The Patient Experience

The Ottawa Hospital (TOH) recently embarked on a journey to become a leader in quality and patient safety in North America. Seeking to perform in the top 10 per cent, three processes have been implemented to significantly transform clinical services, thus improving quality, enhancing service and reducing cost.

1. Hourly rounding: A protocol that incorporates eight specific actions/standards into rounds, our hourly rounding practice sees patients visited every hour from 6 a.m. to 10 p.m., and every one to two hours from 10 a.m. to 6 p.m.
2. Bedside shift report: This clinical practice improves communication at nursing shift changes and, in turn, the quality and safety of patient care. It is aimed at standardizing the exchange between nurses that occurs at the patient's bedside at the change of a shift. TOH’s approach to the process includes the following elements to ensure top-quality patient care and safety: a verbal report, in-room safety check, update to the Care Board, and a signed Transfer of Accountability. Care Boards are erasable white boards that are located in a patient’s room containing standard information, updated routinely so that any member of the care team, the patient and patient’s family can understand what is happening with their care, quickly and easily.
3. Post-visit phone calls: These calls provide opportunities to improve clinical outcomes by identifying safety and quality of care issues, reducing readmissions and improving patient satisfaction. We have also begun trialing post-visit phone calls to patients using Patient Call Manager software.

The Conservative Hip and Knee Class (CHAKC) Program is launched

This year we launched the Conservative Hip And Knee Class (CHAKC), a four-week program caring for patients with hip and knee arthritis as they await therapy or surgery. Through twice-weekly exercises at the Riverside Campus, each class invites six patients to an hour-long gym circuit and education session led by a physiotherapy or rehabilitation assistant, under the supervision of a physiotherapist. The program focuses on self-management, safe exercise, pain management and pacing, as well as strategies to continue exercise once the classes are completed. Since the inaugural class in June 2011, more than 80 patients have gone through the program with very positive results: some patients have even delayed or cancelled their surgeries as they no longer felt it was necessary. Patients also enjoy the group format, which offers collective motivation and encouragement, the proof that they could exercise safely and without significant repercussion and the knowledge that they are not alone.

New CANVent facility opens

This year, TOH celebrated the grand opening of the new CANVent facility. CANVent – also known as Canadian Alternatives in Non-invasive Ventilation – is an innovative program that helps keep patients at higher risk of developing serious complications from simple upper respiratory tract infections out of hospital. CANVent offers critical support to patients who would otherwise require emergency visits or critical care admissions as a result of something seemingly benign, such as an upper respiratory tract infection. Through enhanced awareness, patients are identified, referred and evaluated for risk of respiratory failure, sleep-related respiratory insufficiency and limited airway clearance. Simple but effective strategies are taught to patients and caregivers in order to recognize illness, increase cough capacities and ensure adequate airway clearance. Unique to TOH, the CANVent facility has treated patients coming from as far away as Toronto.

Endometriosis care: Excellence at the national level

Those with endometriosis often suffer in silence from pain and/or infertility, without showing any external signs. Through education, support and guidance, women living with this condition can see a significant improvement in their quality of life, yet expertise in this area remains extremely limited. At The Ottawa Hospital, we have created a team approach to help these women get their lives back. Diagnostic imaging, general surgery, urology, gynaecology and the Pain Clinic have all seen many patients with these issues and are beginning to work together. Under the leadership of the Division of Minimally Invasive Surgery in the Department of Obstetrics and Gynaecology, complex cases of pain, infertility and deep organ involvement are managed with excellent surgical and medical care principles, unlike anywhere else in the country. The Shirley E. Greenberg Women's Health Centre hosts a clinic dedicated to difficult surgical gynaecological consults. This clinic is led by two nurses who have been committed to the program for the last five years. This past year some staff received national and international recognition for their educational and clinical leadership: Dr. Sony Sukhbir Singh received the Canadian Association of Professors of Obstetrics and Gynaecology’s President's Award for his "tireless commitment and valuable contribution" to gynaecology education, while Drs. Karine Lortie and Hassan Shenassa were recognized for national research excellence and leadership in international surgical education with projects that have since crossed over to the United States and countries throughout Africa.

Sign language enhances TOH website

Always striving to give the highest-quality care, TOH seeks to provide patients with improved access to the information they need. To this end, the hospital now offers several key portions of its website in signed languages, and is the first health-care organization to do this. In order to ensure that people with disabilities have appropriate access to health-care services, TOH has been very active in recent years in identifying, removing and preventing the creation of barriers. Today, TOH is leading the way by providing several key portions of its website in American Sign Language (ASL) and la langue des signes québécoise (LSQ). With the help of the Canadian Hearing Society’s translation services, our online welcome message, visiting hours and guidelines, outline of Emergency Department wait times, and Accessibility page and feedback form, are now available in ASL and LSQ. We are committed to adding to this list in future.

