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Health Innovation Award for Patient-Centred Care – Winnipeg Regional Health Authority

Winnipeg Regional Health Authority 2019 Award Winners

Inherited Arrhythmia Clinic

The Manitoba Inherited Arrhythmia Clinic started in 2016. The only one of its kind in Manitoba, it is comprised of a multidisciplinary team of cardiologists, genetic counselors, and other health professionals that sees patients and families seeking identification of and care for inherited heart arrhythmia conditions. Family members can receive an assessment and noninvasive cardiac testing in a single clinic visit, saving them time while increasing clinical efficiency.

The Inherited Arrhythmia Clinic team has improved access for patients and family members needing specialist care, and has doubled the number of clinics it offers over the past 12 months. The team has also identified family members at risk for arrhythmia, which allows treatment to start sooner and reduces the risk of sudden death in an otherwise young, healthy person.

Priority Home Services (PHS)

Priority Home Services (PHS) is an innovative transitional home care service designed to support individuals at home who might otherwise be prematurely placed into long term care.

The program is focused on keeping patients, specifically seniors with significant care needs, safe in their homes for as long as possible using community supports. It is officially described as a short-term (up to 90 days) transitional, intensive, and restorative service available to eligible individuals who may need:

  • intensive case coordination
  • health-care aide or home-support worker assistance
  • rehabilitation services (occupational therapy, physiotherapy, social work, speech language pathology and rehabilitation assistants)
  • other home care supports

Evidence shows that once a client’s acute medical needs have been addressed, the longer they stay in hospital, the more likely they are to lose muscle strength, acquire an infection or fall. For this reason, the WRHA supports the initiative that suggests clients recover better in a home-like environment wherever possible.

Priority Home Services was introduced in order to provide the “right care, in the right place, at the right time,” to support an individual’s desire to return or remain in the community and to help improve patient flow in acute care facilities.

Use of Electrical Stimulation for Wound Care

In late 2016, a team of professionals at Deer Lodge Centre (DLC) became the first in Manitoba to explore the use of electrical stimulation for wound care. While the technology is not new, it had not yet been used in Manitoba, due to lack of expertise and protocols.

Some chronic wounds heal very slowly, do not heal at all, or worsen despite the use of rigorous wound care treatments and medications. Reasons for this are varied, but can include poor circulation, infection, edema, inadequate nutrition and repetitive trauma to the wound site.

For the electrical stimulation trial, the DLC team identified a patient with a pressure wound that hadn’t healed or closed over a two year period despite multiple interventions, medications and treatments. Using Electrical Stimulation Therapy, the patient’s wound received 60 minutes of electrical stimulation four or five times per week. Within 12 weeks, the wound size had been reduced by 98 per cent, and eventually, in combination with other interventions, it closed entirely.

The trial provided important local know-how necessary to add electrical wound stimulation to an already diverse set of wound care tools available to facilities in Winnipeg and Manitoba.

Winnipeg Regional Health Authority 2019 Award Nominees

Adult Medical Clinic Relocation

The Adult Medical Clinic (AMC) is an outpatient, multi-specialty clinic, located at Grace Hospital that sees hundreds of patients per week. The clinic was originally located on the fourth floor of the Dorothy Wood Building behind the main hospital. Elevator issues and the clinic’s distance from clinical and diagnostic testing facilities sometimes caused difficulties for patients with mobility issues.

In 2018, clinic staff saw the opportunity to repurpose space in the former Grace Emergency Department and move the AMC to the main hospital building. The new AMC is spacious, bright and accessible on the main floor, with a drive-up entrance just steps from the front door. All clinic rooms are wheelchair accessible and the laboratory for blood work is one short elevator ride away. The diagnostic department is on the same level as the new clinic, just steps away down the hall.

Alzheimer’s Centre of Excellence at Riverview Health Centre

The Alzheimer’s Centre of Excellence capital project was designed to reinvent Riverview Health Centre’s (RHC) special needs dementia units to reflect best practices in dementia care. This renovation project is transforming the design of living space for residents. Coupled with staff training and education, this project will greatly enhance the quality of care for residents and families.

As part of the project, RHC funded an international study to determine what changes were required to bring RHC to the forefront in providing the best possible quality of life for people in the final stages of dementia.

The team is examining the effects of the transformation on residents, specifically looking at how residents respond to the renovated environment in terms of use of the space, social interactions and sleep patterns. Their findings will record the impact and responses of residents, their families and the staff providing care.

The results of this body of work will be shared to inform the creation and building of other facilities for people with advanced dementia.

