CODE ORANGE Rapid Fire: Physician Engagement - FE and PQI Working Together November 19, 2018 Christopher Lee MD, MSc. Disaster Med., FRCPC Emergency Physician - Vancouver General Hospital
Disclosure Relationship with commercial interests Grants/Research Support None Speakers Bureau/Honoraria None Consulting Fees None Other None
ED ED Traum Traum Med. Med. a a EOC EOC Surg. ICU Surg. ICU Trans- Trans- Rad. Rad. fusion fusion OR OR Ideal VGH 2017
ED Trau Med. ma By June 2018, ED and Trauma at VGH will be EOC Surg. ICU prepared for any traumatic mass casualty incident or disaster. Trans - Rad. fusion OR
PQI Cohort 1 Sep 2017 Jul 2017 May 2018 May 2017 Nov 2017 FE Funding Jun 2017
STAFF STUFF Coaches (PQI, FE) Support staff (PQI, FE) Physician Funding (FE) Teachers (PQI) SPACE SYSTEM QI Framework (PQI)
We need dedicated funding to improve this Number of respondents
ED ED Traum Traum Med. Med. a a EOC EOC Surg. ICU Surg. ICU Trans- Trans- Rad. Rad. fusion fusion OR OR Aim Achieved Christopher.Lee@vch.ca
Physician Quality Improvement (PQI) in Pediatric Asthma Rapid Fire: Physician Engagement – FE and PQI Working Together Dr. Claire Seaton Pediatrician – BC Children’s Hospital, Vancouver November 19 th , 2018
Disclosures • No relevant disclosures 3
1 death ~30 ICU admissions ~ 600 hospitalizations Over 2400 ER visits ~50 000 children with asthma A year of pediatric asthma in BC Bed ouch Plops One 2017 Karen Barker PMR
Current Guidelines
BCPAN: BC Pediatric Asthma Network Asthma Tool Kit Community Practitioner Asthma Care Education Asthma Education Video BCCH ED Action Plan Guideline Asthma Education Dissemination Project Learning Module Training the Trainers BCPAN Workshops
Partners and Stakeholders • Patients and Families • PHSA: BCCH Respirology and ED Divisions • BC Children’s Hospital Research Institute • Child Health BC • UBC: Continuing Professional Development (CPD) • Medical Staff Association (MASES) Grant recipient ($38,000) • Ministry of Health: Guidelines and Protocol Advisory Council Committee (GEPAC) • BC Lung Association 3
BCCH ED Action Plan Project • By March 2019, 100% of children discharged with an asthma diagnosis from the BCCH ED will receive an action plan in the appropriate language for the main caregiver and will be provided with education using the newly created asthma education video. 3
BCCH ED Action Plan Project % of Patients Given Asthma Action Plan 100% 90% 80% 70% 60% Percent 50% 40% 30% 20% 10% 0% 10/12/2018 10/13/2018 10/14/2018 10/15/2018 10/19/2018 10/20/2018 11/4/2018 11/5/2018 11/6/2018 3
What’s next? • Patient interviews and journey mapping: December • Video production: November – January • Child Health BC Online Pediatric Asthma Training Module launch February 2019 • BCPAN and Primary Care Networks – Potential Pilot Project? • BCPAN Inaugural Workshop November 22, 6:30-9pm at Doctors of BC plus Webinar Link for the Province 3
My QI Experience 3
QUESTIONS / CONTACT Dr. Claire Seaton Claire.seaton@cw.bc.ca
Physician Quality Improvement (PQI) Rapid Fire: Physician Engagement – FE and PQI Working Together Dr. Daniel Boston Psychiatry – Victoria, BC November 19 th , 2018
Disclosure Presenter / Faculty Dr. Daniel Boston Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria Lundbeck and Otsuka, Sunovion Consulting Fees Janssen, Lundbeck, Lundbeck and Otsuka Other None 2
Managing Potential Bias Own slides and project Project medications decided by working group 2
QI Project Background Antipsychotics primary treatment of psychosis Common issues: polypharmacy side effects 3
Aim Statement Among admitted 17 to 35 year first episode psychosis patients at Royal Jubilee Hospital by March 31 st , 2018 aim is to achieve a(n): Decrease: Length of stay by 5% Antipsychotic polypharmacy by 30% Increase: Measuring glucose and lipids to 100% Measuring weights to 100% 3
