Previous Profile: Vancouver Coastal Health

 

Any way you look at it, Vancouver Coastal Health (VCH) is diverse. VCH provides acute and community healthcare to one million people - 25 per cent of BC's population. The patients and clients served by VCH live in a range of settings, from cosmopolitan urban areas to coastal regions accessible by ferries and floatplanes. Their care needs are varied too, and every day 22,000 staff, 2,500 associated physicians and 5,000 volunteers work hard to respond to the needs of patients and clients, no matter how small or how complex.

 

A daily care snapshot:

• Almost 1,000 emergency department visits; 
• 300 plus patients in our operating rooms;
• Five life or threatened organ cases; and
• Almost 900 home-care nursing visits.

Diverse also describes the services and initiatives they provide to ensure best possible patient and client outcomes. We aim for innovation, best-practice standards, and continual learning and refinement in our care delivery and service culture.

VCH is committed to quality and patient safety. We would like to share brief descriptions of some of their quality and safety initiatives with you.

 

 Quality Improvement and the VCH Hospitalists:

The VCH Hospitalist Venous Thromboembolism prophylaxis improvement project has been going on for the last two years. VTE is one of the most common and preventable complications of hospitalization resulting in dangerous and at times life threatening blood clots.  Over 4000 cases will have been reviewed at VGH by the end of March this year.  By integrating a VTE risk stratification tool into pre-printed order sets, the compliance rate for appropriate VTE prophylaxis for patients admitted to the Hospitalist program has improved from 30-40% to greater than 90%.  Stemming from this experience, the VGH Hospitalist program is working with other leaders in a collaborative effort to implement best practices in VTE prophylaxis in Hospitalist programs across BC. This effort is expected to impact the care of an estimated 40 to 50% of hospitalized patients in the province.

 

Improvement in Cardiac Care

The VCH Cardiac Care Program has implemented pre-hospital electrocardiograms (ECG) – a diagnostic tool that helps to identify patients who are having an acute myocardial infarction (heart attack).  This has resulted in reductions in treatment times and has developed a database to provide real-time feedback reports to healthcare teams. In addition, standardized management algorithms have been put in place, as well as physician’s orders across the health authority in an effort to achieve best practice at all VCH sites. With the implementation of the pre hospital ECG alone, reductions in door to balloon times (regionally) from been achieved from 115 minutes to 79 minutes. Next steps are to expand the program to increase the scope of patients eligible for timely primary  percutaneous coronary intervention (PCI) a procedure that involves inflating a “balloon” in the blocked artery to widen it so that blood can flow more easily and to continue working with BC Ambulance Services, the community and tertiary care sites to transfer patients for PCI within acceptable time frames.

 

Regional Hand Hygiene Program -launched January 2010   

Phase 1 of the VCH Regional Hand Hygiene Program January 2009 lifted off with letters to all staff including physicians The adoption of “Give Germs the Rub” and the tagline “100% on Board” work together to underscore the importance of staff teamwork and to appeal to everyone’s sense of participation and action to achieve our goal at all levels – locally and regionally - 100% compliance.  

Hand hygiene audit results and other positive feedback show us that the hand hygiene program is making a positive difference to VCH staff safety culture and most importantly, to the health and wellbeing of VCH patients and clients.

 

 

 

 

 

 

 Dr. David Ostrow, CEO, Vancouver Coastal Health

 

 

 

 

 

 

 

 

 

Dr. Grady Meneilly, Medical Director, Medical Services

Phase 2: In January 2010 the public phase of the hand hygiene campaign was launched at VGH.  Posters, light boards, staff badges and “100% On Board” stickers for the public have been developed with the support of community members' feedback.  Messaging is consistent with the BC Patient Safety Council's "It's Good to Ask" campaign.  Patients, families, and their visitors will be encouraged to respectfully ask staff if they have cleaned their hands before providing care.  An information package on this campaign has also been distributed to staff through internal communication networks.

• Click here to view the “How to Handrub” Poster ( pdf-556Kb)

• Click here to view the “How Hand Hygiene” Poster (pdf-360Kb)

 

Tissue Banking

The therapeutic use of human allograft tissue for transplant can enhance the quality of life for the recipient. The VCH Tissue Quality Assurance Program is committed to ensuring adherence to safety regulations and standards for the recovery, processing and distribution of tissues prior to transplant as well as the tracking and traceability and monitoring of adverse events post transplant.  Scheduled internal audits of the facility, equipment, supplies and donor records guarantee the continuity of tissue safety from recovery to transplant.

The BC Tissue Bank led the way in the province for implementing a regional centralized tissue distribution area.  This model has ensured that the safety, efficacy and quality of all tissues transplanted within VCH are compliant with Federal Regulatory requirements and provided for a centralized recipient tracking and traceability method.  This model was adopted by two other Health Authorities in BC and is currently being viewed as a model for the rest of Canada.

The Eye Bank of BC, using a recognized quality methodology, was the first in Canada to implement a new corneal processing technique that provides the transplanting surgeon with the ability to perform a less invasive surgery with less patient discomfort and improved outcomes.   The Eye Bank of BC has continued to share their learnings and experience with this new technique with other Canadian Eye Banks in a hope to improve patient care for corneal recipients across Canada.

 

Human Factors

The Quality and Patient Safety team at VCH has incorporated Human Factors (HF) principles into better understanding human interactions with teams, technologies, and environments. By better understanding human abilities, human limitations, and other human characteristics that are relevant to design and processes (reaction times, training, transfer of skills, etc.), informed decision for the most appropriate systems can be made.

At VCH, HF provides systematic methods to understand and address hazards in work environments to increase safety by reducing errors resulting from inattention, workload, distractions, and fatigue. These principles also identify process improvement opportunities and analyze the potential adoption of new technologies that positively influence the safety, efficiency, and overall wellness of patients and staff in the hospital environment.

Since December 2008, VCH has incorporated HF principles into three medical device evaluations and procurement processes to increase the quality and safety and formalize the acquisition of medical technologies.  HF has also been involved in developing and implementing the VCH Surgical Safety Checklist, and expanding the checklist for use in interventional procedures outside of the Operating Room (OR) setting. Although preliminary in its implementation, the anticipated use of safety checklists at VCH aims to reduce adverse events, increase procedure efficiency, and promote team communication as the World Health Organization has in the OR setting.

VCH is committed to quality and patient safety and has identified this as a strategic priority for the health authority. The VCH Quality and Patient Safety program is also responsible for infection control and accreditation. VCH recognizes that patient safety is inseparably linked with staff safety and works closely with Worksafe and Wellness to ensure the recognition of staff safety issues as well.

These examples are a small sample of the ongoing quality and safety efforts of VCH. 

For more information on Vancouver Coastal Health, please visit their website at http://www.vch.ca

 

 

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