2017-2018 Annual Report

Thunder Bay Regional Health Sciences Centre has one of the busiest Emergency Departments in Ontario with about 9,000 visits per month. With so many patients coming through on a daily basis, the Emergency Department (ED) team is committed to ensuring that each one is satisfied with the care they receive.

“We’re always looking for ways to improve patient satisfaction and the overall patient experience,” said Lisa Beck, Director of the Trauma Program, Critical Care and Emergency Services. “Since patients are at the centre of everything we do, the best way for us to improve is to ask our patients directly how we can do better. Their feedback is applied to Patient Experience Action Plan, where we adapt our services to meet the needs identified.”

One way our Hospital gathers meaningful input from ED patients is through National Research Corporation (NRC) patient satisfaction surveys that are offered to all ED patients. The results are reviewed on a monthly basis so that Hospital administrators can evaluate the impact of changes we’ve implemented.

“Not all ED patients fill out the survey, so we also gather input through a Patient and Family Advisor who actually engages with patients while they’re in our Emergency Department,” said Beck. “We’ve found that real-time feedback to be really helpful and a great example of our Patient and Family Centred Care philosophy at work.”

A common theme among patient feedback was the desire for more information on how the ED works and what can be expected. Patients wanted to know how it’s determined which ED patients are seen first, about visitor policies, and other patient guidelines and policies.

“We understand that visits to the ED can be very stressful and we want to ease the anxieties of our patients and their families,” said Tyler Van Ramshorst, Operations Coordinator for Emergency and Trauma Services. “We now provide a brochure that explains everything ED patients need and want to know while they’re here for care.”

Since the Patient Experience Action Plan has been implemented, ED patient satisfaction rates have improved by 23%, rising from a starting point of approximately 57% to 70% in all dimensions.

“Our improvement efforts are ongoing, but we’re really proud of the progress we’ve made so far,” said Van Ramshorst. “Everyone involved in the working group, and our nurses in particular, have fully embraced the plan and are completely engaged and committed to patient satisfaction. The level of professionalism and dedication to Patient and Family Centred Care under what can be very challenging circumstances is really remarkable. We’re fortunate to have such caring staff in our Emergency Department.”

Thunder Bay Regional Health Sciences Centre’s Emergency Department team is committed to ensuring that all patients are satisfied with the care they receive.

Leadership at Thunder Bay Regional Health Sciences Centre is undergoing development and enhancement training to help support a more respectful environment, ultimately improving patient care.

Promoting a positive and respectful environment begins with positive and respectful leaders. Thunder Bay Regional Health Sciences Centre is applying that approach to continued leadership development and enhancement training.

This new approach to leadership training builds upon the “Me to We to All” method launched last year. It builds upon each leader’s individual strengths to create more collaborative and supportive teams, and ultimately improve patient care.

“Our goal is to increase the knowledge and competency of staff in the areas of acute mental health, senior’s health, Indigenous health and culture, accessibility and the patient experience overall,” said Amanda Bjorn, Executive Vice President of People, Culture and Strategy. “The training is designed to build skills and knowledge to support a respectful environment. In the end, we want all staff to be considerate and kind towards everyone – coworkers, patients and families – and to acknowledge everyone else’s experiences, views and beliefs.”

Hospital employees, volunteers and professional staff will participate in respect education training, which is being lead by the Hospital’s Interprofessional Education department. The training will be delivered through an innovative mixed methodology approach to learning that includes self-assessments, e-learning, in-situ simulation activities, and coaching. A key factor of this education is that all leaders are to be trained as coaches and will take on a key role throughout implementation. The majority of education will provide opportunities for participants to practice techniques and skills and to have meaningful interactions regarding content. Finally, a support component has been built into the training plan to facilitate behaviour and culture change.

“Respect isn’t something that can be taught in a classroom, it’s something that begins within each individual person through self reflection,” said Bjorn. “Everyone should be treated with respect, regardless of age, illness or culture, and accomplishing that starts with ourselves. This approach to learning will help people to understand their own biases and beliefs and how those biases impact others. This training will encourage introspective conversations that will explore thoughts and feelings in the work place, with a focus on racism and other stereotypes that can create barriers to optimal health care. Ultimately, we hope to create a safer space for everyone that comes to our Hospital.”

