Process changes lead to better outcomes and experiences for moms and babies on Quinte 7 The Quinte 7 Maternal/Child unit at Belleville General Hospital is working to improve the experience for moms going through C-section. One component of this has been to improve the booking process for repeat C-sections to ensure low-risk babies are being delivered after 39 weeks gestation. “Babies born by repeat C-section earlier than 39 weeks are more likely to spend time in the Special Care Nursery,” Lynne Allen and Peg Jacklin, Patient Care Leads (PCLs) on Quinte 7 have explained Dr. Melanie Chanda, Chief/ been instrumental in ensuring low-risk, repeat C-sections are being Medical Director of Obstetrics and booked during the ideal 39 week window. Gynaecology. “We want mom and baby to be able to have skin-to-skin contact right away and not be separated. From a patient satisfaction, clinical outcome and cost point of view, it’s best to wait until 39 weeks to deliver these babies.” Historically, that hasn’t always been easy. QHC process issues made it difficult for obstetrician offices to book Csections in that 39 week window. They often ended up being booked too early or not at all and the mother placed on a wait list for the C-section to be performed last-minute. “Recognizing the concerns around this, Quinte 7 worked with the OR booking office, Anaesthesia and obstetrician offices to fix the problem,” said Shelley Kay, Manager, Quinte 7. “We talked as a team to determine how we could regularly schedule these C-sections and very rarely have to cancel them.” Now, the C-sections are scheduled for early in the morning, Monday-Friday (with weekends as required). The Patient Care Leads (PCLs) on Quinte 7 keep the lines of communication open with obstetrician offices and ensure patients are being booked in that 39 week window. And the data shows their efforts are paying off. The average rate of repeat C-section moms having their babies delivered prior to 39 weeks has gone from 25+ per cent down to less than 11 per cent. And often, when a baby is delivered earlier than 39 weeks it’s for a medical reason, at the parents’ request, or scheduled just a day or two before 39 weeks. “Everyone wants what’s best for mom and baby,” said Shelley. “We just needed to figure out how to make the process work seamlessly.” “We now have moms saying that their more recent C-section experience was better than their last,” said Dr. Chanda. “It’s great to make changes that are benefiting our patients.”
Directors and managers put their Lean training to the test In keeping with our goal of continuous improvement across the organization, managers and directors took part in Lean training over the past year. A component of this training was forming small groups and tackling smaller-scale improvement initiatives. Some were easy fixes, some were a little more complex – all are contributing to a better QHC! Here is a quick summary of some of the projects.
Improving IS Helpdesk responsiveness and service Before: Any of the three helpdesk staff would answer phone, email or online tickets as available – there was no structured process for responding, no continuity of service, and a lack of communication with the customer. The majority of requests were not being entered into the system. There was a lack of metrics tracking what kind of tickets were coming in and how they were being addressed. Now: Implemented a daily ‘Dispatcher’ role to triage incoming issues and requests, and to enter all tickets into the system. This provides continuity and improved work flow, as well as metrics needed to inform additional improvement efforts (still to come). Wow! The team has reached a 100% compliance rate for entering tickets – up from 40%.
External Recruitment Process Before: QHC had an inefficient external recruitment process with many unnecessary delays. The time required for pre-screening candidates, setting up interviews and calling references led to delays in hiring. Now: HR instituted a new electronic recruitment platform that: eliminates paper copy resumes; allows candidates to answer pre -screening questions at time of application; and allows interviews to be scheduled easily online (candidates are given four time slot options and asked to pick one that fits their schedule). Reference checks have been eliminated unless it’s for a leadership role, or management requests the check. Wow! HR used to spend an average of 5.5 hours per day working through the recruitment processes. They now spend about 20 minutes per day!
Portering requests in the Emergency Department (ED) Before: In the BGH ED, porters were delayed 19% of the time (by an average of 16 minutes) because there was a lack of communication between the person ordering the portering request (UCC or DI) and the most responsible nurse. Patients were often not ready to leave ED because: they were still hooked up to a monitoring device, they didn’t have an arm band, or the nurse was drawing blood (top 3 reasons). Some of the staff involved in improving the portering request process Now: The UCC notifies the nurse that the in the ED. From left: Anne Krock, Hospitality Manager; Viviane portering request was sent. The nurse Meehan, Process Improvement Coordinator; Luke Callaghan, HSR; places the patient’s belongings in designated bag, ensures the patient has an Donna Ray, HSR; Joseph Mancuso, Director, Support Services; Joyce Hall, HSR; Andrew Pearce, Resource/Switchboard Team Leader. arm band, removes all leads and other items, attaches the patient to a portable tank as required, and notifies the family that the patient is about to go to the floor.
