QI in Action eBulletin #93: Change Ideas for Quality Improvement Plans

In this issue

• Quality Improvement Plan (QIP) Priority Indicators
• 7 Day Post Hospital Discharge Follow Up
• Same Day & Next Day Appointments
• Involving Patients in Decisions About Their Care and Treatment
• Identifying Patients for Palliative Care who Subsequently have their Palliative Care needs Assessed using a Comprehensive and Holistic Assessment
• Non-Palliative Patients Newly Dispensed an Opioid
• Resources
• Upcoming Webinars   

Quality Improvement Plan (QIP) Priority Indicators

On November 27, 2019 the 2020/21 Quality Improvement Plans (QIPs) were launched. The priorities that will guide quality improvement efforts over the coming year remain similar as last year. Please see the following resources for specifics on the priority indicators:

• Quality Priorities for the 2020/21 Quality Improvement Plans
•  Indicator Technical Specifications: 2020/21 Quality Improvement Plans
• Quorum: Indicators and Change Ideas

To help you plan this year’s change ideas, please see initiatives other teams have taken within their 2019/2020 QIPs for each priority indicator:  

Percentage of those hospital discharges (any condition) where timely (within 48 hours) notification was received, for which follow-up was done (by any mode, any clinician) within 7 days of discharge

• Aurora-Newmarket FHT will be collaborating with the local hospital to book post hospital appointments prior to the patient’s discharge
• City of Lakes FHT will pilot integrating a tool to identify patients at risk for readmission
• East Elgin FHT will be introducing coordinated care plans at follow up appointments
• Petawawa Centennial FHT will be checking the local hospital’s database for discharge reports
• Summerville FHT will be working with partners to develop a portal and educational materials
• Sunset Country FHT will be collaborating with the local hospital to connect unrostered patients seeking primary care services at a hospital with a primary care physician
• Teams are conducting medication reconciliations for patients discharged from the hospital
• Teams have RNs performing telephone follow-ups with patients or are printing out a list of patients discharged daily for providers

Percentage of patients and clients able to see a doctor or nurse practitioner on the same day or next day, when needed
Teams are:

• Adding additional survey questions to better understand access
  • Credit Valley FHT is creating an Access Survey to create a patient focus group to understand what access means to patients
• Blocking times within NP/MD Schedules for same day/next day acute appointments
• Analyzing appointment availability data
• Offering after-hour clinics
  • Lakehead NPLC will expand office hours to include more evening and weekend hours and open walk-in access six days a week
• Offering e-visits and expanding e-booking of appointment

Percent of patients who stated that when they see the doctor or nurse practitioner, they or someone else in the office (always/often) involve them as much as they want to be in decisions about their care and treatment

• Survey Completion Targets
  • Teams administer the survey upon the completion of programs
  • Teams have set weekly, monthly, quarterly and/or annual targets
  • Grandview FHT will be developing an EMR search to query patients that have had a visit in the last 4 weeks to request targeted survey feedback
  • Smithville FHT will incentivize patients and staff to meet survey completion targets
  • Windsor FHT is creating pre and post surveys for their Team Care Centre
• Modes of Communication
  • Teams survey patients via tablets, kiosks, website, paper surveys, emails, patient portals, patient feedback cards, newsletters and social media
  • Carefirst FHT will have posters in their waiting room in different languages
  • Guelph FHT will encourage patient centered goal setting across disciplines through standardized prompts in charting tools
  • Harbourview FHT will be creating patient self-management resources
  • Kincardine FHT will have Patient Navigator Volunteers that will help with way-finding questions and encourage the completion of surveys
  • North Shore FHT will be developing an introductory handout for locums to highlight their commitment to patient centred care
• Sharing Survey Results
  • Teams accumulate survey results to present at team meetings and/or to patients
    • Belleville NPLC will have open discussions at huddles and team meetings around including patients in decisions about their care
  • University of Ottawa Health Services FHT will have a dedicated Survey Working Group to analyze survey results and make recommendations for improvement
• Patient Advisory Committees
  • Bridgepoint FHT will draft letters to recruit patients to participate in the Patient Advisory Committee

