Emergency Room Data Collection Expands

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1 Cancer Care Ontario s Access to Care welcomes you to the spring issue of the Access to Care Executive Update - providing you with the latest information about access to care initiatives. Emergency Room Data Collection Expands Nearly 100 Ontario hospitals gear up to expand their emergency room (ER) data collection efforts in support of the province s ER Wait Time Strategy. The Emergency Room National Ambulatory Initiative (ERNI), first introduced in 2009, measures and reports how long patients spend in ERs. With the addition of five new data elements, clinicians will soon collect 8 data elements related to the patient journey through the ER from arrival to departure. Emergency Room Data Collection Expands Q&A with CCO s New President and CEO ATC Survey: Long Wait Patients Ontario to Gain Real-time Picture of ALC Patients Information Strategy Updates 4 Data Quality Assessment Report Wait Times Continue to Improve The Access to Care Executive Update is produced by the ATC Communications Team. To subscribe/unsubscribe or send questions, comments and feedback, please contact us at With our efforts over the past two years, we are already seeing dramatic improvements, says Dr. Howard Ovens, Provincial ER Clinical Lead. The addition of specialist consult data will enable us to gain an even more thorough understanding of where some of the challenges lie and how to overcome them. The Access to Care (ATC) deployment model for ERNI gives hospitals an intuitive framework for project delivery, including the identification of specific leadership and project-related roles within each hospital; engagement with clinicians; change management; effective tracking of hospital progress and guidance and support materials. It s a recurring question, says Lynn Guerriero, Director, ATC. How is ATC able to get the already time-pressured ER clinicians and staff from hospitals across the province to record and submit under rigorous deadlines volumes of accurate, timely information that will meet stringent data quality standards? Ontario is the first province in Canada to establish ER wait time targets and publicly report results. The province has already seen reduced ER wait times and fewer patients leaving without seeing a physician. (cont d) ATC provided ERNI hospitals with posters acknowledging the significant efforts of hospital staff who are working with ATC to reduce ER wait times.

2 2 Zzz Emergency Room Data Collection Expands (cont d) The five new data elements that will be captured through ER expansion: Consult Request Date Consult Request Time Consult Request Service Consult Arrival Date Consult Arrival Time In April 2011, ERNI Expansion goes live with the collection of five new data elements related specifically to Specialist Consults. This diagram illustrates where the Specialist Consult is in the ER Length of Stay. Focus on York Central Hospital As ERNI Expansion 2011/2012 prepares to go live, York Central Hospital is engaging its medical leadership in ER data collection. The hospital designed a poster that personalizes the data collection issue by featuring some of its own doctors. We wanted to convey the importance of collecting accurate data. Good clinical documentation leads to improved patient care and also benefits the physician, says Dr. Karim Jessa, Director, Medical Informatics at York Central Hospital. Q&A with CCO s New President and CEO We asked Michael Sherar, Cancer Care Ontario s (CCO) new president and CEO to share his thoughts on ATC. Here s what he told us. What message would you like to send about ATC to external stakeholders? In my first few months at CCO what has impressed me most about ATC is the quality of work, diversity of skills and commitment the ATC team brings to the work they do. Some people may be surprised to learn that through ATC, Ontario currently reports on wait times for over 190 different procedures and diagnostic exams. CCO s ATC team continues to be an integral part of the Ontario government s Wait Time Strategy. In my role, I am looking forward to further leveraging the expertise of the ATC team with respect to their highly effective deployment process for mobilizing and engaging hospitals across the province. It's truly impressive. What excites you about ATC? ATC has already demonstrated its capacity to make a real difference in the patient journey by supporting improvement through information, analysis and reporting. ATC brings to light challenges and opportunities for improving access to care in Ontario. I'm looking forward to seeing continued achievement of access improvements through ATC. Find out more about improvements in wait times in Ontario - Wait Times Continue to Improve.

3 ATC Survey: Long Wait Patients A recent ATC survey identified the most significant barriers to discharge for Ontario s longestwaiting ALC patients. ATC collected information at a single point in time on ALCdesignated patients waiting more than 40 days to move to a more appropriate level of care. The unexpectedly high volume of these patients close to half of all ALC patients signaled that the longstanding problem is only escalating. The numbers were spread almost evenly across acute and post-acute care beds with more than 80 percent awaiting long-term care placement. The results clearly convey the urgency and extent of the problem for all healthcare providers and health policy leaders attempting to manage the problems, says Dr. Peter Nord, ATC Physician Champion for ALC. These survey findings also open the door to the development of targeted strategies that focus on the longest-waiting ALC patients who are putting the most strain on the system. The survey data opened a window on the issue, says Rose Cook, Senior Consultant, ER/ALC Projects, Toronto Central LHIN. ATC s information enabled us to better assess the long stay ALC issue in our LHIN and put in place actionable strategies to transition clients to more appropriate levels of care. Ontario to Gain Real-time Picture of ALC Patients Beginning in May, Ontario will for the first time gain access to near real-time data on the province s Alternate Level of Care (ALC) designated patients and how long they are waiting for an appropriate level of care. As part of its ALC program, ATC will begin collecting information on these patients in 94 acute-care and 20 post-acute care facilities, representing more than 9 percent of the province s hospital beds. The hospitals will begin submitting real-time data to the Wait Time Information System (WTIS) in May. This is a very exciting development with the potential to significantly improve patient care and the quality of our healthcare system, says Lynn Guerriero, Director, ATC. The program positions Ontario as a leader in this area as the first province to collect standardized, near real-time ALC data. The information collected will be used to improve patient flow, reduce ER wait times, and inform decisions regarding the allocation of resources for hospitals and communities. This program was introduced in recognition that this is a complex systems issue, says Ms. Guerriero. When ALC patients are waiting in hospital beds for a more appropriate destination, it has a significant impact on overall patient flow including for those patients waiting to be admitted to the hospital. ATC was selected to participate in a poster session at the annual Taming of the Queue conference in Ottawa in March. The image above outlines the results of the ALC long wait survey.

