Patient-Centred Innovation

Since April 2019, the Diagnostic Imaging Outpatient Centre (DIOC) has been improving patient access and reducing wait times for CT exams. Located at Misericordia Health Centre, the DIOC’s walk-in CT delivery model diverts less-urgent and non-urgent outpatient exams from acute centers, improving patient access and reducing wait times.

Initially selected in 2018 to represent Manitoba in the national SPOR iCT Rewarding Success Funding Opportunity, the DIOC proposal focused on balancing increased patient access with funding models that improve sustainability. It was ultimately rewarded with project funding by Manitoba Health, Seniors and Active Living.

The model was created to improve access, increase efficiency and ensure sustainability over the long term. Since opening at Misericordia Health Centre, more than 1200 additional exams and an extra 300 walk-in exams have been provided through the clinic’s expanded hours. Evaluation has shown a 37 per cent decrease in the cost per CT exam performed at the site and survey results indicate high patient satisfaction with the new service, which offers convenient hours at an out-patient facility.

Progress is tracked in several ways, including patient satisfaction (via survey), cost per exam and CTAS 4 and 5 volumes presenting to Emergency Departments for CT scans. Indicators show improvements across all categories and the DIOC shows promise as a model that could be used in other settings throughout the province or for other services.

The Manitoba Acute Coronary Syndrome (ACS) Network has introduced optimization and standardization in the care of coronary artery disease across the province. After implementing 17 provincial standards based on national and international guidelines, the Network has helped ensure patients are receiving harmonized therapy while identifying targets for improving patient care.

The standards created by the Network have helped improve patient care in both Winnipeg and rural communities. They ensure rapid identification of ST-Elevation Myocardial Infarction (STEMI) and patient transport to the Cardiac Centre for therapy.

The care processes outlined empower clinicians to make critical decisions to avoid treatment delays and improve patient outcomes. Collaborative partnerships with provincial and federal stakeholders have helped advocate for ACS resources in remote Manitoba communities, including immediate access to fibrinolytic agents and point of care troponin testing.

Numerous partnerships have helped the Network effectively communicate evidence-based clinical practice for treating ACS patients, gain a better understanding of the barriers faced in treatment across various Manitoba regions and share electronic data so clinic metrics and outcomes can be tracked and reported on.

Since implementation, the ACS Network has seen a reduction in STEMI and NSTEMI mortality rates. Time between first contact, identification and intervention has also been reduced.

Emergency Response Services (ERS) now perform ECGs when reporting for 911 calls related to chest pain. If a STEMI is diagnosed, they are able to avoid a trip to the emergency department and bring the patient directly to the Heart Cath Lab for treatment. This work has now been expanded to Southern Health-Santé Sud and Interlake Regional Health Authority.

The Manitoba Chronic Obstructive Pulmonary Disease (COPD) System of Care is transforming the way COPD is treated and managed. The initiative aims to deliver patient-centered care while reducing length of hospital stays, emergency department visits and chances of re-admission.

Less than five per cent of Canadians live with COPD, yet it is still the leading cause of emergency department visits and extended hospital stays in Manitoba. The COPD System of Care improves the relationship between acute and community care, allowing patients and their families to self-manage the condition and connect to community-based services. It also optimizes medications and therapies for patients in hospital.

The initiative—and groups working together—have developed a standard protocol across the province to help patients receive the same quality of service at any location. There is also a system to identify patients at high risk for re-admission and, if there is re-admission, community partners can contact acute respiratory therapy to update them and plan for eventual discharge.

The team believes these tools will help create a province-wide approach, and ongoing evaluation is helping measure outcomes against other Canadian provinces. They also analyze emergency room visits, hospital admissions and wait times. Since implementation the initiative has resulted in clearer communication, improved clinical resources and clinician experience, enhanced access to spirometry and quality assurance processes.