Leadership at Thunder Bay Regional Health Sciences Centre is undergoing development and enhancement training to help support a more respectful environment, ultimately improving patient care.

Thunder Bay Regional Health Sciences Centre is another step closer to offering a full cardiovascular program. In January, Dr. Elrasheed Osman joined our team of talented physicians. He is the second vascular surgeon at our Hospital, and key to our commitment to deliver comprehensive cardiovascular care.

The addition of Dr. Osman and his knowledge and experience improves our capacity to provide much needed vascular services, closer to home, for patients across Northwestern Ontario. Dr. Osman joins our other vascular surgeon, Dr. Mary MacDonald, who joined our team in October of 2016.

With two highly skilled vascular surgeons, we can provide life-and-limb saving care in a much more timely fashion. This means patients across Northwestern Ontario will have shorter wait times for treatments, closer to home. Previously, patients would have had to travel to Southern Ontario, resulting in heightened levels of stress and additional financial burdens.

For critical and emergency patients in particular, local access to vascular surgery can make all the difference in terms of saving lives and limbs, which is particularly important for our patients and families since amputations occur more frequently in Northwestern Ontario than the rest of the province. With two surgeons now in place, we hope to improve vascular health in the Northwest by making arterial bypass surgery more accessible.

Last year, Dr. MacDonald dealt with approximately 245 vascular cases. With the arrival of Dr. Osman, we can double the number of patients who will benefit from their services. By the end of the year, we will welcome a third surgeon to our team, enabling us to handle over 600 vascular procedures annually.

Dr. Mary MacDonald and Dr. Elrasheed Osman are helping bring much needed vascular services, closer to home, for patients across Northern Ontario.

Hospitals across Ontario are facing capacity challenges. Thunder Bay Regional Health Sciences Centre is no exception and has experienced uncharacteristically high patient admissions since the winter of 2017/18.

In the face of ongoing capacity challenges, patient flow is a priority and ensures our patients receive the right care, at the right time, by the right provider. Patient flow refers to the way care is planned and delivered, including medical care, physical resources, and internal systems. In other words, patient flow refers to the care and resources needed to support patients throughout their journey at the Hospital, from admission to discharge and beyond, while maintaining safety, quality and patient satisfaction.

“Patient flow remains as one of the largest issues affecting our Hospital, especially when you factor in that our Emergency Department (ED) is one of the busiest in the province. Of all the people who come to our ED, many need to be admitted,” said Dr. Stewart Kennedy, Executive Vice President of Medical, Academics, and Regional Programs. “Every improvement means that an admitted patient in the ED can move into an inpatient bed sooner.”

A large contributing factor to patient flow and overcapacity is Alternate Level of Care (ALC) patients who no longer need to be in a hospital, but still require some form of health care such as rehabilitation, home care, or a long-term care facility. Unfortunately, the needs for such services often exceed what our community agencies can provide.

“By focusing on how and when we admit and discharge patients, and finding efficiencies in processes, we have reduced the amount of time patients spend waiting in the Hospital when they don’t need to. Efficiency means getting patients well sooner,” said Dr. Kennedy.

An example is the introduction of an electronic system used at the bedside by clinicians. The information in the system allows members of the health care team to see and address potential delays in services for patients, such as diagnostic testing or physiotherapy.

Working together with health system partners is also important to ensure that patients receive safe, quality care. “We are all committed to enhancing the coordination of care to support best possible outcomes and experiences for patients and work closely on a daily basis,” explained Kennedy.

Dr. Stewart Kennedy, Executive Vice President of Medical, Academics and Regional Programs at Thunder Bay Regional Health Sciences Centre

A full cardiovascular surgical program at Thunder Bay Regional Health Sciences Centre is expected to be up and running in 2020. The burden of cardiovascular disease in Northwestern Ontario is well above the provincial average. Meeting the acute care needs of our patients means providing cardiac and vascular care close to home. Capital planning is now underway, bringing our Hospital one step closer to launching the new program.

