CODE ORANGE Rapid Fire: Physician Engagement - FE and PQI Working - - PowerPoint PPT Presentation

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CODE ORANGE Rapid Fire: Physician Engagement - FE and PQI Working - - PowerPoint PPT Presentation

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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

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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

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Disclosure

Relationship with commercial interests Grants/Research Support None Speakers Bureau/Honoraria None Consulting Fees None Other None

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EOC

ED Traum a Med. Surg. ICU Trans- fusion OR Rad.

EOC

ED Traum a Med. Surg. ICU Trans- fusion OR Rad.

Ideal VGH 2017

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EOC

ED Trau ma Med. Surg. ICU Trans

  • fusion

OR Rad.

By June 2018, ED and Trauma at VGH will be prepared for any traumatic mass casualty incident or disaster.

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May 2017

FE Funding Jun 2017

Jul 2017 Nov 2017 May 2018

PQI Cohort 1 Sep 2017

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STAFF STUFF SPACE SYSTEM

Coaches (PQI, FE) Support staff (PQI, FE) Teachers (PQI) Physician Funding (FE) QI Framework (PQI)

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We need dedicated funding to improve this

Number of respondents

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EOC

ED Traum a Med. Surg. ICU Trans- fusion OR Rad.

EOC

ED Traum a Med. Surg. ICU Trans- fusion OR Rad.

Aim Achieved

Christopher.Lee@vch.ca

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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 19th, 2018

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Disclosures

3
  • No relevant disclosures
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Bed ouch Plops One 2017 Karen Barker PMR

~50 000 children with asthma

Over 2400 ER visits

~ 600 hospitalizations ~30 ICU admissions 1 death

A year of pediatric asthma in BC

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Current Guidelines

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BCPAN: BC Pediatric Asthma Network

Practitioner Education

Guideline Dissemination Training the Trainers

Community Asthma Care

BCCH ED Action Plan Project BCPAN Workshops

Asthma Tool Kit

Asthma Education Video Asthma Education Learning Module

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Partners and Stakeholders

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  • 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
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BCCH ED Action Plan Project

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  • 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.

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BCCH ED Action Plan Project

3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 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 Percent

% of Patients Given Asthma Action Plan

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What’s next?

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  • 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

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My QI Experience

3
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  • Dr. Claire Seaton

Claire.seaton@cw.bc.ca

QUESTIONS / CONTACT

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Physician Quality Improvement (PQI)

Rapid Fire: Physician Engagement – FE and PQI Working Together

  • Dr. Daniel Boston

Psychiatry – Victoria, BC

November 19th, 2018

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Disclosure

2

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

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Managing Potential Bias

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  • Own slides and project
  • Project medications decided by working group
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QI Project Background

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Antipsychotics primary treatment of psychosis

  • Common issues:
  • polypharmacy
  • side effects
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Aim Statement

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Among admitted 17 to 35 year first episode psychosis patients at Royal Jubilee Hospital by March 31st, 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%
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Project Team

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  • 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
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FE & PQI Linkage(s)

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  • Engagement/QI working groups
  • Engagement/QI event
T E C H N I C A L C U L T U R E
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PDSA Cycles

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  • Engagement/QI working groups
  • Engagement/QI event

Technical

  • Clinical Order Set

Culture

  • Working Groups
  • Schizophrenia
  • Bipolar and PRN
  • Engagement event(s)
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Preliminary Outcomes

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Target Change Actual Change Length of Stay ▼ 5% ▼ 19% AP Polypharmacy ▼ 30% ▼ 23% Baseline Current Change Admit Lipids 3% 54% ▲ 51% Admit Glucose 26% 85% ▲ 59% Admit Weight 7% 86% ▲ 79% D/C Weight 54% 66% ▲ 12%

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My PQI Experience

3
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  • Dr. Daniel Boston

daniel.boston@viha.ca

QUESTIONS / CONTACT

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Physician Quality Improvement (PQI)

Rapid Fire: Physician Engagement – FE and PQI Working Together

  • Dr. Dawid van Rensburg

Terrace, BC

November 19th, 2018

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Disclosure

2

Presenter / Faculty

  • Dr. Dawid van Rensburg

Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria None Consulting Fees None Other None

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Managing Potential Bias

2

Not Applicable

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QI Project Background

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▪ 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.

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Aim Statement

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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.

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Project Team

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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

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PDSA Cycles

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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

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High Intensity QI Workshop

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Outcome, Next Steps

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▪ Highly effective way to introduce QI knowledge ▪ Further integration across the board needed ▪ We wanted engaged physicians - Now what….

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My PQI Experience

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Perceived barriers in working together is mostly artificial. Access the expertise and support available

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  • Dr. Dawid van Rensburg

djvrmed@gmail.com (250) 615 6003

QUESTIONS / CONTACT

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Physician Quality Improvement (PQI)

Rapid Fire: Physician Engagement – FE and PQI Working Together

  • Dr. John Hwang

Royal Columbian Hospital New Westminster, BC

November 19th, 2018

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Disclosure

2

Presenter / Faculty

  • Dr. John Hwang

Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria None Consulting Fees None Other None

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Managing Potential Bias

2

Not Applicable

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RCH Physician QI Leaders

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ROI ?

$$$

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RCH Physician QI Leaders

3
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Format

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  • 50% QI Project Presentations
  • 50% “Strategizing”
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“Strategizing”

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  • Support
  • Align
  • Robust Local QI Program
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Building a Local QI Program

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  • Local PQI/FE Project Coordinator
  • Local Physician QI Lead
  • Local Frontline QI Program
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Outcome

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Robust Local QI Program

Strong Frontline QI Culture Measurable Results Continuous Improvement

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  • Dr. John Hwang

john.hwang@fraserhealth.ca (604) 354-9756

QUESTIONS / CONTACT