CQIP

The majority of patients visiting the University of Saskatchewan’s Student Wellness Centre are seeking care for mental health related illnesses. The Student Wellness Centre is a designated primary health care site that includes primary care providers, counsellors, psychiatrists, and a mental health nurse. Dr. Ansell’s project is exploring whether a shared care model reduces the wait time to specialist consultation and if the shared care model results in happier patients and providers. View her poster to find out!

Dr. Fakhir’s team chose acute bronchiolitis in children as the focus of their QI project because there is a lot of variation in how the condition is treated across different hospitals, provinces, and even countries. Dr. Fakhir found physicians in the former Cypress Health Region were not using evidence-based clinical pathways, that there were barriers to pathway use, and a lack of organizational support. The aim of Dr. Fakhir’s project was to reduce chest x-rays and respiratory swabs by 50% by the end of 2017. View his poster to learn more about his project!

The focus of Dr. Fink’s CQIP project was on improving transfers and handovers between tertiary care and the community. Safe handovers require timely sharing of concise, reliable information about patients. After reviewing a week’s worth of discharge summaries from internal medicine, Dr. Fink found that while the quality of information was good there are often delays in making that information available. He introduced a number of process improvements aimed at improving timeliness of information sharing. View his poster to learn more about his project!

Dr. Heggie had the perception that many visits to the Yorkton Regional Health Centre’s ER were by patients with chronic obstructive pulmonary disease (COPD). COPD is best managed by family physicians in their offices, as through the use of patient tools to help people self manage their condition. The former Sunrise Health Region had the highest smoking rate in the province (28.9% compared to 24.6% in Sask.). YRHC ER faced frequent visits for COPD due to advanced age, comorbidities, current smoking, and a lack of referral to community resources for COPD education and self-management of chronic disease. Dr. Heggie's aim was to increase the referral rate of possible COPD patients from the YRHC ER to a community pulmonary rehabilitation program by 50% by October 2017. View her poster to learn more about her project!

Inguinal hernias are fairly common. Surgeons often receive referrals from family physicians with an ultrasound accompanying it. Typically, inguinal hernias are easy to detect on clinical examination, especially if they are larger ones. Surgeons find that these ultrasounds rarely influence how they treat patients. As a result, reducing these unnecessary ultrasounds could save patients and the health care system time and resources. For his CQIP project, Dr. Ogaick communicated to general practitioners that an ultrasound is not necessary for patients with inguinal hernias that are readily apparent on clinical examination, then looked at the impact this had on the number of ultrasounds accompanying referrals. View his poster to learn more about his project!

Studies have shown that 30% of antibiotics prescribed in intensive care units (ICUs) are unnecessary or inappropriate. Effective strategies for promoting judicious antimicrobial prescribing in this care setting must take into account the critical conditions of ICU patients and the collaborative approach to care on these units. For his CQIP project, Dr. Peermohamed and a pharmacist met with the ICU team in-person three times per week to discuss all patients actively receiving antibiotics; after these meetings, they provided recommendations to the ICU team. View his poster to learn more about his project!

Dr. Rees's quality improvement project focused on developing a subspeciality service model for breast pathologists to improve care for breast cancer patients and reduce inefficiencies. Breast cancer pathology reports provide essential information and contribute to the management plan of breast cancer patients. Poor quality, delayed, or incomplete breast cancer reports impact the quality of patient care. In the past, breast cancer cases have been reported by general pathologists in Saskatoon and the quality and turnaround time of these reports has not been monitored. Dr. Rees began to measure and monitor the quality and turnaround time of breast cancer pathology reports. View her poster to learn more about her project!

While working in the pre-op clinic, Dr. Shahid noticed that unnecessary testing happens on a daily basis. The results of preoperative tests rarely change how patients are managed and in some cases can cause them harm. Dr. Shahid worked with a team of stakeholders, including experts and representatives from different departments, to look at preoperative testing done on patients scheduled for knee and hip surgery. The team found most unnecessary testing occurs because providers are not aware of guidelines and the lack of a standardized tool or protocol for testing. The team's goal was to reduce unnecessary testing before surgery by 50%. View her poster to learn more about her project!

