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Innovation in health care

A letter from the Winnipeg Health Region

BY ARLENE WILGOSH
Winnipeg Health Region President & CEO
Wave, September / October 2013

Arlene Wilgosh
Arlene Wilgosh

One of the big challenges of running a healthcare system is making sure that people have access to the right care at the right time.

That's true whether we are talking about the operation of community-based clinics or personal care homes. But it is especially true when we talk about our hospitals.

Although we here at the Winnipeg Health Region continue to look for ways to move health services into the community, hospitals remain the linchpin of our healthcare system.

On any given day, hundreds of patients come through the doors of our hospitals in need of care they can't get anywhere else. Some arrive via the Emergency Department, suffering from a stroke, a broken arm or a pain in the side. Others may be admitted for a hip replacement, heart surgery or kidney transplant.

But no matter what their particular needs, our goal remains the same: to ensure they get the best possible care, as efficiently and effectively as possible.

Which brings me to Dr. Dan Roberts.

As this story explains, Dr. Roberts is the head of the Winnipeg Health Region's Internal Medicine program. If you have spent a few nights recovering from a stroke or major surgery at the Health Sciences Centre, Grace, Victoria or St. Boniface hospitals, then chances are you have slept in one of the beds he is responsible for managing.

Dr. Roberts is also an innovator, in the sense that he is constantly looking for ways to use data to enhance the delivery of care. In 1988, for example, while serving as Director of the Intensive Care Unit, Dr. Roberts spearheaded the creation of the first Critical Care Database in Canada. He also developed a city-wide, integrated adult intensive care service. Both of these initiatives helped enhance the delivery of care within the Region.

More recently, Dr. Roberts and members of his department have been involved in a major project called the Overstay Reduction initiative. The initiative was launched last year, first at the Grace Hospital, then at St. Boniface Hospital, with one simple goal: to make sure patients do not stay in hospital longer than medically necessary.

The notion that some patients may not be discharged from hospital as soon as they are medically cleared may seem hard to fathom at first. After all, who doesn't want to get home as soon as possible?

But, of course, things aren't always as straightforward as they seem. It must be remembered that all the patients we treat have unique issues that must be factored into their care. Some, like the stroke patient highlighted in our story, may need to work with a physiotherapist or occupational therapist before they can be discharged. Others may need support from Home Care or a social worker before we can be sure it is safe for them to go home. In each case, we must ensure that the patient receives the care and support they need before they are released from hospital.

The problem is that sometimes that care is not delivered as efficiently as it could be. Research done by Dr. Roberts and his team, for example, revealed that overstays - the term used to describe patients who remain in hospital longer than medically necessary - happen more frequently than one might think. The numbers suggest that although 75 per cent of patients are discharged from hospital as soon as they are medically cleared, about 25 per cent stay longer than they should. Of this group, seven per cent stay an average of 25 days longer than necessary.

This poses a bit of a challenge because it means that we have some beds being used by people who should not be in hospital. And that means there is less capacity to accommodate patients in need of a bed from other areas, such as the Emergency Department, the Intensive Care Unit or surgery, which can result in a backlog of patients throughout the system.

Fortunately, Dr. Roberts and his team were able to identify some solutions to this problem. As our story explains, there are many components to the Overstay Reduction initiative. But the key is that it ensures patients at risk of not being discharged on time are identified soon after being admitted to hospital. This allows for a single staff member to take charge of the patient's file and make sure they get the services they need in a timely manner so they can be discharged when they are medically ready to go home. The result is staff at the Grace and St. Boniface hospitals have been able to reduce the average length of stay for all patients by 14 per cent, or about two days.

Since its launch at the Grace and St. Boniface hospitals last year, the Overstay Reduction initiative has been rolled out on selected wards at the Health Sciences Centre and Victoria Hospital. Once the initiative is fully implemented, it is expected to significantly improve the flow of patients at all four hospitals. It is important to note that similar types of initiatives are also underway at Seven Oaks and Concordia hospitals, albeit with slight differences to accommodate the needs of those community-based facilities.

As I have written previously in this column, one of our main goals here at the Region is to improve patient flow throughout the system. The good work being done by people in the Internal Medicine program is just one example of how we are working toward this objective. There are many other innovative efforts underway within the Region that will ultimately help us deliver care more efficiently and effectively.

All of these initiatives will help us build a more sustainable health-care system, one that ensures taxpayers are getting value for their dollars. But most of all, they will help us deliver on our pledge to ensure people living in our community have access to the right care at the right time.

Wave: Sept / Oct 2013

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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