Standardized quality of care would improve hospital service: BCMA care, quality, efficiency, patients, measures

tiffiant

Standardized quality of care would improve hospital service: BCMA
Better communication with patients facing surgery a key reform

Standardized quality-improvement measures should be put in place provincewide to improve efficiency and care for the more than 400,000 patients who undergo surgery each year, says a B.C. Medical Association report released today.

Enhancing Surgical Care in B.C. says that with the growing demand for surgery driven by an expanding and aging population, and more emphasis on quality and safety of care, the time is ripe for all hospitals to share best practices and adopt similar methods to improve surgical services.

Much of that could be achieved by improving communication with patients before, during and after their operations, according to the report.

Surgery cancellations and operating-room delays are two of the most frustrating problems for patients and their doctors, it states, and when OR costs can run as high as $1,800 an hour (excluding doctor fees) there should be more attention paid to finding solutions that could work for all hospitals.

A previous report found that surgical cases start as scheduled in as few as a third of ORs, and that when there is a delay in the first case of the day, that has a ripple effect on all that follow.

Delays occur for all sorts of reasons: when patients are late being transferred, when health providers are late, when surgical supplies aren’t prepared in advance, when equipment fails, and when urgent or emergent cases bump other surgeries.

Dr. Sam Bugis, a St. Paul’s Hospital general surgeon who chaired the group that prepared the report, said that at some hospitals, the practice is to start with the most complicated, longest cases so that the latest (and thus easiest and least serious) cases on the schedule can be postponed if delays arise.

“But the amazing thing is this isn’t all figured out,” he said. In some hospitals, he noted, OR staff have a pre-surgery “huddle” to discuss the day’s cases, which can drastically improve safety and prevent delays, but it’s not a standard procedure.

tiffiant

A previous report sampling 42 B.C. hospitals had found that only half of operations were completed on schedule. (There are about 170 ORs in B.C. hospitals).

The report released today concludes that the ministry of health should set up a panel to identify best practices that would be consistently applied in every hospital in the province, rather than just those that choose to adopt them on a piecemeal basis.

For instance, in recent years the Fraser Health Authority started using surgery quality indicators to boost and measure performance.

The tool helped three hospitals reduce surgical-site infections to seven per cent from more than 13 per cent between 2006 and 2009. The program is now being implemented in another 18 hospitals, but, Bugis noted, not everywhere in the province.

Underutilization of operating rooms is another source of frustration for doctors. Over the holidays, hospitals close some ORs for short periods; during the summer, some ORs shut down for as long as six weeks. The closures are partly due to staff vacations and budgetary constraints, Bugis said, “but we think that closures shouldn’t be so automatic.

“There should be a review of each health region’s policy regarding OR closures to recapture unused OR time,” he said.

“While these OR closures do coincide with reduced availability of staff and patients, the reduction in OR capacity may be more than necessary to accommodate the reduced availability,” the report states.

Ryan Jabs, spokesman for the ministry of health, said the government has already planned for a working group to prepare an inventory of unused ORs and any spare OR time during standard working hours, as well as an inventory of seasonal closures.

But Jabs dismissed the notion that they are a budget-constraint measure: “Seasonal slowdowns in the summer and around winter holidays allow health authorities to accommodate vacation requests from staff, who — like everyone — are entitled to take time off to recharge their batteries and spend time with family and friends.”

Jabs said there are some programs already underway across B.C. intended to address other issues in the report.

tiffiant

The provincial government has already planned for a working group to prepare an inventory of unused operating rooms and any spare OR time during standard working hours.