH were (l-r) Jen Pranger, Alison Adamson, Gavin Webb, Marianne Walker and Jane Cabral.
Launched in 2010, the awards program recognizes organizational efforts to improve healthcare workplaces in ways that contribute to providers’ quality of work life and the quality of the care and services they deliver.
Our Food Services Department decided to support the Children’s Foundation of Guelph and Wellington with its Christmas drive for 800 families in need. One staff member suggested adopting a family after hearing about it on the radio at work. Everyone in the department was quick to agree and get out shopping.
The department sponsored a family of 7 including 5 children and 2 parents (kids' ages from 3 - 16). Information provided as to the names and ages of family members along with their needs and wishes list. As a group, they managed to get everything on both lists.
It was definitely a group effort and really brought the spirit of Christmas to the department. They are already talking about adopting again for next Christmas and hope other departments will consider doing the same.