Each year, we submit a Quality Improvement Plan (QIP) to the Ministry of Health and Long-Term Care. Our QIP identifies specific priorities for quality improvement in five dimensions including effectiveness, efficiency, patient-centredness, safety, and timeliness. This year, we submitted separate QIPs for each of our hospital sites. At the Kingston General Hospital site we are aiming to improve patient satisfaction with the information they receive from hospital staff after they leave the hospital, reduce readmission rates for patients with COPD and unnecessary time spent in acute care, increase the proportion of palliative patients who are discharged home with support and the proportion of patients receiving medication reconciliation upon admission, improve patient satisfaction with emergency care, reduce the incidence of hospital acquired pressure ulcers and reduce emergency department wait times. At the Hotel Dieu Hospital site we are aiming to help patients understand how to best manage their care by providing them with sufficient verbal and written information at their appointments, reduce readmission rates for patients with COPD, achieve high levels of patient satisfaction with ambulatory care and urgent care, ensure effective clinic utilization and timely communication with referring physicians following patients' clinic visits, increase the number of designated patients receiving medication reconciliation, and achieve wait time targets in the urgent care centre. For more information on our hospital QIPs, visit the KGH site or the HDH site.
Accreditation is a voluntary process that allows health-care providers to assess every aspect of health care and service against national standards of excellence. Both our Kingston General Hospital and Hotel Dieu Hospital sites received the Accredited with Exemplary Standing during our last Accreditation Canada surveys. This means that our organizations have surpassed stringent national standards of quality and quality improvement in terms of governance, clinical leadership, people, processes, information, and performance. We are scheduled to undergo our next survey in the spring of 2018. This represents a unique opportunity for KHSC to use the Accreditation Canada standards as a way of unifying clinical areas across both hospital sites around common standards of excellence.
KHSC is a top performer on the essentials of quality, care, and service
In 2017-18 Together with patients and families, we will:
Achieve or exceed seventy-five per cent of KGH & HDH Quality Improvement Plan targets
Use Accreditation Canada Standards to learn, improve, and model excellence
How are we doing?
Quality Improvement Plans:
All indicators identified in the Quality Improvement Plans (QIPs) at both sites of KHSC speak to the commitment of KHSC to improve five dimensions of patient care: effectiveness, efficiency, patient‑centredness, safety and timeliness.
Both sites of KHSC are involved in a SE LHIN initiative to improve the effectiveness of care for patients with chronic obstructive lung disease (COPD) and to reduce readmission rates of patients with COPD by introducing evidence-based care processes across the SE LHIN. Results from both sites indicate that patients are generally satisfied with their care. The most recent patient experience survey data from the Emergency Department Patient Experience of Care (EDPEC) survey and the Canadian Patient Experience Survey – Inpatient Care (CPES-IC) survey reflects patient perceptions of care during the spring and early summer. Although actual results were marginally below the target, patients at the KGH site said they received enough information about what to do if they were worried about their condition or treatment after discharge. There is a solid plan to achieve this target by year end. A sample of clinic patients at the HDH site said they received enough information at their clinic appointment. Patient satisfaction with care in the Emergency Program at both sites was quite positive. Although the % of patients that “would recommend” the KGH ED at the highest level was just below the target (59.2% against a target of 60%), there is a commitment to achieve target by year end. The % of patients that “would recommend” the HDH UCC was very high; however, the % that rated their care in the UCC as 7 or higher on 10-point scale was below the target of 90%. That target was set as an aspirational target in the winter of 2017, knowing that renovations to the UCC triage area were planned, and anticipating that the overall rating of care would be positively affected by the renovation. That result has not materialized yet. At that time, the EDPEC survey was a new instrument. The target was set with only 2 quarters of EDPEC data available. The previous patient experience survey results were not comparable. The UCC leadership will explore the EDPEC data further to understand which responses are most closely correlated with overall satisfaction and where to target improvement efforts. Some Q2 indicators of efficiency remained below target: timely communication with referring doctors at the HDH site and alternate level of care (ALC) days at the KGH site. Clinic utilization at the HDH site was on target. Performance will continue to be monitored and improvement opportunities identified.
Patient safety indicators at both sites emphasize medication reconciliation, which is an effective way of reducing medication discrepancies and enhancing patient safety. Some Q1 medication safety indicators were slightly below target; however, medication reconciliation processes have been established and will continue to be reviewed and communicated to ensure compliance.
An accreditation work plan was endorsed by the KHSC Executive and distributed throughout KHSC. The work plan guides accreditation preparedness. The accreditation communication plan continues to support the information requirements of board committees and all members of the KHSC community. An Accreditation 2018 section of the KHSC-KGH site intranet has been developed as the “go to” site for accreditation information. Accreditation familiarization walkabouts continued in Q2. Over 100 walkabouts have occurred thus far throughout KHSC. The Accreditation Coordinator, Manager of Quality and Patient Safety, and Patient Safety and Quality Specialists are communicating regularly with accreditation teams to share accreditation information, timelines and expectations, and to respond to questions and concerns. Accreditation teams completed the self-assessments, reviewed the self-assessment results and identified strengths, opportunities for improvement, unmet and partially met standards and Required Organizational Practices (ROPs). Self-assessment results from all teams were reviewed and a list of high priority, high impact items were identified to address unmet or partially met criteria. This information was proposed to the KHSC executive for discussion, endorsement, priority-setting, and assignment of resources. KHSC Executive identified some key corporate priorities and confirmed available resources and support. The Accreditation Coordinator has worked with Accreditation Canada and the Executive to develop a preliminary survey schedule.