Our healthcare system is facing unprecedented challenges related to overcapacity. There are so many patients moving through the system that any unnecessary waiting or delay in their progress creates ripple effects across the entire system. To improve patient flow, prevent unnecessary waiting for patients, decrease length of stay, and improve patient outcomes, eight pilot units across the province are involved in the project to implement the SAFER-f Patient Flow Medicine Bundle. This bundle helps improve communication with patients, move them through the system to achieve their care goals, and then safely focus on getting them back home as soon as possible. The goal of this program is to reduce unnecessary waiting in hospital for patients with success being contingent on collaboration, communication, and adoption of innovative ways to safely move patients towards discharge in a timely yet safe approach.
At the end of November, representatives the SAFER-f pilot units gathered with Quality Improvement coaches, Project Managers, and the SAFER-f provincial team in Truro for the third implementation of the Quality Improvement Collaborative and the first time in person! Quality improvement collaboratives (QICs) offer a unique opportunity for teams from across the organization to share, learn and 'take home' best practice examples, to support local improvement efforts.
“Your experiences, the actions you take to improve inpatient care, and what you will discover through testing your change ideas will pave the way for how high-quality inpatient care is delivered,” said Melissa Buckler, Network Lead of the Episodic and Integrated Acute Care Network.
Buckler said the outcomes that emerge from the successes on the pilot units will help stage the spread and scale of the SAFER-f Medicine Bundle across inpatient care within Nova Scotia Health.
“SAFER-f is more than a care directive and isn’t designed as a one-size fits all for patients. We encourage providers to use discretion – it’s not black and white and we invite you to challenge and find what works for you,” said Erin Leith, Director of Quality Improvement and Safety at Nova Scotia Health. “SAFER-f is a principle-based improvement where teams will implement the bundle in a way that works for them. Arguably type of improvement can be challenging, but it’s not about striving for perfection , but it gives license to act for patients within the framework.”
Leith acknowledged that the units are at different stages of implementation, but the day was about how we are working to improve patient care and experience.
Sean Seames, Health Services Manager at the South Shore Regional (Bridgewater), said rounds and visualization boards have helped improve communication across the spectrum of care providers on their unit.
“One area we would see an improvement is if SAFER-f was implemented in our emergency department,” said Seames. “Our physicians note that the patients who are in emergency beds waiting to come to our floor are too late by the time they get to our unit. They are the most likely to benefit from SAFER-f but by the time they get here it may be too late.”
Amber Humes, Health Services Manager at the Hants Community Hospital, agreed that including SAFER-f principles into bullet rounds has shown early successes.
“I really enjoy looking at Tableau to see our data and the improvements – we are seeing shorter Length of Stays, and more accurate expected Date of Discharge, said Humes. “Our clinical leader is incredible and supportive, and this has been very helpful.”
Additionally, Humes said the 4 Q’s help communicate with patients, but they also help communicate with families and “That’s a big win!” she says.
Humes shared that a challenge her unit is facing is that they have more than fifty per-cent Alternate Level of Care (ALC) patients. The team also feels the need for after hours and weekend allied health coverage to prevent patients from losing progress or decommissioning over the weekend.
John MacIntyre, Unit Manager at the Glace Bay Hospital, expressed that commitment and support from zone leadership and communication are essential parts of the successful implementation of SAFER-F.
“The visualization board and bullet rounds help improve communication, respect, team collaboration right at the start”, said MacIntyre. “We have worked to bring our physicians on board which involved them having to change their previous practice for rounds. They were asked to change their practice of seeing those patients ready for discharge first rather than prioritizing their own patients which was a long-standing practice. Having the bullet rounds helped us bring them on board to this change and they definitely see it as a benefit,” said MacIntyre.
Participants also had the opportunity to share their Plan, Do, Study, and Act (PDSA) Cycles and work through challenges and opportunities. The PDSA Cycle involves implementing elements of the SAFER-f Patient Flow Medicine Bundle and evaluating how small tests of change can improve processes.
Shannon Andersen, Manager of Patient Services at Colchester East Hants Health Centre, said that with every PDSA cycle, she sees a lot of affirmation in her unit is doing.
“When we started, it felt like it was just focused on nursing and we had to be intentional to pull in the larger team. This has been fabulous for everyone!” she says. “Our team uses white boards in every room and made their Four Questions signage much larger and laminated them for high visibility.
Andersen shared that although the red and green colour codes were new to team members, it has made it easier to share information across the larger team. She had templates built for the team so they can use their phones for data collection.
During the session, participants also discussed patient populations for which SAFER-f principles and tools don’t work. They received support to use their discretion on which patients receive the tools. For example, it is not appropriate to have conversations about expected date of discharge for a patient who is in a palliative care setting.
When teams from multiple healthcare sites come together to learn and share improvement methods and ideas, teams can better identify barriers in patient care within the healthcare system and provide solutions improve patient experience. While challenges remain, the discussion exemplified that change is possible and happening in our province’s healthcare system.