Systematic reviews show that a single fraction of radiation of treatment can provide similar results to multiple factions for palliation of painful bone metastases. In Canada, Choosing Wisely Canada released recommendations  in 2014 specifically for radiation oncology on using a single fraction for uncomplicated bone metastases. In 2016, the Canadian Partnership Against Cancer (CPAC) released a spotlight report on sustainability and quality in cancer control recommending the use of a single fraction of radiation therapy for painful bone metastases. CPAC identified the desire to have a pilot project to identify ways that practitioners can increase the use of a single fraction in jurisdictions, of which Saskatchewan and Manitoba were chosen. Dr. Wright's future plan for his CQIP project is to obtain and discuss survey results, collect real-time data on an ongoing basis, share anonymous results with practitioners, and implement processes to promote single fraction use. View his poster to learn more about his project!

EVAR for abdominal aortic aneurysm represent an advance in patient care, effective alternative to traditional open surgical repair resulting in decreased postoperative morbidity and mortality and reduced ICU/hospital stay. Unlike open repair, lifelong follow-up imaging is recommended after EVAR. The intent of this project was to implement an EVAR follow-up program utilizing ultrasound instead of  CTA when appropriate.

Providing venous thromboembolism (VTE) prophylaxis to certain patients who have undergone abdominal/pelvic (AP) cancer surgery is considered standard of care in many other sites in North America outside Saskatoon. Currently in the Saskatoon Health Region, there is no protocol for this. The aim of Dr. Sothilingam’s was to see if establishing protocols for assessing risk and guiding perioperative treatment for AP cancer patients would improve care equity and reduce incidences of VTE in the 30 day postoperative period.

The HIV rate in Saskatchewan in 2015 was 13.9 per 100,000 compared to the 5.8 in Canada. 2016 rates in Saskatchewan have increased to 14.5 per 100 000. Testing is the first step of the HIV treatment cascade. The aim of Dr. Hamilton’s project was to increase HIV testing at all points of patient contact and to ensure that people living with HIV are diagnosed and linked to appropriate and accessible treatment and care. The goal is to increase the number of completed HIV tests in North Battleford by 50% by the beginning of November 2017.

For his CQIP project, Dr. Betcher aimed to implement nucleic acid amplification testing to directly identify the presence of S. aureus and mecA resistance genes in positive blood cultures to allow for earlier targeted antimicrobial therapy. Read his poster to learn more.

For his CQIP project, Dr. Bharadwaj aimed to: 1) review the rate of non-diagnostic lung biopsies in Saskatoon over the last 5 years; 2) determine what factors may contribute to a non-diagnostic specimen including target size, location, presence of necrosis, core number and sizes; and, 3) determine what factors may contribute to a non-diagnostic specimen including target size, location, presence of necrosis, core number and sizes. Read his poster to learn more.

For his CQIP project, Dr. Craib aimed for consistent implementation of components of Enhanced Recovery After COLORECTAL Surgery in BUH; revised colorectal surgery ERAS pathway for BUH formalized in order sets by end of September 2018; and, loop closed in terms of educating all providers of care within the team how the changes in care will affect them but more importantly, the patient. Read his poster to learn more.

For her CQIP project, Dr. Dahl aimed to improve the communication between Acute Care General Internal Medicine & the Family Physician by providing the Discharge Summary at time of Discharge. Read her poster to learn more.

For her CQIP project, Dr. Dokouhaki aimed to determine the pattern of ANA test ordering among physicians of the (previous) SHR based on the geographical distribution, type of the service and specialty/subspecialty practice. To employ appropriate measures based on the utilization pattern to decrease inappropriate utilization of the autoimmune testing (ANA as an indicator) at least by 50% by the end of 2019. Read her poster to learn more.

For his CQIP project, Dr. du Plessis aimed for consistent implementation of components of Enhanced Recovery After COLORECTAL Surgery in BUH; revised colorectal surgery ERAS pathway for BUH formalized in order sets by end of September 2018; and, loop closed in terms of educating all providers of care within the team how the changes in care will affect them but more importantly, the patient. Read his poster to learn more.

For his CQIP project, Dr. Friesen aimed to reduce the number of inappropriate emergent CT scans of the brain performed at the Victoria Hospital by 50% by September 2018. Assuming that 25% of scans may be inappropriate, a total reduction of 12.5% is required. Read his poster to learn more.

For her CQIP project, Dr. Kurji aimed to decrease the use of IV broad spectrum antibiotics in patients admitted to ACPeds with community acquired pneumonia by 50% by next respiratory season. Read her poster to learn more.