Cognitive Behaviour Therapy* with Mindfulness (CBTm)

The roll-out of CBTm classes at Access Fort Garry brought multiple disciplines together with the goal of enhancing access to community-based psychological interventions. The team focuses on offering evidence-based psychological interventions that help people learn new skills for managing issues such as anxiety and depression, sleep problems and relationship problems. Classes are led by trained facilitators who teach attendees about the basic principles and skills of CBT.

The classes offer community access to psychological therapies, interventions and streamlines referral processes.

To date, more than 200 people have had access to evidence-based psychological interventions through the rollout of CBTm. Feedback from clients indicates they appreciate the easy access and find the class material helpful.

*Cognitive Behavioural Therapy is a talk-based therapy method which seeks to identify and challenge the thoughts, images, beliefs and attitudes (cognitive processes) we hold in an effort to address emotional distress.

Cuddler Program

St. Amant’s Health and Transition Services facility (formerly called River Road Place) supports infants and children with developmental disabilities who are referred to St. Amant for specific clinical intervention. In many instances, these children have limited interaction with their families, who live in rural or northern communities.

Established in 2018, and supported by volunteers recruited and trained by St. Amant Volunteer Services, this program helps ensure that these infants and children have an opportunity to cuddle with a supportive adult on a daily basis. Cuddlers receive child-specific training as well as developmental-based training. For example, cuddlers are trained to “play” on the mats with each child, based on teachings of how to assist each child to reach developmental milestones such as sitting, core strength, leg and arm strength and speech and language development.

The project includes a monthly “cuddle schedule” that covers day, evening, weekend and statutory holiday coverage. Many infants and children are visited by multiple cuddlers a day. Quarterly statistics measure the number and hours of contact, the number of children cuddled and the number of cuddlers on the waiting list. There is a huge commitment from the volunteer cuddlers, with connections being built between the cuddler and the child, and between the cuddler and the staff.

Do No Harm – Fall Prevention

An Internal Medicine 30 bed- unit at St. Boniface Hospital has sustained a 70 per cent reduction in the rate of patient falls with or without injury from 2016 to 2019.

Falls are the most common type of occurrence to impact patients on this unit.

By applying Lean methodology and using daily management system tools, the clinical leadership team has been able to embed evidence-informed fall prevention initiatives into standard operating practices while developing a safety culture and problem-solving approach among front-line staff.

Employment and Income Assistance and WRHA Integrated Disability Assessment Panel

In the summer of 2018, the Downtown Point Douglas My Health Team put together a pilot program to reduce the average wait time for individuals applying for medical disability benefits. Clinicians from the community area My Health Team formed a medical panel to work together with Employment and Income Assistance (EIA)program managers to review applications.

As a result of this initiative, the wait time for applicants was reduced to an average of one week, down from a standard four to six week wait before the project was implemented. Decisions very rarely take more than two weeks. This successful team approach is now being implemented across other community areas.

This initiative in Downtown Point Douglas has resulted in improved access to and quality of care, and an enhanced patient and family experience that has reduced waiting time for decisions and responses. Decisions are made by EIA with rationale from a medical panel that has broad experience and knowledge in both the community area and the health-care system.

This work also engaged primary care providers in the community area to learn more about EIA and the application process through education and feedback.

Expecting the unexpected: Developing pathways for ophthalmology consult patient assessments

Patients referred for an ophthalmology consultation outside of routine clinic hours are sent directly to the Misericordia Eye Care Centre of Excellence (ECCE). The ECCE sees an average of 125 to 180 consultations per month who present outside of regular clinic hours. In order to best accommodate those patients, a seamless transfer to and intake into the ECCE is imperative.

Prior to the implementation of these revised pathways, patients were sent to Misericordia for ophthalmological concerns by health-care providers, but no connection was made to the site in advance of the patient’s arrival. As a result, registration staff were often unaware of the incoming patient and nursing staff were not always prepared upon the arrival of a new patient; this ultimately caused confusion for the patient. The new pathways established between Misericordia and referring sites has eliminated this confusion.

Today, advance notification is directed to the ECCE by the referring site/ provider which informs registration staff who may initially greet the patient at the site and nurses time to prepare in advance for incoming patients.

Before the initiative began in February 2019, the unit was notified of approximately 10 per cent of consults in advance which increased to 40 per cent in the first few months of implementation. Re-education and implementation of the texting system has allowed the site to reach a rate of 70 per cent of advance notification in July 2019. A goal of 80 per cent compliance is in reach.

