EZ Medicine Quality Council - SCIC Newsletter

EZ MEDICINE QUALITY COUNCIL-SCIC EZMQC-Strategic Clinical Improvement Committee -Quarterly Newsletter

September 2019

Publications "Deprescribing benzodiazepines among hospitalized older adults: A quality improvement initiative" in BMJ Open Quality. – Congrats to Dr F. Carr and Team “High-users of acute care in a teaching hospital: A deeper dive into predictive patient and system factors” Canadian Journal of General Internal Medicine –Congrats Dr A. Gantayet , Dr N. Kassam and Team

International and National Conferences Poster Presentations: 1. The international Society on Thrombosis and Haemostasis in Melbourne Australia Title: Time from suspected thrombotic thrombocytopenic purpura to initiation of plasma exchange in Alberta Canada and impact on survival: A 10 year provincial retrospective cohort study, Authors: Dr D. Sawyer and Dr L. Sun 2.IIHI/BMJ International Forum on Quality and Safety in Healthcare 2019 in Taipei Title: Targeting Incomplete Bowel Preparations for Inpatient Colonoscopies, Authors: Dr L Russell, Dr A Kohansal and Team

Oral Presentations: 1. 2019 International Conference on Residency Education (ICRE) Title: Using Quality Improvement (QI) Methodology to Develop a Standardized QI Educational Curriculum for Internal Medicine Residents, Authors: Dr C. Collins, Dr N. Kassam and Dr A. Tapardel 2. 2019 Canadian Society of Internal Medicine (CSIM) Conference Title: Utilization of Prophylactic Azithromycin in Patients with Frequent COPD Exacerbations, Authors: Dr K. Liu and Dr A. Hirji

Access Partnership Project In an effort to establish linkages between Specialty and the community providers The telephone consultation system – Connect MD will be reviewed and Trialed in the Fall/Winter 2019 by specific sections

Connect Care Update Connect Care Wave 1 launch: NOVEMBER 3, 2019 Physician Update Wave 1 Patient Movement Day – SAVE THE DATE Patient movement day offers a unique opportunity for clinicians to take a practical look at what in-patient journeys will look like in Connect Care. All physicians, prescribers, nurses, allied health and other staff are encouraged to attend.

They can see and learn about how complex patient movements are coordinated with clinical information system (CIS) tools and workflows.

Wednesday September 18, 2019 from 08:30 to 16:00, Bernard Snell Hall, Walter C. Mackenzie HSC Details: Byte: Patient Movement Day

Connect Care MD Training and CPD credit Basic training for Wave-1 physicians has now started! If you have NOT already registered for basic and personalization training sessions please immediately contact: mip@ahs.ca Connect Care physician training is eligible for Continuous Professional Development (CPD) credit. The Royal College of Physicians and Surgeons of Canada have approved up to 12 hours training for credit.

Mandatory Privacy Awareness Training All physicians must complete privacy awareness training prior to gaining Connect Care access. This can be done independently and online by completing “InfoCare: On Our Best Behaviours” through MyLearningLink.ahs.ca (MLL).

MLL has a “Required Courses” menu item and section. Note that the many courses listed are not required of physicians, with the exception of InfoCare. Physicians will receive explicit instructions in their Connect Care training packages about which modules fit their needs. However, all courses are available for those interested in getting additional training.

Details: MyLearningLink for Physicians To stay up-to-date on all things related to Connect Care: http://www.bytesblog.ca/ Connect Care Clinician Handbook: http://handbook.ahs-cis.ca/ Operations Update: Playbook Chapter 5 released • 60 Day Launch Readiness Assessment (LRA) (Sept 4) • Clinical Operations Readiness Day summit (Sept 5) • Inpatient Cutover Dry Run: Sept 5 • Capacity Management and Financial Readiness day (Sept 6) • Inpatient Cutover Dry Run: Sept 17 • Patient Movement Day (Sept 18) • Shadow Charting (Sept 23 – Oct 18) for areas in Medicine, Oncology.

• End User training continues 30 Day Launch Readiness Assessment (LRA) (Oct 1) • Outpatient Abstraction (Oct 1 – 31) • Workflow Dress Rehearsals occurring throughout October • Research Enrollment Conversion (Oct 7 –Nov 1) • Medical Conversions (Oct 14 – Nov 1) • Command Centre: Build and Configuration (Oct 15) • Oncology Conversion (Oct 15 – Nov 1) • Inpatient Cutover Dry Run: (Oct 16) • Appointment Conversion (Oct 19 - 20) • Prepare Super Users for launch • End User training continues 

Non-Medical Device installation ends

Education around workflows occurring on the units August—November.