For her CQIP project, Sarah aimed to improve communication between the interdisciplinary hospital team to the primary care team regarding the hospital stay as well as improve the quality of discharge summaries, and discharge prescriptions by 20% within 9 months. Read her poster to learn more.

For his CQIP project, Dr. Mabadeje aimed to reduce surgical stress; maintain post-op physiological function; enhance mobilization after surgery; reduce rates of morbidity; faster Recovery; and, shorter length of stay in hospital. Read his poster to learn more.

For her CQIP project, Dr. Machnee aimed to decrease CHF admissions to YRHC by reducing variability within clinical practice. Read her poster to learn more.

For his CQIP project, Dr. Moulton aimed to improve the acute stroke clinical and imaging pathway by facilitating prompt diagnosis and triage through the creation and implementation of a dedicated acute stroke MR protocol. We hypothesize that the use of fewer and more specialized sequences (DWI, FLAIR and SWI) will be sufficient for diagnosis and characterization of acute stroke. By reducing scan time, we anticipate improvements in availability, throughput, efficiency and MR image quality. Read his poster to learn more.

For her CQIP project, Dr. Onaolapo aimed to study the barriers to implementing same day discharge for total laparoscopic hysterectomy patients with the goal of reducing the admission rate of TLH patients by 75% By March 31, 2019. Read her poster to learn more.

For his CQIP project, Andrew aimed to improve communication between the interdisciplinary hospital team to the primary care team regarding the hospital stay as well as improve the quality of discharge summaries, and discharge prescriptions by 20% within 9 months. Read his poster to learn more.

For her CQIP project, Dr. Regush aimed to reduce the return to RUH of postpartum women at risk of postpartum hypertension by 50% by Dec. 2018 for reason of postpartum hypertension or related condition by improving identification of women at risk for postpartum hypertension and directing appropriate standardized discharge planning. Read her poster to learn more.

For her CQIP project, Dr. Reis aimed to set a pathway in place at the Regina Family Medicine Unit that identifies, recalls, and directs management to ensure patients with diabetes are within the recommended target for blood pressure control (<130/80) by September 2018. Read her poster to learn more.

For his CQIP project, Dr. Rossouw aimed to follow the Heart Pathway and using the HEART SCORE as a clinical decision making tool so that 95% of patients with possible cardiac related chest pain should reach a decision on safe and appropriate disposition within 6 hours after initial assessment by an emergency physician. Read his poster to learn more.

For her CQIP project, Dr. Ryan aimed to create a point of care with ongoing communication tool for use in palliative care to be ready to use in real-time in 2018. Read her poster to learn more.

For his project, Dr. Tyan aimed to reduce the number of trips to Saskatoon by 25% in the next 6 months for patients with suspected lung cancer that live more than 100 kms away from Saskatoon. Read his poster to learn more.

For his CQIP project, Dr. Wasko aimed to have seniors living safely in their homes longer. Read his poster to learn more.

For his CQIP project, Dr. Willms aimed to improve the percentage of patients aged 50 and older who sustain a fragility hip fracture and begin anti-osteoporotic treatment to ~80% and initiate a fracture liaison service (FLS) in Saskatoon that will not only evaluate patients post hip fracture but all patients who sustain a fragility fracture to eventually prevent hip fractures. Read his poster to learn more.

For her CQIP project, Dr. Achyuthan looked at how access to care could be enhanced by using technology to modernize physician services. The project, which was done in partnership with Dr. Michael Stoll, looked at how apps – Facetime, Google Duo and REACTS – could be used instead of some in-office physician-patient visits. A retroactive review of appointments over an eight-week period showed that 34% of office visits could have been done without patients coming into the office.

The goal of Dr. Allen’s CQIP project was to create a pathway that identified and addressed mental health disorders and pain behaviours that are known to magnify musculoskeletal pain in adolescents. Several screens were trialed, with variable success, but Dr. Allen found that open discussion tailored to each patient, engagement of the family physician, and sharing contact information for community and online resources was a simple way to address teens presenting with chronic pain.

For his CQIP project, Dr. Chokani looked at improvements for the timely notification of HIV test results. Throughout his research, Dr. Chokani found that 25% of the 70 HIV cases he retroactively reviewed hadn’t received their results within 90 days of being tested for HIV, and approximately 50% of new cases were caused by that 25% cohort. Making improvements to the testing and notification process could help those who are HIV-negative to remain negative and to help engage those who are HIV-positive in care.

