Like most health care organizations in Canada, the University of Ottawa Heart Institute undergoes regular review by Accreditation Canada. This rigorous process assesses hospitals against more than 900 standards and criteria. As part of its 2013 accreditation, Accreditation Canada identified four Heart Institute programs as Leading Practices that are “particularly innovative solutions to improve quality.”
Selected by an independent panel of experts, Leading Practices are considered to be exemplary programs that other organizations can look to as models of health care delivery. Accreditation Canada promotes these effective practices as part of its knowledge exchange activity. The four Heart Institute Leading Practices include:
The largest acute home monitoring program in Canada, Telehome Monitoring primarily targets elderly patients with heart failure who live in rural areas and have a history or likelihood of readmission. Patients are provided with a home monitoring system that transmits vital signs, weight and other data via phone back to the Heart Institute. The program has substantially decreased readmission rates, reduced adverse drug events, increased patient confidence with self-care and improved follow-up care. Patient satisfaction with the program is extremely high.
Guidelines Applied in Practice (GAP)
The GAP tool is a simple, effective mechanism used to assess and guide the care of heart attack and acute coronary syndrome patients. Written in patient-friendly terms, it is used during the hospital stay to educate patients and provide patients and families with a plan of care to be shared with their family physicians post-discharge. Guidelines Applied in Practice has helped to reduce 30-day in-hospital mortality in the Champlain region by half and has increased the uptake of best practices.
The GAP tool is structured as a patient self-care management tool. It is written in patient-friendly terms and provides the patient and family with a plan of care to be shared with their family physician post discharge. It is a simple but effective tool that is used to assess and guide the care of myocardial infarction (MI) and acute coronary syndrome (ACS) patients. It allows the full team to participate in the care of patients. The tool is used during the hospital stay to educate patients. At discharge nurses review patients’ compliance with best practices, follow-up with physicians and provide a copy of the plan to the patient to share with their family physician.
This program has improved patient outcomes in the Champlain LHIN with 30 day in-hospital mortality rate being reduced from 12% in 2001 to 6% in 2008/09. We have also seen an improvement in the uptake of best practices. In 2011 71% of patients across the LHIN were receiving the GAP tool. Work is continuing to ensure compliance with best practice increases to meet the CCORT benchmarks consistently in all LHIN acute care hospitals. Hospitals are given the % rate with which each of them comply with all of the elements of best practice care for acute coronary syndrome (medications, rehabilitation, follow-up, quitting smoking etc.).
An innovative aspect was the partnership we developed with the Canadian Institute for Health Information (CIHI) to create 16 new permanent fields in the Discharge Abstract Database (DAD). Each hospital abstracts data into the DAD so that we now have regional data at the hospital level regarding compliance with medications and modifiable behaviour at discharge. As a result of the CIHI initiative this data can now be captured by any hospital participating in CIHI. Finally, the actual data abstraction with the GAP tool takes less than 1 minute so we have been able to implement with no additional costs.
Automated Calling to Improve Best Practices Compliance in Acute Coronary Syndrome
This outbound calling system is designed to assist patients with acute coronary syndrome in following best practice guidelines after discharge. Using an interactive voice response system, patients are called at one, three, six, nine and 12 months; asked specific questions about medications and lifestyle issues; and flagged for callback by a registered nurse when patient responses indicate the need. These follow-up calls have identified issues with prescription practices, provider knowledge and patient knowledge deficits, and social and financial issues. The system is a companion to the acute coronary syndrome GAP program.
The Guidelines Applied in Practice (GAP) initiative provides a regional systematic approach for identifying and ensuring all patients hospitalized with acute coronary syndrome (ACS) are receiving best practice guidelines upon discharge from hospital. Safety research confirms patients experience complications and adverse drug effects when transitioning from hospital to home. Adherence to cardiac medications declines sharply during the first six months post discharge. Recognizing that medication noncompliance is linked to poor health outcomes and increased adverse events the University of Ottawa Heart Institute designed an interactive voice response (IVR) system to support patients after discharge following an ACS event.
This is an outbound calling system designed to assist patients to remain on best practice guidelines. It’s a companion system to ACS GAP regional program to follow patients to one year post discharge to maintain compliance with ACS best practice. All ACS patients are called at 1,3,6,9, and 12 months. Each call asks specific questions about medications prescribed on discharge and determines whether or not they remain on guidelines. When patients indicate they are no longer taking guideline medication, they are called by an RN and efforts are made to return the patient to best practice guidelines through discussion with family physician. There are also questions on lifestyle issues including diet, smoking cessation, activity etc. Our follow-up calls have identified issues with prescription practices; provider knowledge deficits; patient knowledge deficits and social/financial issues. We provide this service to all our ACS patients discharged home and to our regional patients.
Ottawa Model for Smoking Cessation
The only clinical tobacco cessation program of its kind in Canada, the Ottawa Model systematically identifies, treats and follows smokers over the long term in hospitals, primary care clinics and other outpatient settings. In Ontario, the program has been found to improve long-term quit rates of hospitalized smokers by more than 11 per cent. The Ottawa Model has been implemented in more than 150 health care settings across Canada.
“Each of these programs has been important for improving the quality of care in our region,” said Sharon Ann Kearns, Director of Quality and Performance Measurement, Privacy & Risk, at the Heart Institute. “We’re very pleased that Accreditation Canada has chosen to highlight them as examples for other health care providers around the country.”