TOH expands The Ottawa Hospital Inter-Professional Model of Patient Care

Over the past year, the implementation of The Ottawa Hospital Inter-Professional Model of Patient Care (TOH IPMPC©) has been rolled out with 90 teams across the five TOH sites. A guide that organizes the delivery of patient care among health professionals from different disciplines, TOH IPMPC takes into account the hospital’s core competencies, collaborative patient-centered practices, and our overall strategic direction. To enhance collaboration, patient care teams have made process changes based on this guide. By working together, health-care providers can now make better use of their skills and knowledge, and more effectively coordinate care based on patient need. As a result, patients receive higher quality care.

‘Cardiac Arrest with Roles Defined’ protocol enhances patient safety

The ‘Cardiac Arrest with Roles Defined’ (CARD) study aims to enhance patient safety in the operating room. Developed by a multidisciplinary team of doctors, nurses and health-care professionals, CARD combats two key problems that can prevent a team from functioning efficiently during a code: unclear role definition and overcrowding. By addressing these problems, CARD protocol provides enhanced safety for surgical patients. Using the CARD protocol, members of the OR team are assigned a specific role in the event of a code, and are given a card to wear during the resuscitation. The cards are printed with the role’s name and associated tasks, clearly defining to everyone in the room what the wearer must do during a code. By working together with the University of Ottawa Skills and Simulation Centre, this multidisciplinary team of health professionals and administrators is enhancing patient safety.

The Ottawa Hospital engages stakeholders in its Cancer Program transformation

In an effort to become more patient- and family-centred, in 2011 The Ottawa Hospital’s Cancer Program initiated the ‘Patient’s Reference Panel on Cancer Program Transformation’. 15,000 recent patients and their families were contacted and hundreds of volunteers were recruited. Ultimately 36 panellists were randomly selected to participate in a series of group meetings as part of the Patients’ Reference Panel, which was designed to combine the direct experience of patients and their families with a balanced and detailed view of the Cancer Program’s operational abilities. It also drew together doctors, nurses and other program staff to identify those priorities that could have the most dramatic effect on the patient experience. The information collected from these sessions will ultimately be used to make changes that will improve the cancer care experience of patients and their families.

The Ottawa Hospital puts the finishing touches on the Cancer Centre

This year, The Ottawa Hospital completed the construction of the Cancer Centre by adding beautiful artwork to its walls creating a stunning healing space for patients going through treatment. Award-winning Canadian photographer Michelle Valberg provided the calming and inspiring photographs. Renowned for her soulful portraiture and stunning landscapes, Michelle possesses a magical combination of creativity, entrepreneurial spirit and community commitment. Understanding that there are enormous challenges in dealing with cancer, these beautiful photographs are already going a long way towards helping put patients at ease and providing much-needed inspiration.

The Ottawa Hospital offers high risk breast cancer screening

Ottawa area women who are at high risk for breast cancer now have access to a new Ontario Breast Screening Program (OBSP) High Risk Screening Centre at The Ottawa Hospital. Starting in July, The Ottawa Hospital began arranging genetic testing and counselling for women between the ages of 30 and 69 who were at high risk for breast cancer and is now offering these women an annual mammogram and breast MRI. Referrals to this program are based on specific criteria such as genetics, and family or medical history. This allows the women at high risk to be routinely updated regarding their health and gives them the knowledge to ask more informed questions.

The ‘Wellness Beyond Cancer Program’ is launched for an increasing population of cancer patients – the survivors

Providing care and support for people at the end of active cancer treatment, the Wellness Beyond Cancer Program ensures our patients get the follow-up care and resources needed to best manage their health. With ongoing research and medical advances in cancer care, many more patients are surviving the disease. As a result, The Ottawa Hospital developed this program to empower patients to assist in managing their own care and well-being, and help them transition back to their family doctors and the community. Upon admission to the cancer program, a patient will be asked for the name of their primary health-care provider and reminded to continue their non-cancer-related care with them throughout their active cancer treatment. If necessary, the cancer program team at The Ottawa Hospital Cancer Centre will work with the patient to find a primary care provider. When referred to the Wellness Beyond Cancer Program, at the end of active cancer treatment, the patient will be asked to complete a ‘needs assessment’. The needs assessment will help the patient self-identify their needs and will be used to arrange referrals to the appropriate community resources, allow program nurses to individualize their support of the patient, and assist patients to focus on group session content relevant to their needs. Once discharged from active cancer treatment, the patient and their primary care provider will receive a detailed individualized care plan summary, including diagnosis, treatment, cancer team, recommended surveillance and a summary of the patient self identified needs. The continued partnership of a patient’s family physician will ensure a seamless transfer of care once active cancer treatment is complete.

Implementation of the new Hip Fracture pathway

In April 2011, The Ottawa Hospital implemented a new Hip Fracture Pathway, based on the regional model created for the Champlain LHIN. This model looked at best practices across Ontario and created a standardized care path for patients, providing the optimum care. Since implementing the Pathway, the hospital has achieved its goal, ensuring that surgery for hip fracture patients takes place within 48 hours of admission. We have also optimized care to decrease the incidence of delirium as well as the risk of re-fracture by identifying osteoporosis early on and discussing treatment options with patients. By improving education to patients and their families as it relates to their care and stay at The Ottawa Hospital, we have helped manage their expectations and have reduced their anxiety.