Dr. Chui looked at improving the telemetry order admissions set to decrease unnecessary use of this expensive technology for his CQIP project. This process was created collaboratively and was implemented and structured into interdisciplinary bedside rounds. While there didn’t seem to be a change in the compliance of the order set, initial results suggested a 12% decrease in the average telemetry duration for patients. 

The aim of Dr. Cloud’s project is to optimize the evaluation and follow up of patients who present at the emergency department (ED) and are assessed for potential heart attack and near future risk. A rapid access chest pain clinic (CRAC) was established which saw patients within seven days of being sent home at moderate risk and shifted lab testing so repeat bloodwork came in sooner for low risk patients, so they could potentially go home sooner.

In Dr. Dueck’s CQIP project, she found that 56% of oncology patients who presented to Emergency Rooms (ER) during a one-year period in Saskatoon with side effects from chemotherapy and radiation did not require admission to the hospital. Dr. Dueck’s aim was to determine the medical diagnosis and utilization patterns and to see if there was an alternative care access that would reduce the ER burden, as well as improve the experience, care and quality of life for oncology patients.

A review of CT scans and medical records indicated that during 2017, 51 inpatients in Regina had potential signs of a stroke. Of that number, 21 were diagnosed with having one and only six of which met the recommended timeframe of 30 minutes or less from when they were first looked at to when they received their CT Scan. With that in mind, the purpose of Dr. Faires’ CQIP project was to develop an in-house stroke alert protocol.

Research for Dr. Holinaty’s CQIP project was done in a family practice setting and looked at trying to increase organ donor rates through physician-patient conversations at the clinic. For the first cycle, Dr. Holinaty’s clinic went from zero patients with coded donor status to 52 (22%) in a two-month period. For the second cycle, the RN at the clinic included it as part of her pre-screening call and the conversation with a physician will be moved to a different visit type.

As a means of decreasing infection rates in Caesarean deliveries, Dr. Jabs led a CQIP project that saw azithromycin added to the usual mix used for prophylaxis. With 95% compliance in administering the drug, infection rates dropped 0.5% to 3% throughout the course of the project. The project found that the implementation of addition of azithromycin to usual antibiotic prophylaxis did not reduce surgical site infection in women undergoing cesarean delivery.

When he found out that a 2017 CIHI report said the epidural rate in Yorkton was 26%, Dr. Kasim decided to lead a CQIP project on increasing his local epidural rates to match the national and provincial rates of 60% over three years. The implementation plan included proving more education to nurses and patients, updating the admission form to capture information on whether patients want an epidural, and improved coordination of care between physicians.

Two-thirds of patients experience some degree of pain during colonoscopy, so Dr. Laosebikan decided to lead a QI project on reducing the assessed pain score to 1/10 for all colonoscopy patients undergoing this procedure at Melfort Hospital. He looked at two ways of addressing this through the use of Propofol and scheduling with the GP anaesthesiologists, and increasing the dosage of midazolam. Results showed approximately 9 out of 10 patients who received Propofol were pain-free compared to 7 of every 10 patients receiving Midazolam.

After doing a retrospective chart review of 280 patients in her practice, Dr. Lett was shocked to discover that 87% of her pregnant patients were iron deficient between 24 and 28 weeks and 44% were anemic in that cohort. For her CQIP project, Dr. Lett created screening and treatment algorithms for iron deficiency and anemia in pregnancy. The aim of the project was to improve access to IV iron for pregnant women in Regina. 

The aim of Dr. Lett’s project was to address pre-operative anemia rates in orthopedic join replacement patients. Through his CQIP project, Dr. Lett found that two thirds of patients who were undergoing surgery for hip and knee arthroplasty were anemic before their surgeries. As part of his project, his team developed a letter and toolkit for patients and their family doctor to optimize anemia during the 9-12 months from signing consent and their surgical date.

The aim of Dr. Ndubuka’s CQIP project was to increase the immunization rates for one-year-olds from 82% to 90% and two-year-olds from 80% to 90% by March 31, 2019 in Stanley Mission First Nations. Resulting immunization rates for the one-year-old and two-year-old cohorts were 99% and 87%, respectively. The two main initiatives that helped achieve those rates was providing transportation for mothers from their homes to the clinic and providing immunization evaluations for all children under the age of eight who were assessed in the clinic.

