Just imagine what we can achieve with timely hospital discharge data province-wide

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I just read the article, Team reduces time for transcription of doctor dictations, in the Lean News section of this website and if I could vote “it fired me up” for the piece more than once, I would.

Let me make an attempt to explain why it fires me up.

Firstly, this is a HUGE step toward improving timeliness, appropriateness and efficiency of patient care. It’s also a huge step toward improving provider satisfaction and experience, by making the right information available at the right place and at the right time. Happy providers who can do their jobs with little interference – such as the need to search for missing information, or order extra tests, or wait (and make their patients wait) until the documentation that they need shows up — also tend to have more time to reflect on the patient in front of them, and focus on their primary job — first rate patient care.

Secondly, for me, as a health informatics “geek” whose primary job is to support our health care system leaders to better understand the impact of the changes that we are all making in our system, this is a tremendous step forward. Here’s why….

Historically, discharge summaries for patients released from hospital can take weeks, and commonly months, to be dictated by the discharging physician, and then transcribed into the information system that holds all this information for the province. This is not to say that all physicians are slow to complete their discharge paperwork, some, in fact well over half, are very timely. There are also some hospitals, like Cypress Regional Hospital found, where for a variety of reasons, there are backlogs of discharge data that need to be transcribed, and until it is transcribed, it’s not available in the information system.

When you look at the whole province, overall, the data in this “Discharge Abstract Database” are only complete for patients discharged 6-9 months ago….. As a practical example, that means that we are just (about now, July 2014) able to see summary information for the patients discharged in December 2013, and the data for ALL patients discharged then is still not yet in the system. For the hundreds of patients who have been discharged across Saskatchewan since then, we do not have any way to know why they were in the hospital, how long they stayed, nor what treatments they received. Without this basic information it’s virtually impossible to understand the provincial impact of changes to improve care. How can our providers and leaders understand if the change they made last week is working? Or if it’s still working a month afterward? Is care better, safer, more timely? Are patient outcomes better? Is it safe to shorten hospital stays for patients? Did we treat someone in hospital who should have received care elsewhere? Etc..

One of the key strategic objectives for our health system is to reduce hospitalizations related to “ambulatory care sensitive conditions” (ACSCs). These are conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disorder, and asthma that result in largely preventable hospitalizations. If the patient’s care is well managed by their primary health care providers and team, these hospitalizations don’t occur, and hospital resources can be reallocated to other acute care services, or, even better, toward enhanced primary care and public health services that support chronic disease management, and curb the increase in smoking, obesity, and lack of exercise that lead to hypertension, diabetes and other chronic heart and lung conditions that plague our population.

There is great work underway through the Chronic Disease Management-Quality Improvement Program (CDM-QIP) for physicians, and through the work of many primary health care teams across SK to improve the consistent use of evidence-informed care and guidelines for chronic disease patients, but if we can’t see if this great improvement work is keeping these patients out of hospital, is it enough???

Thanks to Cypress for taking the bull by the horns and tackling this big issue of timely hospital discharge data. It takes teamwork among physicians, transcription services teams and our system leaders to make these changes effective and sustainable. I hope your successes will be picked up quickly and successfully replicated across the province. By this time next year I’d like to be able to understand how the patients discharged last MONTH (not last YEAR) are doing — just a small challenge, heh?

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