“We are excited to be making significant progress, in collaboration with the University Health Network’s Peter Munk Cardiac Centre,” said Arlene Thomson, Senior Director, Cardiovascular Program Development and Implementation. “We are working closely with the Capital Planning Branch at the Ministry of Health and Long-Term Care to ensure our facility is ready to offer these new, much needed services.”

The new program will require more beds, specifically for cardiovascular patients. Our Hospital is also working with architects and planners to identify appropriate locations for the new areas that will be needed for this program. This includes 19 additional patient beds, a new surgical suite and related renovations, new vascular lab, renovations to Ambulatory Care and Central Processing and other updates as required.

“Right now, our goal is to build within our Hospital walls where possible. An expansion of our current Hospital is likely, and will be done within accordance of Ministry guidelines and in such a way that will support our ability to provide quality patient care across all clinical units.”

The Ministry of Health and Long-Term Care has committed to funding 90% of the construction costs associated with the project. It will be up to our community to cover the remaining 10% of the construction costs plus 100% of the capital equipment costs.

To learn more about cardiovascular care at our Hospital, please visit http://tbrhsc.net.

Arlene Thompson, Senior Director of Cardiovascular Program Development and Implementation, looks over expansion plans for the Hospital’s new Cardiovascular Surgical Program.

A patient may require a urinary catheter for a variety of reasons. A new medical directive empowers nurses to remove the catheter when it is no longer needed, which can reduce incidences of urinary tract infections.

Over-use of urinary catheters has been a common trend in Hospitals, and one that particularly affects senior patients. Thunder Bay Regional Health Sciences Centre is committed to improving seniors’ health and has pledged to “lose the tube”; an initiative that will improve patient care by reducing the length of time a urinary catheter is in use.

“Research has shown that patients greatly benefit from early removal of unnecessary catheters. It not only reduces the risks of infection, but also enables patients to be mobilized much sooner,” said George Fieber, Nursing Practice Lead. “This new medical directive, introduced and championed by Dr. Zaki Ahmed and Dr. Margaret Woods, empowers nurses to make an informed judgment call about how soon catheters can be safely removed.”

The new process was based on a toolkit developed by Choosing Wisely Canada in association with the Canadian Society of Internal Medicine. It supports physicians and nurses in three areas of focus:

1. Early removal of unnecessary urinary catheters on inpatient wards
2. Restrictive insertion of urinary catheters in operating rooms
3. Restrictive insertion of urinary catheters in emergency departments

“We’re building on the best practices and directives provided by the toolkit in order to better address the needs of our Hospital, and the patient population that we serve,” said Fieber. “This is a great initiative that will help improve the experiences of our senior patients and is reflective of our Patient and Family Centred Care philosophy.”

Andrea Raynak, Clinical Nurse Specialist, Chronic Disease Prevention and Management.

Service demand is growing for senior patients. In addition to requiring health care more often, their needs are different from the general population. A new program at Thunder Bay Regional Health Sciences Centre supports senior patients to receive the right care, at the right time, and by the right provider.

"My family recently experienced the Hospital's Geriatric Program when our Step-Dad was diagnosed with dementia. He was assessed early in his admission to the Emergency Department and was monitored closely throughout his stay by the Geriatric Care Coordinator,” said a family member. “We had been struggling at home with his changing care needs but the team listened to us and guided his care accordingly, keeping us informed every step of the way. We're very impressed by the level of care our Dad received and are hopeful, that as a result, he can remain healthier and at home."

Beginning in the Emergency Department, the Program aims to streamline the assessment process of at-risk seniors through collaboration with internal and external partners, consultation with geriatricians, physicians, St. Joseph’s Care Group, and the North West LHIN’s Home and Community Care.