4 4 Information Strategy Cancer Care Ontario s Information Strategy supports CCO s work to improve performance under the Ontario Wait Time and the ER/ALC Information Strategies, as well as CCO s efforts in support of the Ontario Cancer Plan and the Ontario Renal Network. The strategy is built on four interdependent elements, each with key objectives and supporting activities: Updates Ontario appoints new advisor on Alternate Level of Care The former dean of the Faculty of Health Sciences at Queen s University has been appointed Provincial ALC Lead by Ontario s Ministry of Health and Long- Term Care. Dr. David Walker will advise the ministry and guide the implementation of strategies designed to address the increasingly serious challenge of ensuring patients receive the appropriate level of care. His team will visit areas of the province with the greatest ALC challenges where they can assist in introducing action plans for moving patients into more suitable care environments. Dr. Walker was the chair of the Expert Panel on SARS and Infectious Disease Control in 200. He also headed an independent review of the 200 legionnaires disease outbreak in Toronto. In 2007 he was appointed inaugural Chair of the Board of the Ontario Agency for Health Protection and Promotion. infrastructure people, processes and technology that provide a robust foundation for the delivery of actionable information and technology products and services; instrumentation development and deployment of comprehensive, integrated information and technology solutions across the patient journey; informatics analysis and reporting of data in a way that provides actionable information to decision makers for performance management; and innovation innovative use of information and technology to deliver business value. New standard procedure service areas for SETP reporting The Surgical Efficiency Targets Program (SETP) has implemented standard procedure service areas for reporting purposes. Standard service areas enhance SETP reporting by enabling a more detailed analysis of key performance indicators and improving comparability across hospital participants. SETP reporting by standard procedure service areas is available in iport Access and has been incorporated into reports since November SETP Standard Procedure Service Areas Anaesthesiology Cardiac Surgery Endoscopy General Surgery Gynaecologic Surgery Neurosurgery Obstetrics Surgery Oncology Surgery Oral and Maxillofacial Surgery and Dentistry Orthopaedic Surgery Otolaryngolic Surgery (ENT) Plastic and Reconstructive Surgery Thoracic Surgery Transplant Surgery Urologic Surgery Vascular Surgery

5 Data Quality Assessment Report The Wait Time Information System (WTIS) Data Quality Assessment Report 2009/10 analyzed data based on the four dimensions of CCO s Data Quality Framework timeliness, validity, reliability and usability, and found the following results: Overall WTIS data quality at the provincial level was rated high ; based on the assessment of wait time data from 94 facilities. During 2009/10, 7% of surgical waitlist entries were entered within two business days of the Decision to Treat Date and/or Procedure Date. MRI/CT submissions were at 98%. The validity dimension was assessed as appropriate. Completeness and comprehensiveness were rated as good. The reliability dimension was assessed as moderate. The usability dimension was assessed as appropriate. ATC Informatics continues to provide high quality wait time information on the public website, monthly reports and through iport Access. For further information on this report, please contact the CCO Corporate Data Quality Improvement Team at: on.ca. Wait Times Continue to Improve Seventy five percent of patients in Ontario and British Columbia receive treatment/surgery within government benchmarks for all treatment/surgery types. This is one of the findings in this year s Canadian Institute for Health Information (CIHI) annual report on wait time improvements, Wait Times in Canada A Comparison by Province, Released in March, the report notes Ontario s continued wait time progress, providing an overview of wait times for five priority areas: cancer treatment, cardiac care, diagnostic imaging, joint replacement and sight restoration. With very short wait times across most priority service areas compared to other provinces, Ontario remains a national leader. The CIHI report confirms the sustained improvement of wait times in Ontario, says Dr. Jonathan Irish, Interim Clinical Lead, Access to Services and Wait Times, Province of Ontario and Provincial Head for the Surgical Oncology Program at Cancer Care Ontario. At the same time, Ontarians are waiting less for most surgical and diagnostic procedures. However, wait times for some surgeries have increased and these areas will continue to need close monitoring. These include otolaryngic surgery, other orthopaedic surgery and some other ophthalmic surgeries. Among the other findings in the report: Ontario continued to see a decrease in wait times for knee replacement and cancer radiotherapy between 2008 and 2010, while no change was observed for hip replacement and cataract surgery. 90% of patients in Ontario received treatment within the benchmark for three out of six procedures in Ontario is one of only five provinces that report wait time information for CT scans and one of four provinces that report wait time information for MRI scans in a manner that permits comparison; Ontario has shown a decrease in wait times over the last year for CT scans. Dr. Irish adds: The strong partnership of clinician experts, hospital leaders, LHINs and the ministry has made these improvements possible. Find out more about Wait Times in Canada A Comparison by Province, 2011.

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