Proportion of patients with a progressive, life-limiting illness who were identified to benefit from palliative care who subsequently have their palliative care needs assessed using a comprehensive and holistic assessment

• Carefirst FHT intends to introduce the Palliative Performance Scale (PPS) assessment for their complex patients in the INTEGRATE program
• Mount Forest FHT, in partnership with eHealth Centre of Excellence (eCE), will contact patients who have been identified in the EMR as having 4 or more chronic conditions and/or have had 4 or more emergency room visits in the past 6 months and invite them to engage in developing a coordinated care plan
• Teams are implementing the use of the Palliative Toolbar created by eCE
• Teams are providing advanced care education for providers
  • Teams are exploring the Ontario Palliative Care Network (OPCN) Palliative Care Toolkit for strategies and documentation requirements in our patient care environment
• Teams are developing and implementing standardized identification methods within EMRs
  • Great Northern FHT will be incorporating the surprise question “Would you be surprised if patient were to die next year?” within their workflow
  • St. Joseph’s Urban FHT plans to create a list of diagnoses that capture the diseases that are potentially progressive and life threatening from our patient population. From this group of patients, they will determine palliative status using a possible prognosis of less than 1 year.

Percentage of non-palliative patients newly dispensed an opioid within a 6-month reporting period prescribed by any provider in the health care system within a 6-month reporting period

• Identification of patients on opioids:
  • Bancroft FHT will implement a Rural Outpatient Opioid Treatment Program
  • Brockton and Area FHT will incorporate the review of hospital discharge opioid prescriptions as part of their Medication Reconciliation Program
  • Chapleau and District FHT will implement a telepharmacist-led opioid stewardship program
  • Lakehead NPLC will be using a standardized approach to safe prescribing in which patients will have a risk assessment tool, pain assessment tool and treatment agreement completed
  • Nipigon District FHT will implement the HARMS program developed by Marathon FHT
  • Petawawa Centennial FHT will increase the number of opioid contracts completed and plan a process to follow up with patients prescribed an opioid
  • St. Michael’s Hospital Academic FHT will collaborate with St. Michael’s Hospital departments to develop patient-oriented discharge plans for opioid taper when initiated in hospital
  • Thamesview FHT will implement a cannabinoid program focusing on the reduction of polypharmacy
  • Wawa FHT will participate in a RAAM clinic with other community agencies
  • Teams are working on developing queries to identify patients
• Pain Management Programs:
  • Alliston FHT will be performing a falls risk assessment of all patients in the geriatric program
  • Dufferin Area FHT will continue to offer the Power Over Pain group and individual appointments
  • Hanover FHT will review a rehab plan after joint replacement surgeries
  • Powassan and Area FHT will offer patients a mindfulness for chronic pain program
• Increase physician sign up for MyPractice reports
• Increase Opioid Toolbar Use
• Teams are focusing on education and awareness for patients and providers:
  • Exploring professional development opportunities for providers to educate on pain management programs and/or opioid prescribing
  • Post-operative pain management handouts for patients

To learn more about the initiatives listed above please email improve@afhto.ca.

Resources:

• Early ID of Palliative Patients: 12 Lessons learned from the field – HQO Webinar
• AFHTO EMR Queries for Opioids
• eCE Opioid Toolbar
• eCE Early ID of Palliative Patient Toolbar
• QIP Navigator
• More information on MyPractice: Primary Care Reports

Upcoming Webinars:

• Overview of 2020/2021 QIP Priorities Webinar – Dec 9, 2019 4-5 pm
• Increasing Access to Patients through Virtual Care Visits Webinar – Dec 10, 2019 12-1 pm

In Case You Missed It: Check out eBulletin #92 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.