Project Team Dr. Daniel Boston , Psychiatrist, Early Psychosis Intervention (EPI) Service Drs. Andrea Bardell, Psychiatrist, EPI Service Lead (former) Dr. Chris Blashko, Psychiatrist, Inpatient Psychiatric Lead Dr. Diana Ingram, Psychiatrist, Psychiatric Emergency Services Lead Dr. Bree Zehm, Mental Health & Substance Use (MHSU) Clinical Pharmacist Monica Flexhaug, MHSU Project Manager Susan Rich, MHSU Inpatient Manager Alison Steinbart, Medication Safety Consultant Curtis Bilson, PQI Data Analyst Rosie Holmes, PQI Coordinator Dr. Daisy Dulay, PQI Physician Advisor And others 3
FE & PQI Linkage(s) Engagement/QI working groups T E C H N I C A L Engagement/QI event C U L T U R E 3
PDSA Cycles Technical Engagement/QI working groups Clinical Order Set Engagement/QI event Culture Working Groups Schizophrenia Bipolar and PRN Engagement event(s) 3
Preliminary Outcomes Target Change Actual Change ▼ 5% ▼ 19% Length of Stay ▼ 30% ▼ 23% AP Polypharmacy Baseline Current Change ▲ 51% Admit Lipids 3% 54% ▲ 59% Admit Glucose 26% 85% ▲ 79% Admit Weight 7% 86% ▲ 12% D/C Weight 54% 66% 3
My PQI Experience 3
QUESTIONS / CONTACT Dr. Daniel Boston daniel.boston@viha.ca
Physician Quality Improvement (PQI) Rapid Fire: Physician Engagement – FE and PQI Working Together Dr. Dawid van Rensburg Terrace, BC November 19 th , 2018
Disclosure Presenter / Faculty Dr. Dawid van Rensburg Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria None Consulting Fees None Other None 2
Managing Potential Bias Not Applicable 2
QI Project Background ▪ Terrace physicians require the knowledge and ability to plan, implement and evaluate projects that target change. ▪ Several physicians have participated in QI workshops to date; but still do not feel they have the skills to lead a QI project. ▪ Terrace Physicians Initiative Group Society (TPIGS), the Terrace Medical Staff Association, is developing and with this additional physicians are becoming involved. ▪ There is new interest in approaching health care improvements from a QI approach. 3
Aim Statement By March 2019, 50% of Terrace physicians will show: ▪ a 50% increase in their knowledge of quality improvement. ▪ involvement in QI projects and activities. ▪ competence to move QI theory into practice. ▪ confidence in leading QI projects and activities. 3
Project Team Physician lead - Dawid van Rensburg MSA lead - Sarah Panofsky PQI Coach - Lee Cameron MSA physicians Health Service Administrator - Chris Simms Director of Care – Shirley Nichol 3
PDSA Cycles Through collaboration between TPIGS & PQI , quality improvement education was provided to Terrace physicians: ▪ High intensity 8 hour QI workshop ▪ Individual IHI online Open school ▪ All other avenues of teaching - i.e. IHI conference ▪ PQI workshops 3
High Intensity QI Workshop 3
Outcome, Next Steps ▪ Highly effective way to introduce QI knowledge ▪ Further integration across the board needed ▪ We wanted engaged physicians - Now what…. 3
My PQI Experience Perceived barriers in working together is mostly artificial. Access the expertise and support available 3
QUESTIONS / CONTACT Dr. Dawid van Rensburg djvrmed@gmail.com (250) 615 6003
Physician Quality Improvement (PQI) Rapid Fire: Physician Engagement – FE and PQI Working Together Dr. John Hwang Royal Columbian Hospital New Westminster, BC November 19 th , 2018
Disclosure Presenter / Faculty Dr. John Hwang Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria None Consulting Fees None Other None 2
Managing Potential Bias Not Applicable 2
RCH Physician QI Leaders $$$ ROI ? 3
RCH Physician QI Leaders 3
Format • 50% QI Project Presentations • 50% “Strategizing” 3
“Strategizing” • Support • Align • Robust Local QI Program 3
Building a Local QI Program • Local PQI/FE Project Coordinator • Local Physician QI Lead • Local Frontline QI Program 3
Outcome Robust Local QI Program Strong Frontline QI Culture Measurable Results Continuous Improvement 3
QUESTIONS / CONTACT Dr. John Hwang john.hwang@fraserhealth.ca (604) 354-9756
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