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Agnita Pal

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  • OS29 - Realizing the Promise of "Big" Data (ID 34)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 203CD
      • Abstract
      • Slides

      Purpose/Objectives: Alternate level of care (ALC) data in the Discharge Abstract Database (DAD) is important for understanding the needs of patients in acute care beds that are waiting for more appropriate services. Historically ALC data has not been comparable across regions due to differences in clinician criteria used for ALC designation. To standardize ALC reporting, CIHI has released new ALC Guidelines for clinicians in acute inpatient care. As part of the Emergency Department Waits and Patient Flow Initiative, Saskatchewan Health Quality Council (SK HQC) has implemented new guidelines and tools to improve ALC reporting in the province. In this presentation, CIHI and SK HQC will promote new ALC guidelines and lessons from Saskatchewan’s implementation, including toolkit and approach to standardization.

      Methodology/Approach: In 2015, at request of the Western Canada CEO Forum and in collaboration with the Western Patient Flow Collaborative (WPFC), CIHI launched a project to standardize ALC designation practices in acute inpatient care. CIHI worked with administrative and clinical leaders to develop and pilot clinical guidelines in western regions. ALC reasons were streamlined and clarified for reporting to the DAD. Implementation across western regions is currently underway. Saskatchewan’s initiative was established in April 2013 to aggressively address ED wait times and by 2014, ALC emerged as a priority. A survey on regional ALC practices was completed, followed by a Rapid Process Improvement Workshop to reduce variation in ALC data collection and reporting. A Patient Flow Toolkit was released to operational leaders and point-of-care staff to increase their awareness of ALC data standardization in the context of changes in the health system. Stakeholder engagement and use of provincial implementation teams were key to successful implementation.

      Finding/Results: To facilitate implementation, CIHI released the clinical guidelines, a mobile friendly clinician tool, and job aids to help interpret coding requirements. New codes were implemented in the DAD. In Saskatchewan, although ALC is a known contributor to long ED wait times, understanding of ALC population was incomplete without standardized ALC data. A standardized ALC data collection form was implemented with daily, electronic collection as of May 2016 about ALC details, such as reasons, barriers to discharge and timelines. The initiative is now starting to use the provincial ALC data for recommendations around strategic investments. The Regions are also beginning to use the data to guide some of their operational work.

      Conclusion/Implication/Recommendations: Accurate and comparable ALC data is important at every level of health system for informing discharge planning at facility to measuring system gaps at regional/provincial levels and identifying access inequalities nationally. CIHI continues to work with stakeholders to broaden adoption of the guidelines across Canada. Saskatchewan expects to release a dashboard with performance indicators updated daily at hospital, regional and provincial levels. Information about ALC patients is expected to be used for health system planning at all levels–not only in acute hospital care, but also in community care. Initiative focused on ALC data standardization but change management and working from a base of influence as opposed to authority has been the key to successful implementation.

      140 Character Summary: CIHI will introduce new ALC guidelines and Saskatchewan HQC will share lessons from their implementation, including toolkit and approach to standardization.

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