More cost-ef­fec­tive health care needed

Pro­grams for high-risk groups can pre­vent un­nec­es­sary and ex­pen­sive hos­pi­tal stays, writes JACK KITTS.

Ottawa Citizen - - FRONT PAGE - Dr. Jack Kitts is pres­i­dent and chief ex­ec­u­tive of­fi­cer of The Ot­tawa Hos­pi­tal.

Pro­grams for at-risk groups can pre­vent more hos­pi­tal stays, writes Jack Kitts,

Canada’s health-care sys­tem is un­der strain. Our coun­try has an ag­ing pop­u­la­tion and our hos­pi­tals are mov­ing from pro­vid­ing acute care to man­ag­ing chronic dis­eases. With all these fac­tors in play, Cana­di­ans must rec­og­nize that the cur­rent sys­tem is frag­mented, in­ef­fi­cient and does not serve our pa­tients ef­fec­tively. We must do things dif­fer­ently.

His­tor­i­cally, hos­pi­tals have been paid for ser­vices, not re­sults. But re­cent fund­ing re­forms in­tro­duced in On­tario are re­shap­ing that prac­tice. In­stead of be­ing al­lo­cated an­nual in­creases with few ex­pec­ta­tions for im­proved per­for­mance, hos­pi­tals are grad­u­ally be­ing funded based not only on how many pa­tients they treat, but also how well they treat them.

As CEO of The Ot­tawa Hos­pi­tal, I’m proud of our staff for demon­strat­ing suc­cess over the past year with in­no­va­tive ideas that pro­vide pa­tients with bet­ter care at a lower cost.

One big idea starts with the de­cep­tively sim­ple premise that the way hos­pi­tals sched­ule their surg­eries has a pro­found im­pact on the qual­ity and cost of pa­tient care.

By re­or­ga­niz­ing the way op­er­at­ing-room time is man­aged and as­signed, our hos­pi­tal is giv­ing pa­tients faster ac­cess to ur­gent, life-sav­ing surg­eries for con­di­tions such as in­ter­nal bleed­ing, head trauma and mus­cle and joint in­juries. The changes in­clude set­ting aside more op­er­at­ing-room time specif­i­cally for ur­gent pro­ce­dures and spread­ing elec­tive surg­eries more evenly through­out the week to re­duce sharp swings in vol­ume.

The pay­off has been dramatic since the changes were in­tro­duced last Jan­uary.

Of the 120 pa­tients who re­quire ur­gent surgery ev­ery week, nine out of 10 now get it within 24 hours of ad­mis­sion. Pre­vi­ously, some pa­tients waited more than 72 hours.

For some ur­gent surg­eries, the hos­pi­tal is out­per­form­ing the wait-time tar­gets set by the On­tario govern­ment. For ex­am­ple, pa­tients with frac­tured hips now get to the op­er­at­ing room within 24 hours, which is faster than the pro­vin­cial stan­dard of 48 hours.

The faster route to surgery elim­i­nates the need for pa­tients to spend days in hos­pi­tal wait­ing for an op­er­at­ing room. It al­lows them to re­cover more quickly be­cause they are not left to weaken or de­te­ri­o­rate while they wait.

In­deed, be­cause of the sched­ul­ing changes, our hos­pi­tal is safer for pa­tients today com­pared to three years ago, when we had fre­quent sur­gi­cal back­logs.

Fewer pa­tients now suf­fer from surgery-re­lated ad­verse events, such as delir­ium and uri­nary tract in­fec­tions. The mor­tal­ity rate among ur­gentsurger­y pa­tients has dropped from 3.9 to three per cent, trans­lat­ing to 40 lives saved.

The im­prove­ments in ef­fi­ciency — shorter hos­pi­tal stays and bet­ter use of beds — have given our hos­pi­tal the op­por­tu­nity to do the same vol­ume of cases with fewer beds, less staff and less re­sources. As a re­sult, we have achieved an ef­fi­ciency gain equiv­a­lent to $9 mil­lion, or nearly one per cent of The Ot­tawa Hos­pi­tal’s $1-bil­lion an­nual bud­get.

Doc­tors now care for more ur­gent-surgery pa­tients in less time; there are fewer ag­gra­va­tions and lo­gis­ti­cal con­flicts for staff, mak­ing the hos­pi­tal much more ef­fi­cient and a pleas­ant place to work.

More im­por­tantly, we have not can­celled a sin­gle surgery due to bed short­ages — a dramatic change com­pared to three years ago when we can­celled more than 600 surg­eries due to in­ef­fi­cien­cies. This fact alone shows that a smoothly flow­ing hos­pi­tal saves time and money, while pro­vid­ing bet­ter care for pa­tients.

An­other big idea comes from Dr. Jeff Turn­bull, The Ot­tawa Hos­pi­tal’s chief physi­cian.

When Dr. Turn­bull visits pa­tients, it’s not al­ways in the hos­pi­tal. He tours the city’s home­less shel­ters and sup­port­ive-hous­ing projects to in­spect in­juries, pre­scribe treat­ments or some­times just to hold peo­ple’s hands to as­sure them that they mat­ter.

Dr. Turn­bull’s pro­gram makes it eas­ier for the most vul­ner­a­ble and hard-to-treat pa­tients to re­ceive the med­i­cal care they need. Many of them have spent decades in shel­ters and are con­sid­ered to be be­yond the reach of the health and so­cial-ser­vices sys­tem.

Yet the para­dox is that when they are in cri­sis, they fre­quently land in our emer­gency de­part­ments, an ex­pen­sive ser­vice that rarely meets their needs. When they are ad­mit­ted, they tend to stay in hos­pi­tal al­most twice as long as the av­er­age pa­tient. They go to hos­pi­tals, not nec­es­sar­ily be­cause they have med­i­cal emer­gen­cies, but be­cause hos­pi­tals are the clin­ics of last re­sort.

We have learned that Dr. Turn­bull’s pro­gram not only pro­vides the most high-needs pa­tients with more ef­fec­tive and com­pas­sion­ate care, but also re­duces over­crowd­ing and long waits in emer­gency de­part­ments. In the first eight months of op­er­a­tion, Dr. Turn­bull’s pro­gram di­verted 756 visits from our hos­pi­tal’s emer­gency de­part­ments, free­ing up ex­tra ca­pac­ity equiv­a­lent to $378,000. By com­par­i­son, the cost of op­er­at­ing Dr. Turn­bull’s pro­gram over the same pe­riod was $170,000. These sav­ings al­low us to treat more pa­tients with the same level of re­sources.

In re­cent years, we have put in place sim­i­lar pro­grams for other high-risk groups such as frail se­niors, preg­nant teens and the men­tally ill, all of whom ben­e­fit from hav­ing hos­pi­tal ser­vices brought to places where they are most com­fort­able re­ceiv­ing care. These pro­grams are not only good for our pa­tients; they are also good for the hos­pi­tal be­cause they al­low us to use our re­sources more ef­fi­ciently.


Dr. Jeff Turn­bull from The Ot­tawa Hos­pi­tal checks one of his pa­tients, Thomas Sabourin, at the Sal­va­tion Army in ByWard Mar­ket.

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