Transcript of "Improving Provincial Waiting Time: Hip and Knee Arthroplasty "
Taming of the Queue March 29, 2012 Improving provincial waiting time forHip & Knee Arthroplasty through reduction in LOS Jane Squire Howden Co-Chair, Provincial Hip & Knee Working Group Bone & Joint Strategic Clinical Network 1
What have we done? Developed a quality improvement approachthat is being used to ensure evidence based care continuum implemented in 12 arthroplasty sites across Alberta to reduce wait times and Improve Quality 2
Spread the Integrated Care Path across AlbertaTarget improvements in: √ Efficiency: Length of stay √ Accessibility: Waiting times √ Safety: Adverse events; surgical safety checklist √ Appropriateness: Patient mobilization; antibiotics √ Acceptability: Patient satisfaction √ Effectiveness: Pain control; on-time first case setup 3
Measurable Progress June 2010 – May 2011• Quarter over quarter improvement in LOS oFrom 6.4 days (F08/09) to 5.1 days (F10/11 Q4)• Reductions in both acute care LOS and transfer LOS• 8000 actual bed days have been saved combined with an increased volume of 901 cases province wide• Projected bed days saved for F11/12 – 11500• Improvements in accessibility, acceptability, safety,• Effectiveness, efficiency & appropriateness 4
OLD: Patient Navigation Path Service 179 Physician A Service 1Service 311 Primary Care Group Physician WAgency F Agency Y For Profit Rehab. Public Rehab Service 467 Service 222 5
Hip and Knee Care – History• Alberta Health Services and Alberta Bone, Joint Health Institute and Alberta Orthopedic Surgeons developed an evidence-based Hip and Knee Replacement Continuum• Pilot project to test the continuum was 2005 – 2006• Edmonton, Calgary, and Red Deer implemented the continuum• Continuum implementation spread to all sites that are doing Hip and Knee Replacements• Provincial Hip and Knee Working Group provide leadership 6
NEW: Integrated Hip & Knee Care Path Multi-faceted Systematic Evidence-based Increased Community Care Community Care Hospital Care 7
Goal• Fully implement the Integrated Care Path• To improve waiting time for Hip & Knee Arthroplasty• Improvement in Length of Stay across province• To improve Quality and Safety indicators in each site• Eliminate waste & reinvest savings 8
Process• The use of a collaborative model to: o engage 12 hip and knee arthroplasty front line teams Alberta-wide o develop and implement a quality improvement scorecard & plans to achieve a targeted goal o support evaluation and ongoing monitoring of improvement indicators• Team leads report progress monthly to the Provincial Hip and Knee Working Group• Face to face meetings 2 x’s per year with all team members province-wide 13
Providers are the secret to sustainabilityEngage and support providers as they are the solution What front line providers know: ohow ‘it really works and doesn’t work’ - they treat the people owhat is practical ‘on the ground’ The front line providers are: RN’s Surgeons, Anesthetist, Internal Medicine, Occupational Therapy, Physical Therapy, anyone that works directly with the patient. 14
Providers are the secret to sustainabilityEngage and support providers as they are the solution What front line providers may not think about: oProviders’ individual decisions actually drive total access, quality and cost of ‘the system’ oThere is a ‘continuum of care’ that is connected. oWhat happens in one part affects all parts up and downstream oTeams are essential – within and across the continuum oTeams working with data can drive major improvements 15
First steps to managing Wait timesThe Bone & Joint Clinical Network worked with ABJHI to develop 5 year strategic plan to address wait times & achieve 14 week waiting time targets.• Determined one set of Wait Times Rules - what is being measuring and how will it be measured starting with Family Doctor referral• Transparency – all arthroplasty surgeons in the province provided ABJHI with waiting time data so that “true demand” could be captured• Waiting list clean up – methods to achieve this consistently across province• Modelling to manage pent up demand (backlog), then steady state requirements to meet demand across province. 17
Keys to Success• Use of bottom-up approach more successful vs. top-down approach• Multidisciplinary team participation & buy in.• All team members have the same “authority” in decision making• Evidence based decision making 18
Keys to Success• Front-line staff determined improvement strategies to meet the target• Look across the continuum of care• A small change can have a big impact• Data is the basis for all decisions.• This is not a research project, the data does not have to be perfect to be usable. 19
Keys to Success• Regular meetings that require teams to report on activity.• No judgment, support the teams to achieve goals through sharing successes and ideas to resolve challenges. 20
Efficiency Results Length of Stay Average length of stay based on administrative data 21
Appropriateness Results Mobilization Day 0“Mobilization Day 0” - patient weight-bearing at bedside with assistance and use of aids on day of surgery. Mobilization Day 0 not tracked for 3 of 11 sites 22
Accessibility Results Wait time from Referral to Surgery (T0 – T2) 500 450 400 350 Current 300 Baseline Days 250 200 150 100 50 0 Alberta 1 2 3 4 5 6 7 8 9 10 11 SitesT0-T1 Wait Times data collected from surgeon office or central intake clinic data setsT1-T2 Wait Times data from administrative data sources 23
5-Year Plan to Reduce Waits 60 Edmonton South 5090% Wait Time (Weeks) 40 North Central 30 Calgary 20 14 Weeks from 10 Decision to Surgery 0 Baseline F2011/12 F2012/13 F2013/14 F2014/15 F2015/16 24
Measurable Progress• From June 2010 to October 2011 11,384 acute care bed days were saved, equating to over $8.5 million dollars to be reinvested• In 2011/12, nearly 1300 additional arthroplasty cases where completed to assist in reducing wait times. 80% of patients are now meeting the wait time target compared to 65% in 2010/11.• Final goal of 90% of patients having their surgery completed in 14 weeks by 2015/16 is on track. 25
Thank you! Jane Squire Howdenjsquire@edmontonmsk.ca 26
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