“When at-risk or frail senior patients aged 65 years and older arrive at our Hospital, they are assessed using standardized tools. A Geriatric Care Coordinator can identify potential geriatric health concerns and facilitate the appropriate care plan,” said Ron Turner, Senior Director of Patient Care and Health Professions. “By providing senior friendly care early, we can achieve improved continuity of care, enhanced patient experiences and better outcomes.”

During assessment, the Geriatric Care Coordinator looks for signs of geriatric syndromes, including mobility issues, weakness, frailty, functional decline, pain, cognitive impairment, dementia, delirium, and other risk factors often associated with seniors. The Geriatric Care Coordinator also supports discharges for patients who do not require acute care in a hospital setting; and works with community partners to provide a smooth transition to home or other programs and services that would best address their needs.

“Research has shown that prolonged hospital stays can lead to further complications, particularly for senior patients,” said Turner. “Having someone on the team who is directly responsible for organizing their care needs ensures that patients will get the appropriate level of care they need, in a safe way and without undo delays.”

So far, the program has yielded successful results. The average length of stay for senior patients has decreased and continues to do so as the program progresses. Patient experiences have been enhanced and families and caregivers have expressed content with their level of inclusion in the care plans of their loved one and the ongoing support provided after discharge.

To learn more about our Hospital’s commitment to seniors’ health, visit www.tbrhsc.net.

A new Geriatric Program at Thunder Bay Regional Health Sciences Centre provides early assessment and interventions to ensure senior patients receive the right care, at the right time, and by the right provider.

Indigenous people in our community are sicker than non-Indigenous people. One reason for this is access to culturally safe primary care. Stronger links between primary care (family physicians, nurse practitioners) and acute care (hospital) can help. That’s why Anishnawbe Mushkiki Community Health and Wellness and Thunder Bay Regional Health Sciences Centre are working together.

“We initially met to better understand each other’s role in the community, and quickly realized the potential to enhance care and experiences for Indigenous patients,” said Jean Bartkowiak, Hospital President & CEO.

Anishnawbe Mushkiki Executive Director Michael Hardy was immediately encouraged by the opportunity. “We can be even more responsive to Indigenous needs, values and preferences,” he said. “We can break down the silos between health care sectors and providers to ensure seamless transitions for patients. We will truly be working together to provide patient and family centred care across the continuum of care.”

Anishnawbe Mushkiki is an Indigenous-led Primary Health Care Organization. Their health care team includes physicians, nurse practitioners, nurses including footcare and wound care specialist, dietitians, diabetes educators, social workers, traditional healers and other health care professionals.

At Anishnawbe Mushkiki, clients can access a variety of services, including clinical care and integrated chronic disease prevention and management, family-focused maternal and child health care, addictions counselling, traditional healing, counselling, youth empowerment and cultural programs.

Working more closely together can address current disparities affecting the urban Indigenous population in Thunder Bay. For example, some patients who visit the Hospital Emergency Department (ED) could be seen in a primary care setting. On discharge, the Hospital can refer such patients to Anishnawbe Mushkiki , where they can be connected to a family physician or nurse practitioner for ongoing care. “Patients would benefit from continuity of care and wellness programs to improve overall health,” explained Hardy.

There are benefits to the health care system, too. “By improving overall health, future ED visits are prevented,” noted Bartkowiak. “Thousands of visits to the ED could be diverted, which translates to improved wait times and resource utilization for those requiring acute care services at our Hospital.”

The collaborative approach goes beyond the Emergency Department. “Our organizations are exploring and moving forward with initiatives that enhance access to other areas of care. One is transition services from in-patient to out-patient for Indigenous mental health patients,” said Hardy.

It all aligns perfectly with Anishnawbe Mushkiki’s mission to provide culturally safe, comprehensive care empowering patients through their health and wellness journeys by offering health promotion, primary and traditional approaches to patient and family centred care, and with the Hospital’s commitment to Indigenous Health.

Michael Hardy, Executive Director of Anishnawbe Mushkiki and Hospital Board Director, and Jean Bartkowiak, Hospital President & CEO are working together to improve the health of Indigenous patients and families.