Digital Health, in partnership with Manitoba Health, Seniors and Active Living, has been working to coordinate business processes and digital health technology to operationalize Home Clinics through the Enrolment and Episodic Information Sharing (EEIS) project. A Home Clinic provides its enrolled patients with comprehensive, continuous and coordinated care, thereby improving health outcomes. This is a key step towards achieving a longer term vision of a robust, equitable and accessible primary care.

The project has introduced the following technical components:

• a Home Clinic portal to enable clinic registration,
• the ability for Home Clinics to enroll a patient directly from within an EMR,
• the ability for EMRs to download most recent patient demographics from Client Registry,
• addition of patient enrolment information in eChart Manitoba.

In 2020, the EEIS project is introducing new information sharing to support patient care in alignment with Manitoba’s Provincial Clinical and Preventive Services Plan. This will include the delivery of key patient information from the Home Clinic and Home Care program to eChart.

Moving Forward was designed to improve patient mobility on an acute medical unit at Health Sciences Centre Winnipeg. The initiative, created by a research team made up of members from quality and patient safety, physiotherapy and nursing departments received funding from the Dolly and Michael Gemby Nursing Fund through the Health Sciences Centre Foundation.

The initiative was created in response to the concern that patients were not adequately mobilizing, as units often waited for a physiotherapist to assess the patient. Moving Forward created a culture where early and sustained patient mobility were prioritized, both during their hospital stay and after discharge. Staff and patients were educated about the importance of mobility, participated in interviews on the topic, and patients recorded progress by tracking their mobility.

Study results showed length of hospital stays decreased during the intervention period but sadly this was not sustained in the post intervention period. Falls also declined in the intervention and post intervention period; there were no pressure ulcers reported through the entirety of the project. A decrease in patient activity following the intervention period underscores the importance of maintained efforts and ongoing monitoring for sustained success.

The Diagnostic Imaging (DI) No Show Campaign aims to reduce diagnostic imaging ‘no shows’ throughout the province in order to improve capacity and utilization while lowering the average wait time for patients.

The team implemented a ‘One Number to Fax’ initiative in 2018 and followed up with a ‘One Number to Call’ initiative in April 2019 across Winnipeg sites. Since the campaign’s inception, MRI no shows have decreased 27 per cent, resulting in a savings on average of 91 MRI appointments per month at Winnipeg sites alone. 

The ‘One Number to Fax’ expanded provincially from MRI to ultrasound at WRHA sites. The project will be expanded to sites across the province for ultrasound. Plans are also in the works to incorporate appointment reminder software, telephone and text, which are being tested currently.

The Rehabilitation Centre for Children’s (RCC) physiotherapy services has been re-evaluating how care is provided to infants referred for plagiocephaly and torticollis.

Located at the Specialized Services for Children and Youth (SSCY) Centre, a physiotherapy clinic model of care was implemented in 2017 after a national environmental scan and review of clinical practice guidelines. The project aimed to improve access to care by addressing wait times while maintaining high levels of patient satisfaction.

Originally developed to change the service delivery method at SSCY, physiotherapists from SSCY and the Children’s Hospital have come together to discuss and align management of these conditions. This includes statistical analysis of efficiency, access to services and a qualitative analysis of parent satisfaction. The results of this project will be made available in 2020. This work has been generously supported by the Children’s Hospital Foundation, Child Health Advisory Council Grant.

Translating Emergency Knowledge for Kids (TREKK) leads multidisciplinary pediatric education sessions targeted toward health-care providers working in emergency departments across rural and northern Manitoba. TREKK sessions include simulation training and brings together experts in the delivery of pediatric emergency care to share their knowledge and skills. TREKK has also developed a number of innovative family educational tools.

The initiative includes a variety of pediatric emergency specialists, including physicians, residents and STARS mobile education leaders. Its goal is to increase patient access to quality pediatric emergency care by sharing evidence-based information and training opportunities with health-care providers in various settings throughout the province. Since its inception, the initiative has visited eight communities and provided dozens of education sessions.