Implementation of Recommendations from the Patient Journey Work of the Local Health Involvement Groups

In 2018, the Local Health Involvement Groups produced a report on the Patient Journey, an important topic given the WRHA’s major health system transformation. Discussions informing this report examined patient access, navigation and quality, where the training was made compulsory for staff. Since its inception, it has evolved into a sustainable, ongoing orientation for all employees.

The development of the program’s curriculum was supported by the regional mental health and emergency programs. The project team will conduct an annual review of the program and propose next steps to potentially broaden its scope throughout the region.

More than 600 employees have attended this program and the feedback has been overwhelmingly positive.

Mindful Practice

St. Amant’s Mindful Practice program helps staff recognize opportunities to incorporate mindfulness into everyday situations and interactions. Staff are encouraged to become aware of how their actions and choices affect others and choose to provide supportive, comforting care to those they serve.

The program includes additional training opportunities, tools to incorporate into work practices, communication through blogs or staff newsletters, and a peer-led Mindful Practice Advocate program.

When the program began, the team realized mindfulness was new for many staff, and that they required practical, hands-on training to understand and apply the benefits.

All staff are required to take a 2.5-hour training course. Each session has a mix of staff from various departments, which provides different perspectives, ideas and experience. Staff feedback has been consistently positive.

The team believes Mindful Practice is important in every workplace and has provided the training for other facilities as well as within the Catholic Health Corporation of Manitoba. The program has also been presented at the Canadian Conference on Developmental Disabilities and Autism.

Moving Safely After Heart Surgery

Moving Safely is a novel approach to recovery from open heart surgery that was implemented at St. Boniface Hospital in 2018. The approach is based on kinesiological principles of movement and offers a wider range of activities for appropriate candidates who are under sternal precautions following surgery.

The traditional approach was very restrictive with respect to weight and range-of-motion activities. This resulted in patients having trouble moving within their limitations, either when completing tasks once home or when being kept in hospital for a longer stay due to mobility restrictions.

Spearheaded by a physiotherapist-led team, this new approach aimed to improve a patient’s ability to function and to decrease length of stay in hospital. The team solicited feedback from cardiac surgeons and the cardiac surgery program, developed resources and trained colleagues in other disciplines to change the delivery of recovery care in hospital.

This initiative involved cardiac care providers at St. Boniface Hospital as well as throughout Winnipeg and Brandon. More than 150 staff were provided training on the new approach. Patient training is provided via an online video and is also available on the Cardiac Sciences Program website.

Outpatient Total Hip Arthroplasty

Grace Hospital’s Surgery Program team planned and executed a pilot project for Outpatient Total Hip Arthroplasties (hip replacements). The team standardized and streamlined processes that resulted in increased mobility, shorter hospital stays as well as decreased surgical time and post-operative pain. This work also created an enhanced patient, family and patient support experience before and after surgery.

The project improved timely access to care by decreasing wait times for hip replacements, while ensuring that patients receive an optimum level of care.

In-patient unit nurses ensure a post-operative follow-up call is made to all hip replacement outpatients after they return home to check in and to reinforce their discharge instructions. The Hip and Knee Resource Centre keeps a log to track patients who undergo and will undergo outpatient hip replacement.

The project has decreased the standard length of stay for hip replacement patients from three days to less than a day.

Partnerships through Activities, Learning and Sharing (PALS)

Research suggests that an individual with neurodevelopmental disabilities can have up to 700 paid staff involved in their care over their lifetime. Isolation and loneliness are common in these individuals. St. Amant’s volunteer services department started the PALS program to help address this issue.

The PALS program, offered in collaboration with St. Amant’s Health & Transition Services and Volunteer Services, is a matchmaking service for friendship. Designed to help people with neurodevelopmental disabilities to participate more fully in leisure opportunities, PALS creates friendship matches between volunteers and people receiving services. The program compiles information about both parties to find shared interests and match people together.

These relationships address feelings of loneliness, improve quality of life, and create a support network for the people St. Amant supports. For people with disabilities, it is also important to have people in their lives who know them well enough to advocate for them in case their family cannot.

There have been 60 PALS matches since 2017. Volunteers are provided with the requisite training and ongoing support.

Quick Start for Depression

Depression affects approximately 16 per cent of the population in Canada and is the leading cause of disability worldwide. To increase timely access to care, Quick Start for Depression, a two-session, evidence-based psychological intervention, was developed and delivered to adult outpatients (and their families) on a waiting list for depression services in the WRHA. The decision to include a family member in this intervention was based on the belief that depressed individuals often require more support to make changes.