The aim of Curtis Newton’s CQIP project was to increase observed independence mobility by 10% in Units 1 and 2 at Cypress Hills Regional Hospital in Swift Current. Newton engaged patient family advisors, leaders and frontline staff to talk about mobility as part of this project. While a driver in was to get patients wearing their own clothes, Newton found that an increase in mobility – to 85% and 67% in Units 1 and 2 – after implementation was because of a change in culture. 

In Saskatoon, about half of next-day ultrasound examinations had relevant results and a large proportion of patients was discharged home. The aim of Dr. Oyedokun’s project was to develop a clinical pathway to guide emergency department (ED) physicians in choosing the optimum location and timing of ultrasound imaging to decrease the number of patients returning to the ED for next-day ultrasounds by 50% within six months.

Hospital contact is currently a missed opportunity for screening patients for multiple chronic medical conditions. COPD is one of the most chronic medical conditions leading to hospitalization but still underdiagnosed and under treated. Using the Canadian health institute screening survey, Dr. Pepler performed screening on admitted patients on 4B ACU medicine ward and subsequently 4A ACU medicine ward and 4D surgical ward at Pasqua Hospital in Regina and found that 48 patients with no prior diagnoses of COPD was referred for screening spirometry.

The target of Dr. Radwi’s project was to establish physician well-being as a routine institutional performance measure and quality health metric at the Saskatchewan Cancer Agency (SCA). Physician burnout is a growing concern across Canada, mirroring a phenomenon that is occurring globally in medicine. The SCA employs physicians who deal with cancer diagnosis and management, and physician wellness would be a crucial institutional measure. 

With HIV being a problem in Saskatchewan, Dr. Rusnak chose to focus his CQIP project on changing the culture around HIV testing in the emergency department. To do this, his team created an opt-out system for HIV testing for patients visiting the emergency department who requiring bloodwork. Through this process, the current physician-led testing and follow up model was replaced with a more collaborative, nursing-led process that involved resources from emergency medicine, public health, biochemistry and infectious diseases.

Surgery can all aggravate obstructive sleep apnea (OSA) and increase the risk of post-operative respiratory failure. It’s recommended that patients at highest risk receive continuous oximetry after surgery. Dr. Schweitzer found that only 10% of patients qualifying for continuous oximetry received the recommended monitoring. To increase appropriate monitoring of patients with OSA by 25%, Dr. Schweitzer and her team created a new monitoring algorithm and pre-printed order sets, and a plan for education sessions for physicians and nurses on the new process.

Sickle Cell Anemia is a relatively small patient population of more than 40 in our province, but it is growing substantially. Current national guidelines say that when these patients present to the emergency with a pain crisis, the goal should be for them to get a dose of opioid analgia into their system within 30 minutes of triage. Our patient population takes on average more than an hour for treatment. The aim of Dr. Stammers’ CQIP project was to create interventions to achieve that goal.

For his CQIP project, Dr. Stoll worked with Dr. Greeta Achyuthan to see how the patient experience could be improved by using technology that most people already use every day. Instead of patients travelling between one and three hours for an in-person appointment, Dr. Stoll did some visits remotely by using Facetime and Google Duo. In a retrospective chart review of 20 clinic days with about 500 patients, he concluded that more than a third of those visits could have been done remotely.

Through his CQIP project, Dr. Vizhul looked at improving the Morbidity and Mortality model, based off past successes seen with one coming from Ottawa. After rolling out the template in Regina, Dr. Vizhul looked to change the way problems were identified based on whether the problem was due to cognitive or system issues, and then created guidelines that would help identify errors and prevent future ones.

There is variation across Saskatchewan in the ability of Family Physicians to order MRI examinations. In most of the province, ordering is open to Family Physicians; however, in Saskatoon, the ability to order MRI is restricted to “specialists” only. As a result, there is pressure in Saskatoon to open up the ordering practice to Family Physicians. Dr. Weibe’s CQIP project focused on exploring the potential impact of changing the ordering policy in Saskatoon to align with the rest of the province.

For his CQIP project, Dr. Wingate and his team looked at improving communication between emergency room physicians and family physicians. When a patient presents to the Emergency Department, outpatient sheets are generated, which are then submitted into a patients’ electronic medical records, which is reviewed by the family physician. Dr. Wingate found that 42% of these sheets had been submitted. Through interventions and process adjustments, the team was able to increase that rate to 99%.