QI Basic Training EPIQ Workshop dates: Location: ECHA room: TBD October 23, 2019 - 12:30hrs - 1630hrs December 4, 2019- 0800hrs - 1200hrs January 22, 2020- 1230hr - 1630hrs March 10, 2020- 0800hrs - 1200hrs May 21,2020 - 12:30hrs - 1630hrs To register for a class please email UA Physician 'Lifelong Learning' <lll@ualberta.ca> or for further information please email: Taniya Birbeck <tbirbeck@ualberta.ca>

Featured Quality Improvement Projects Sun Safety

Reducing Length-of-Stay for Stable Antepartum

Project Lead: Dr. Marlene Dytoc

Patients

Currently only 18% of Canadians wear sunscreen daily. There are many gaps in knowledge that lend to this low participation rate in sun protection. Early protection is especially important as there is a positive association between early age sunburn and subsequent risk of melanoma. There are identifiable gaps in the knowledge and sun safety practices among elementary school children. As these gaps can be addressed at an early age, awareness campaigns in elementary schools are especially important in developing lifelong sun safety behaviors.

Project Lead: Dr. Winnie Sia

Our project team developed a 30-minute presentation and accompanying questionnaire to be completed by students before and one week after the presentation. The presentation focused on practical sun safety knowledge while the questionnaire tested this knowledge and reported the child’s sun safety behaviors.

The students achieved an average 18.5% improvement in knowledge-based questionnaires after our presentation. One week after the presentation, students reported improved sun safety practices including wearing sun screen more often and bringing protective gear (including hats and sunglasses) to school.

A key area of opportunity identified for future exploration is to support student access to sun protective gear (sunscreen, hats, sunglasses, etc.) while at school. Our project team’s recommendation, is the concept of a ‘sun safety class room’; for this classroom there would be the addition of sunscreen to the annual school supply list and the additional request of a hat and sunglasses to be kept at school similar to the current school practice of keeping students indoor running shoes in the classroom.

Moreover, a reminder by the teacher is suggested for students to put on sunscreen and sun gear before heading outdoors. Also, for under privileged schools, hypo allergic sunscreen samples could be supplied by sunscreen donor companies.

The Royal Alexandra Hospital (RAH) is the obstetrical tertiary referral center for northern Alberta, northern British Columbia, and the Northwest Territories. Many out-of-town prenatal patients are admitted to the RAH antepartum ward due to prematurity (threatened preterm labor, premature rupture of membranes (PPROM), short cervix, and cervical incompetence).

In the case that these patients are stabilized, Canadian guidelines recommend community-based or at-home management until birth. However, out-of-town patients often remain admitted to a RAH inpatient ward because of a lack of appropriate or affordable housing in Edmonton. These admissions can be for an extended period of time which consumes costly inpatient beds which should be for acutely ill patients.

Additionally, patients who stay admitted undergo daily unnecessary medical interventions, have limited privacy on the wards and reported experiencing decreased quality and quantity of sleep.

Alberta Perinatal Health Program, 2016 data showed 1186 patients were admitted to RAH with PPROM and cervical diagnoses, and 133 patients for >7 days (2823 bed-days).

These admissions account for at least $1.8 million annually.

Amongst this cohort, 48% of patients reside outside the Edmonton zone. This data identified the opportunity for exploring antepartum outpatient accommodation alternatives.

The aim of this QI study is to decrease the overuse of acutecare beds in the RAH antepartum ward while improving patient experience. The intervention is to provide appropriate out-of-town prenatal patients who have been stabilized after initial medical assessment an alternative accommodation in an outpatient setting (boarder rooms located in a building attached to the RAH) until they deliver or are safe to return to their home community. Two boarder rooms will be trialed in late September 2019.

2019 EZMQC-SCIC Meetings: Save the date! December 5, 2019 Contact Us Pamela Mathura-QI Consultant pam.mathura@ahs.ca Photography: Navi Gill (Medical Student) providing sun safety presentation to a grade six classroom.

Dr. Narmin Kassam-Associate Chair, Clinical Affairs nkassam@ualberta.ca

Yvonne Suranyi-Executive Director EZ EZMQC-Strategic Clinical Improvement Committee Dedicated to QI Capacity, Capability and Collaboration Visit Us: https://www.ualberta.ca/department-of-medicine/ezmqc-scic