Wow! Already, the number of portering delays in the ED has been reduced by more than 20%. And now, when a porter is delayed, it’s for an average 6 minutes instead of 16!
Multi-physician incomplete chart sign out Before: Incomplete medical charts could only be signed out to one physician at a time, as opposed to simultaneously. This was resulting in long delays in chart completion, and potentially poor quality data. Now: An area specific to multi-physician chart sign out was created in the Health Records department. Physicians know they have a chart waiting for them in this area because they are given a “deficiency slip” identifying the chart number and box number. There are instructions on the deficiency slip telling them exactly what they need to do. Wow! Physicians have given positive feedback about this new process, and already, the average time it takes for an incomplete chart to be completed by all required physicians has been reduced by half!
Sweet sen ment – “A few weeks ago there was a pa ent on Quinte 5 who was unfortunately hospitalized about a week before his daughter’s wedding in Europe. On the Saturday of the wedding, his son came from out of town to be with his dad. The staﬀ worked together to get an IPad set up with Face Time and the pa ent and his son were able to see the wedding and par cipate. It was beau ful and you could tell the pa ent was so happy he could be part of her special day. The staﬀ really went above and beyond for this pa ent.” – Dr. Julie Bryson, Chief/ Medical Director of Family Medicine.
Kind and considerate — “I was only in hospital a few hours but the staﬀ at North Has ngs Hospital were the most kind and considerate I have ever had. From the moment I stepped in with severe pain I was comforted and taken such good care of. The two nurses that gave me injec ons and took my blood were so gentle I did not feel a thing. Once again, thank you for the eﬃciency and high quality of care.” ‐ A grateful pa ent (Pictured from le : Jenna Bierworth, RN; Dr. Melissa Fransky; Katelyn Render, RN)
#RespectEveryone A calming presence — “Hamza Chaudhry, Nuclear Medicine Technologist, was incredible with my mom during her appointment. She was anxious, scared and unable to lay flat or s ll for any period of me. Hamza used his gentle voice and so approach to make the scan successful. He was kind, pleasant and never showed any signs of frustra on. Please let Hamza know what a valuable and amazing employee he is. We are forever grateful.” – Debbie Smith‐Abbo
A welcome guest — “Melanie Cooper, a Hospitality Services Rep (HSR) on Sills 3 doesn’t just clean rooms. With a smile, she greets pa ents, chats with them, encourages them to par cipate in their therapies and develops great rela onships with them. Pa ents introduce Melanie to their family and visitors. When Melanie enters a room, she is visi ng a pa ent's temporary home, and she shows great respect for the person’s space and belongings. She even waters plants and puts things within reach for pa ents. Pa ents have told me that they always look forward to seeing Melanie, not just for her housekeeping skills, although those are certainly appreciated, but for her daily visits. Everyone on the floor loves Melanie.” – Kathleen Kirkham, Communica ve Disorders Assistant on Sills 3.
Great guide —“The other day, a pa ent was having trouble finding her way at BGH and I wasn’t sure where she needed to go. Thankfully, volunteer extraordinaire Sharon Ostman came along and asked if she could be of assistance. As the BGH Auxiliary’s Director of In‐Hospital Services, Sharon maintains an informa on sheet for volunteers to assist with way‐finding. She includes layman’s terms that pa ents are likely to ask versus hospital terminology and knows the hospital inside and out! She politely and confidently took the reins and – much to the pa ent’s relief — escorted her to the correct loca on. I was reminded, yet again, how much we need our volunteers! Thanks to Sharon and to all the volunteers at all QHC hospitals that help pa ents find their way.” ‐ Catherine Walker, Manager, Communica ons and Community Rela ons.
Safe parking — Kudos to Kelly Pound, Pa ent Care Lead (PCL) on Quinte 5, who suggested the idea of pos ng a “Staﬀ Parking Only” sign at the Cavell parking lot at BGH. Kelly, who parks in the lot, would o en see visitors pull up to the gates and when they realized they couldn’t park there, they would back up (some mes dangerously) and drive oﬀ, frustrated. Thank you, Kelly, for bringing this safety/improvement idea forward.