The effectiveness of Quick Start for Depression has been measured using validated questionnaires before and after treatment as well as during follow-up periods to assess symptoms and satisfaction with care. The data shows that this intervention was associated with substantial changes in anxiety and lesser, but still notable, positive changes in depression. The majority (90 per cent) of patients who completed Quick Start for Depression reported finding the sessions quite or very helpful. Many patients (94 per cent) reported they were planning on working on the strategies presented in the sessions. Patient feedback indicated that Quick Start for Depression increased knowledge about depression, provided effective strategies for treating depression and that the material was presented in an engaging manner.

Tailored Interstitial Lung Disease Education in Pulmonary Rehabilitation

In October 2018, Deer Lodge Centre’s Pulmonary Rehabilitation Program (PRP) team launched an Interstitial Lung Disease (ILD) group to meet the unique needs of clients who had previously made up a minority of the patients in its standard Chronic Obstructive Pulmonary Disease (COPD)-focused PRP. The unique challenges faced by the ILD clients required the program to rethink its education component to ensure that this client group received timely, targeted education for their specific needs.

The new program includes physiotherapy, respiratory therapy, pharmacy, social work, dietary, rehabilitation and respirology expertise. Clients and their caregivers also benefit from the peer support that the rehabilitation group provides.

The revised, specific programing has been well received to date by patients, who demonstrate improved health outcomes, satisfaction and mental health. The program will now be offered at respiratory sites at Deer Lodge Centre, Misericordia Health Centre and Seven Oaks General Hospital.

Having a regular, recurring option for ILD clients as part of the existing pulmonary rehabilitation program will ensure that ILD clients receive appropriate service for the long term.

Transitional Care Unit

The Transitional Care Unit (TCU) was developed as a patient-centered, restorative care service to provide quality care to adult patients who no longer need acute care, but who require additional time for recuperation, assessment for community services, long term care or supportive housing. Clients are transferred from primarily acute care sites to a more home-like environment at Misericordia Health Centre .The TCU focuses on interventions that promote the client’s ability to adapt and adjust to living as independently and safely as possible. This concept focuses on achieving and maintaining optimal physical, mental and psychosocial functioning.

TCU provides the opportunity for clients to have time to return to a previous level of functioning, or to regain as much independence as possible with the goal of returning to the community whenever safely possible.

The initiative resulted in positive improvements to processes and patient flow. It also resulted in the development of improved clinical approaches to care planning for a vulnerable population that often doesn’t fit traditional programs.

Urgent Telepsychiatry Program

The Urgent Telepsychiatry Program launched in December 2017 to improve access to psychiatric consultation for patients presenting to emergency rooms and urgent care centers in Winnipeg where on-site psychiatric coverage was not available.

The program is a hub-and-spoke design, run out of the Crisis Response Centre. It has grown to provide urgent psychiatric consultation to patients at Grace Hospital Emergency Department, Concordia Urgent Care, Seven Oaks Urgent Care and the Crisis Stabilization Unit. As a result, more psychiatric consultations are being performed in urgent and emergency settings, allowing for timely access to care.

The program has resulted in reduced length of stay in the emergency department, fewer disruptions for patients (fewer transfers between sites) and treatment that is often provided closer to home.

This initiative has immense potential for use outside of Winnipeg in other regional health authorities.

Manitoba Chronic Obstructive Pulmonary Disease (COPD) System of Care

The Manitoba Chronic Obstructive Pulmonary Disease (COPD) System of Care initiative is an adaptation of the original Halifax-based INSPIRED© program that is recognized as a leading practice for COPD care in Canada. The strategy for change is to deliver more holistic, patient-centred care while reducing reliance on hospitals.

Although less than five per cent of Canadians live with COPD, it is a leading cause of visits to the emergency department in Manitoba, and one of the top reasons for hospital admissions with extended hospital stays.

The initiative engaged Seven Oaks, Concordia, and Grace Hospitals, Regional Respiratory Therapy, the WRHA Home Care Respiratory Program, Community Therapy Services and My Health Teams, the Manitoba Lung Association and the Interlake Eastern and Prairie Mountain health regions. All parties were interested in strengthening their approach to managing COPD by improving connectivity between acute care and community care, enhancing capacity for clients and their caregivers to self-manage their condition, and helping clients to connect to community clinical services.

The COPD System of Care initiative has transformed the way COPD is managed. The tools it offers allow the system to proactively identify patients admitted to hospital with COPD or pneumonia with co-morbidity of COPD.

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