The RR5 SCI Rehabilitation team has worked to create a person-focused care model for sharing and tracking team goals with team members, patients and families to improve purpose of communication, accountability and engagement.

The process includes a meet and greet with patients and families within two weeks of admission. The meetings ensure the care team, patient and their family are involved in discussion of the rehab process, the anticipated length of stay and the prognosis based on injury.

The model improves patient engagement and prevents discharge delays. It includes a standardized process to review and set short term goals for patients, and incorporates the ‘Spinal Cord Independence Measure,’ which is used to identify areas for goal setting and evaluate outcomes.

Through the Eyes of the Auditor is a hand hygiene project developed in Health Sciences Centre Winnipeg’s Intermediate Intensive Care Unit (IICU) with the goal of improving staff awareness and compliance with hand hygiene policies.

The initiative included a series of videos created to educate staff on hand hygiene compliance and what the auditors are examining. Multidisciplinary teams, IICU staff and families watched the videos and participated in surveys to determine the effectiveness of the videos.

Monthly hand hygiene audit results have shown improved compliance with hand hygiene, and more frequent discussion among staff, patients and their families.

Through the Eyes of the Auditor was named one of the top projects of the year at the 2019 Critical Care Quality Symposium.

Medical Assistance in Dying (MAiD) services in Manitoba are provided by a highly-trained, inter-disciplinary team for patients across the province with centralized access to standardized services. The provincial team consists of physicians, nurses, social workers, speech language pathologists, administrative professionals, spiritual health providers and pharmacists who are dedicated to supporting a patient and their family through the eligibility review and medical assistance in dying process.

Team members coordinate patient intake, case review, consultation and assessment. They also provide support services to patients and their family members as well as education to health-care providers and the public.

The MAiD team debriefs regularly in order to continuously improve processes, procedures and share personal observations and learning.

Shared Health’s Hematopathology program has initiated implementation of patient-centric diagnostic pathways for lymphoproliferative disorders. These province-wide initiatives will result in a standardized multidisciplinary approach to lymphoma diagnosis and reduce unnecessary testing.

The new protocol streamlines integrated clinical-pathologic diagnostic pathways, pathology consultation services, and will support comprehensive patient management for lymphoproliferative disorders in a timely manner. The model encompasses triaging, early recognition and application of precise diagnostic testing algorithms to achieve superior clinical outcomes.

Rapid Access to Addiction Medicine (RAAM) clinics were introduced at locations across Manitoba in fall 2018. The clinics increase patient access to addictions services and provide a low-barrier entry point to care, including withdrawal management, initiation of evidence-based medications and referral to treatment programs.

Since RAAM was initiated, it has proven to be a positive example of collaboration and innovation. The model has resulted in the creation of various working groups, project development, cross-training and cost and resource sharing. The Winnipeg locations have provided care to more than 1,000 clients with substance-related concerns since opening.

The Living with Hope program is one of the first programs in Canada to directly treat suicidal ideation. Since its launch in the winter of 2018, the program has increased access and quality of care for patients experiencing mental illness and thoughts of suicide.

Located at the Crisis Response Centre (CRC) in Winnipeg, the program provides evidence-based treatment for suicidal ideation when identified by a patient who has recently experienced a mental health crisis. It has also created partnerships between clinical health psychology and psychiatry.

In 2016, Tissue Bank Manitoba and Southern Health-Santé Sud began work on an option that would offer tissue donation to clients in the region, expanding a service previously offered in Winnipeg Regional Health Authority (since 2003) and Interlake-Eastern Regional Health Authority (since 2015).

Thousands of Canadians receive tissue transplants each year. Heart valves, bone grafts and skin are just a few examples of tissues that can be donated.

The initiative went live in Southern Health-Santé Sud on April 24, 2019 with 11 designated facilities in the region participating in efforts to facilitate donation.