Who inspires you? Anyone can share in celebra ng our teams – staﬀ, pa ents, phyysicians and volunteers. Contact Carly Baxter at ext. 2677, email@example.com.
QHC flu season planning We are preparing for a particularly challenging flu season. Our patient volumes at QHC are already higher than usual for this time of year – not leaving much capacity for the extra volume of patients associated with flu season. Recognizing that many Ontario hospitals are already struggling in this way, the Ministry of Health and LongTerm Care recently announced extra funding for temporary beds to be put to use from November to March. These beds will help but won’t completely fix the issues. We have also been working proactively across QHC to address some of our overcapacity issues and ensure we have the resources to face flu season head on. Some of these initiatives include: Increasing staffing hours for RNs, RPNs, PSWs, UCCs, PFCs OT/PT/PTA, Pharmacy, HSR to reflect our requirements during flu season. Creating a Critical Care Surge plan that will guide us when we are inevitably under pressure with too many patients in our ICU. This includes utilizing space in pre-op when necessary and developing Critical Care Surge staff within the Transition Pool. Recruiting and training new staff on units and in our Transition Pool. Establishing “deployment teams” in the BGH and TMH Emergency Departments that identify patients who would be better supported through community resources outside of hospital and helping them access those resources – often diverting admissions. Creating an Emergency Department Transition Pool to support admitted patients while they wait for a bed on a unit. Separating patients with influenza-like symptoms in our Emergency Departments to help manage infection control issues. Re-establishing our Tamiflu supply. Instituting a four-bed Rapid Admission Unit on Q5 to get patients out of the ED and admitted quicker. A dedicated nurse is assigned specifically to intake patients and initiate care plans. Rearranging rooms on Q5 to allow for better isolation of patients with flu. Creating more medicine beds on Q4. Adding four Telemetry packs – to prevent lack of Telemetry availability from being a barrier to patient admission. Much of this work has already been completed, while some of it will get started as we begin to see our first cases of influenza. We will be working with Hastings Prince Edward Public Health to keep surveillance of influenza-like illness. Thank you to all of the staff, physicians and volunteers who got the flu shot this year. Our flu shot clinics are over, but you can still make an appointment to get your flu shot through Occupational Health.
Student volunteer from Switzerland is all smiles at BGH If you work at BGH, chances are you’ve probably seen Jennifer Franchini around the hospital in the past few months. Jennifer, who is visiting from Switzerland, has been volunteering full time with the BGH Auxiliary. She arrived to Canada speaking limited English, but the time she’s spent volunteering at the Information Desk, in the various hospital cafes, and on the patient floors, has done wonders to improve her English. “Jennifer is so pleasant and helpful,” said Jay Moxness, Volunteer Specialist/Recreation Therapist. “She chats with visitors, patients and other volunteers and she’s been a great help to our volunteer program.” Jennifer will be heading back to Switzerland after Christmas to start her new job as a Pharmacist Assistant. Thank you, Jennifer, for your time with us!
Jay Moxness, Volunteer Specialist/Recreation Therapist, and Jennifer Franchini, volunteer from Switzerland, serving tea and scones at the BGHA Volunteer Appreciation Tea on September 28.
Meditech Upgrade Success! Thank you and congratulations to all of those involved in the successful Meditech 5.67 upgrade! The upgrade included testing over 15,000 Meditech changes, over 50 interfaces, hundreds of custom reports, and scenario-based testing across all modules over the past seven months. With all of the work and preparation that went into the upgrade, the day went off with very few issues.
Many of the members of the hard-working IS team. From left: Barry Hillier, Director; Paula Molloy, Applications Specialist; Todd Dafoe, Applications Services Manager; Jamie Kay, Applications Consultant (and project lead); Brad Harrington, VP and CFO; Kara Carriere, Application Services Consultant; Amalan Krishnaraj, Help Desk; Gary Oldfield, Help Desk; Chris Ferguson, Systems Administrator; Stephen Yoksimovich, Technical Services Manager.
A special shout out to Jamie Kay, Ron Baugh, Kara Carriere, Paula Molloy, Michael Jordan, Tyler Nelson, the rest of the IS team, John Remington from Professional Practice, program directors and managers, and all power users and department/unit testers.
QHC Vital Signs Newsletter, November 2017: Published by QHC Communications Department Editor: Carly Baxter (613) 969-7400 ext. 2677, firstname.lastname@example.org
Published on Nov 28, 2017