News Review
HIROC subscribers recognized for patient safety initiatives
Thursday October 25, 2007
If the list of finalists for the 2007 rL Solutions Canadian Healthcare Excellence in Quality Award (CHEQA) is any indication, Healthcare Insurance Reciprocal of Canada (HIROC) subscribers have got their fingers on the pulse of patient safety.

Of the five finalists for the award, which was presented Oct. 12 at the Halifax 7 healthcare safety symposium, four are HIROC subscribers including Toronto East General Hospital, St. John’s Rehab Hospital, Trillium Health Centre and The Credit Valley Hospital.

In interviews for HIROC News articles, representatives from each of the four subscriber organizations referred to patient safety initiatives as a high priority.

The winner of the award, as voted online by Quality Healthcare Network (QHN) members, is Toronto East General Hospital (TEGH) for reducing the length of time a patient with lung cancer waits for treatment as part of its Time to Treat program.

“We’ve been working hard on quality and safety initiatives within the organization for a number of years so this project is just a reflection of the ongoing work and the various clinical teams that are engaged in quality work and really improving processes for our patients,” says Marla Fryers, vice president of programs and chief nursing officer at TEGH.

For winning, TEGH has received $15,000 which Fryers (who was interviewed prior to Oct. 12) hopes will be re-invested in further quality improvement initiatives.

“What we wanted to ensure through this project was rapid access to care,” Fryers explains. “From the time of suspicion to the time of treatment, we wanted to decrease and improve that cycle.”

Through the Time to Treat program, overall time from suspicious X-ray to diagnosis was reduced from 127.8 days to 30.8 days, a 71 per cent reduction. The majority of physicians (from 70 to 100 per cent) rated the treatment processes as better or significantly better as a result of the system redesign.

Another CHEQA finalist and HIROC subscriber is St. John’s Rehab Hospital, which has been recognized for their work in advanced wound care.

“I think it’s a great honour,” says Morty Eisenberg, the hospitalist division head at St. John’s Rehab Hospital. “I’ve been working on this for quite awhile now and I’m very pleased.”

According to Eisenberg, the traditional method of wound care, which involves keeping wounds clean and dry and treating with some antiseptic, is no longer the best approach to take.

Instead, he suggests a process that involves keeping the wound moist.

Following Eisenberg’s advanced wound care process, wounds are treated with a gel to retain moisture and a “fancy” foam dressing is used to help balance the moisture. The foam dressing only needs to be changed once every two or three days as opposed to twice daily with conventional dressings.

“It’s much more comfortable for the patient and it saves the hospital a fair bit in terms of nursing care (because) you’re not having to change dressings twice a day every day,” Eisenberg says.

The third HIROC subscriber short-listed for CHEQA is The Credit Valley Hospital in Mississauga for their work in reducing emergency department wait times by establishing a Rapid Assessment Zone (RAZ).

“We are really quite honoured. It was very hard work implementing this zone in our emergency department,” says Janet Cadigan, nurse manager in the emergency department. “It’s really not about the award. It’s the fact that it provides additional opportunities for us to get different ideas out there as we learn from others.”

The goal of the program is to efficiently manage emergency department throughput of Canadian Triage Acuity Scale (CTAS) level III patients and demonstrate measurable improvement in length of stay, physician assessment times and patient satisfaction using existing space.

Cadigan says level III patients were targeted for the RAZ since they tend to languish for hours in waiting rooms.

Patients come in, they’re assessed, have medical directives initiated, some treatment is initiated and they’re admitted to the Rapid Assessment Zone (RAZ) waiting room.

As a result of their efforts, the total length of stay for CTAS level III patients has decreased as well as their wait time for physician assessment.

Last but not least, the fourth HIROC subscriber short-listed for CHEQA is Trillium Health Centre in Mississauga.

By implementing a standardized process to reduce falls and minimize use of restraints, Tiziana Rivera, manager of seniors’ health and geriatric mental health services, says the organization has been able to save $50,000 a year.

“To be recognized for it is a very positive recognition for the hard work that a very large group of people collaborated on to get the outcomes we had,” Rivera says. “What we did was uncover everything that was current practice and looked at putting in systems and processes that enabled best practice to happen.”

Trillium Health Centre had six injurious falls documented in 2006 and only one in 2007 as of Oct. 1. Injurious falls are considered to be serious adverse events such as hip fractures or severe lacerations.

For more information on any of the patient safety programs mentioned above, follow the links below.

Toronto hospital wins 2007 quality award

Rehab hospital recognized for work in wound care

Hospital reduces ED wait times

System change results in fewer falls and expenses